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Gad AM, Zawam SH. Arthroscopic biceps tenodesis using press-fit bony plug: a case series study. Int Orthop 2024; 48:785-792. [PMID: 37924503 PMCID: PMC10902084 DOI: 10.1007/s00264-023-06021-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE To assess the feasibility, operative time, clinical outcomes, possible complications, and failure rates of all-through arthroscopic biceps tenodesis using press-fit bony plug technique. METHODS This prospective case series study involved 30 skeletally mature patients with long head of biceps pathology (tendinitis after failure of conservative treatment, subluxation, dislocation, or tendon tears). All patients were followed up for 24 months at least. RESULTS Twenty-nine patients regained full shoulder and elbow range of motion; one case suffered from reflex sympathetic dystrophy. There was a significant improvement in the constant, ASES, and VAS scores when comparing the pre-operative and post-operative values. The average biceps strength was 96% compared to the opposite healthy side. No cases were complicated by neuro-vascular deficits or failure of the tenodesis. CONCLUSION Press-fit biceps tenodesis is safe and accessible with low economic demands. We recommend this technique to be used more often when addressing patients with long head of biceps pathologies. REGISTRATION DATA Registration number: N-1562023. Registration date: June 2022 "Retrospectively registered".
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Affiliation(s)
- Ahmed Mahmoud Gad
- Department of Trauma and Orthopedics, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Sherif Hamdy Zawam
- Department of Trauma and Orthopedics, Faculty of Medicine, Cairo University, Giza, Egypt.
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Lucidi GA, Roberti di Sarsina T, Zaffagnini S. Editorial Commentary: The Number One Cause of Anterior Cruciate Ligament Reconstruction Graft Failure Is a Misplaced Femoral Tunnel: Over-the-Top Technique Plus Lateral Extra-Articular Tenodesis Is Recommended. Arthroscopy 2024; 40:435-437. [PMID: 38296446 DOI: 10.1016/j.arthro.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 02/15/2024]
Abstract
Patient factors (notably high tibial slope and narrow femoral intercondylar notch width) and surgical factors (including meniscus treatment and anterior cruciate ligament [ACL] tunnel position) contribute to ACL reconstruction failure. The number one cause of failure is a misplaced ACL femoral tunnel. Tunnel malposition leads to a higher incidence of postoperative meniscal lesions, inferior clinical outcomes, and higher revision rates.
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Affiliation(s)
- Gian Andrea Lucidi
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Tommaso Roberti di Sarsina
- Reconstructive Orthopaedic Surgery and Innovative Techniques-Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Hantouly AT, Ahmed AF, Fermin TM, Macchiarola L, Sideris V, Papakostas E, Hooghe PD, Al-Khelaifi K, Olory B, Zikria B. Short-term outcomes of anterior cruciate ligament reconstruction with or without lateral tenodesis or anterolateral ligament reconstruction: a retrospective cohort. Int Orthop 2023; 47:2991-2999. [PMID: 37632528 PMCID: PMC10673961 DOI: 10.1007/s00264-023-05931-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/06/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE This study aimed to compare the short-term outcomes of ACL reconstruction (ACLR) alone, ACLR with lateral tenodesis, and ACL and ALL reconstruction. METHODS A retrospective cohort of prospectively collected data on all ACL procedures was performed at Aspetar Specialized Orthopaedic and Sports Medicine Hospital between January 2020 and January 2021. Patients were treated with ACLR alone, ACLR with lateral tenodesis, or ACLR with ALL reconstruction. The primary outcome was the subjective International Knee Documentation Committee (sIKDC) score. The secondary outcomes were the ACL Return to Sport after Injury (ACL-RSI) scores, pivot shift grade, subjective knee stability, and subjective pain on activity. RESULTS A total of 100 cases were included. The most common technique was ACLR with lateral tenodesis (42%), followed by ACLR alone (38%) and ACL with ALL reconstruction (20%). The mean age was 28.15 years (15-60), and 94% of the patients were males. Meniscal procedures were more frequent in the ACLR alone group (65.8%). There was no association between subjective stability, sIKDC, ACL-RSI, and pivot shift grade and the three ACLR techniques while adjusting for age, sex, and concomitant meniscus procedures at six weeks, 12 weeks, six months, and nine months. However, there was a significant decrease in postoperative flexion in the ACL and ALL reconstruction group by a mean of 22° (95% CI - 40.7 - 3.4; P = 0.02) at 6 weeks compared to ACLR alone, which was not evident on later follow-ups. CONCLUSION ACLR with/without lateral augmentation procedures yields similar subjective IKDC, ACL-RSI, pivot shift grade, and subjective knee instability at short-term follow-up. Therefore, lateral extra-articular augmentation procedures are safe to be performed.
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Affiliation(s)
- Ashraf T Hantouly
- Department of Orthopedic Surgery, Hamad Medical Corporation, Doha, Qatar.
| | - Abdulaziz F Ahmed
- Department of Orthopaedic Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Luca Macchiarola
- Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, Bologna, BO, Italy
| | | | | | | | | | - Bruno Olory
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Bashir Zikria
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Ma H, Zhang Y, Zhao X. Letter to the Editor regarding the article, "Short-term outcomes of anterior cruciate ligament reconstruction with or without lateral tenodesis or anterolateral ligament reconstruction: a retrospective cohort". Int Orthop 2023; 47:2883-2884. [PMID: 37696992 DOI: 10.1007/s00264-023-05978-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Hui Ma
- Department of Joint Surgery and Sports Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, 272029, Shandong, China
| | - Yuanmin Zhang
- Department of Joint Surgery and Sports Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, 272029, Shandong, China
| | - Xiaowei Zhao
- Department of Joint Surgery and Sports Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, 272029, Shandong, China.
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Borim FM, Jubert NJ, Vinaixa MMR, Portas-Torres I, Bueno JP, Mayayo RS, Peiró JVA, Feliu EC, Monyart JM. Good rates of return-to-sport in athletes after revision anterior cruciate ligament reconstruction using autologous patellar tendon and lateral extra-articular tenodesis: a 2-year follow-up prospective study. Eur J Orthop Surg Traumatol 2023; 33:3125-3133. [PMID: 37039899 PMCID: PMC10504162 DOI: 10.1007/s00590-023-03544-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/03/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Most athletes who undergo revision of the anterior cruciate ligament reconstruction (ACLR) aim to return to their preinjury sport at a similar level of performance while minimizing the risk for reinjury. Additional lateral extra-articular tenodesis (LET) has recently been correlated with improved outcomes and low complication rate. Yet, there are few series evaluating return-to-sport (RTS) and clinical outcomes after revision ACLR using bone-patellar tendon-bone (BPTB) and LET in athletes. METHODS The study cohort consisted of 19 eligible athletes who had undergone their first revision ACLR using BPTB and LET (modified Lemaire) between January 2019 and 2020. Patients were prospectively followed and interviewed in a sports activity survey during a 2-year follow-up. RESULTS Despite all patients returning to sports after revision ACLR surgery, 52.6% resumed playing at their preinjury level. Furthermore, patient-reported functional outcomes improved significantly following revision surgery, as evidenced by improvements in IKDC [64.4 (± 12) to 87.8 (± 6)], Lysholm [71.27 (± 12) to 84.2 (± 9.7)], and SF-12 scales [Physical: 53.3 (± 3) 57 (± 1.2); Mental: 50.2 (± 3.3) to 52.7 (± 2.4)]. One case (5.3%) experienced persistent pain and underwent reoperation for a partial meniscectomy. CONCLUSION After revision ACLR using autologous BPTB and LET, all active individuals are expected to RTS, similar to primary ACLR. The difference comes down to returning to the preinjury level, where the levels are lower depending on the sport and initial level of play. Good mid-term functional outcomes with a low complication rate can be expected in most cases. STUDY DESIGN Case series; Level of evidence IV. ETHICAL COMMITTEE APPROVAL NUMBER PR(ATR)79/2021 and HCB/2023/0173.
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Affiliation(s)
- Felipe Moreira Borim
- Surgery and Morphological Sciences, Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain.
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Bioengineering, Cell Therapy and Surgery in Congenital Malformations - VHIR, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Nayana Joshi Jubert
- Surgery and Morphological Sciences, Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Reconstructive Surgery of Locomotor System Group - VHIR, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Maria Mercedes Revertè Vinaixa
- Surgery and Morphological Sciences, Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Reconstructive Surgery of Locomotor System Group - VHIR, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Knee Surgery Unit, Clínica Corachan, Carrer de Buïgas, 19, 08017, Barcelona, Spain
| | - Irene Portas-Torres
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Joan Pijoan Bueno
- Surgery and Morphological Sciences, Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Reconstructive Surgery of Locomotor System Group - VHIR, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Knee Surgery Unit, Clínica Corachan, Carrer de Buïgas, 19, 08017, Barcelona, Spain
| | - Raquel Sevil Mayayo
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Knee Surgery Unit, Clínica Corachan, Carrer de Buïgas, 19, 08017, Barcelona, Spain
| | - José Vicente Andrés Peiró
- Surgery and Morphological Sciences, Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain
- Reconstructive Surgery of Locomotor System Group - VHIR, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Knee Surgery Unit, Clínica Corachan, Carrer de Buïgas, 19, 08017, Barcelona, Spain
| | - Enric Castellet Feliu
- Surgery and Morphological Sciences, Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Reconstructive Surgery of Locomotor System Group - VHIR, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Joan Minguell Monyart
- Surgery and Morphological Sciences, Universitat Autónoma de Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain.
- Orthopaedic Surgery Department; Knee Surgery Unit, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Reconstructive Surgery of Locomotor System Group - VHIR, Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Knee Surgery Unit, Clínica Corachan, Carrer de Buïgas, 19, 08017, Barcelona, Spain.
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Chiang CH, Ho W, Lin CH, Chih WH, Su WR, Hong CK. Modified arthroscopic intra-articular transtendinous looped biceps tenodesis leads to satisfactory functional outcomes and less frequent Popeye deformity compared to biceps tenotomy. J Orthop Surg Res 2023; 18:603. [PMID: 37587498 PMCID: PMC10428633 DOI: 10.1186/s13018-023-04078-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE The present study aimed to propose a modified intra-articular transtendinous looped biceps tenodesis (mTLBT) using a suture anchor and to compare the functional outcomes and incidence of Popeye deformities between biceps tenotomy and mTLBT. METHODS Medical records of patients who underwent either tenotomy or mTLBT for the long head of the biceps tendon (LHBT) lesion between January 2016 and April 2021 were retrospectively reviewed. The inclusion criteria were patients aged 40-70 years with LHBT pathologies, such as superior labrum anterior to posterior (SLAP) lesions > type II, LHBT pulley system rupture with bicipital instability, and intra-articular LHBT tear. The exclusion criteria were full-thickness supraspinatus tears, frozen shoulder, shoulder fracture, and postoperative traumatic events that affected the operated shoulder. All patients were followed up for at least 1 year. Popeye deformity, bicipital cramping pain, visual analog scale (VAS) pain score, and functional outcome scores (University of California at Los Angeles [UCLA] and American Shoulder and Elbow Surgeons [ASES] scores) were recorded. Fisher's exact test and Chi-square test were used for categorical variables, whereas the Mann-Whitney U test was used for nonparametric variables. RESULTS The mTLBT and tenotomy groups included 15 and 40 patients, respectively. The incidence of Popeye deformity and biceps cramping pain in the tenotomy group (52.5% and 50%, respectively) was significantly higher than that in the mTLBT group (13.3% and 20%, respectively) (p = 0.009 and p = 0.045, respectively). The postoperative VAS, UCLA, and ASES scores were not significantly different between the two groups. One patient in the tenodesis group experienced metallic-anchor pullout. CONCLUSION mTLBT is an arthroscopic intra-articular top of the groove tenodesis that can be performed completely in the intra-articular space and is especially suitable for patients with an intact or partially torn rotator cuff. This technique is reliable for treating biceps pathologies as it results in similar functional outcome scores, lesser biceps cramping pain, and less frequent Popeye deformity compared to biceps tenotomy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Chen-Hao Chiang
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Wei Ho
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chang-Hao Lin
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Wei-Hsing Chih
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, North Dist., Tainan, 70428, Taiwan
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, North Dist., Tainan, 70428, Taiwan.
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan.
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7
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Heard M, Marmura H, Bryant D, Litchfield R, McCormack R, MacDonald P, Spalding T, Verdonk P, Peterson D, Bardana D, Rezansoff A, Getgood A. No increase in adverse events with lateral extra-articular tenodesis augmentation of anterior cruciate ligament reconstruction - Results from the stability randomized trial. J ISAKOS 2023; 8:246-254. [PMID: 36646169 DOI: 10.1016/j.jisako.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Results from the Stability Study suggest that adding a lateral extra-articular tenodesis (LET) to a hamstring tendon autograft reduces the rate of anterior cruciate ligament reconstruction (ACLR) failure in high-risk patients. The purpose of this study is to report adverse events over the 2-year follow-up period and compare groups (ACLR alone vs. ACLR + LET). METHODS Stability is a randomized clinical trial comparing hamstring tendon ACLR with and without LET. Patients aged 14-25 years with an ACL deficient knee were included. Patients were followed and adverse events documented (type, actions taken, resolution) with visits at 3, 6, 12, and 24 months postoperatively. Adverse events were categorized as none, minor medical, minor surgical, contralateral ACL rupture, or graft rupture. Patient reported outcome measures (PROMs) collected at each visit included the Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee Score (IKDC), and ACL Quality of Life Questionnaire (ACL-QOL). RESULTS In total, 618 patients were randomized (mean age 18.9 years, 302 (49%) male). Forty-five patients (7%) suffered graft rupture; 34 (11%) in the ACLR group compared to 11 (4%) in the ACLR + LET group (RRR = 0.67, 95% CI 0.36 to 0.83, p < 0.001). There were no differences in effusion or infection rates between groups. The ACLR + LET group experienced an increased number of hardware removals (10 vs. 4). Overall, the rate of minor medical events (11%), minor surgical events (7%), and ipsilateral or contralateral ACL tears (10%) were low considering the high-risk patient profile. Increasing severity of adverse events was associated with lower PROMs at 24 months post-operative. Patients in the ACLR + LET group reported greater degree of pain at 3 months only. There were no clinically significant differences in range of motion between groups. CONCLUSIONS The addition of LET to hamstring tendon autograft ACLR in young patients at high risk of re-injury resulted in a statistically significant reduction in graft rupture. While the addition of LET may increase rates of hardware irritation, there was no significant increase in overall rates of minor medical adverse events, minor surgical events, or overall re-operation rates. The concerns regarding complications associated with a LET did not materialize in this study. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- M Heard
- Deparment of Surgery, University of Calgary, T2N 1N4, Canada; Banff Sport Medicine, T1W 0L5, Canada
| | - H Marmura
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; School of Physical Therapy, Western University, N6A 3K7, Canada
| | - D Bryant
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; School of Physical Therapy, Western University, N6A 3K7, Canada
| | - R Litchfield
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, N6A 5C1, Canada
| | - R McCormack
- Department of Orthopaedics, University of British Columbia, V5Z 1M9, Canada; New West Orthopaedic & Sports Medicine Centre, V3L 5P5, Canada
| | - P MacDonald
- Department of Surgery, University of Manitoba, R3A 1R9, Canada; Pan Am Clinic, R3M 3E4, Canada
| | - T Spalding
- University Hospital Coventry and Warwickshire NHS Trust, CV2 2DX, UK
| | - P Verdonk
- Department of Physical Medicine and Orthopedics, Ghent University, 9000, Belgium; Antwerp Orthopedic Center, 2018, Belgium
| | - D Peterson
- Department of Surgery, McMaster University, L8S 4K1, Canada
| | - D Bardana
- Department of Surgery, Queen's University, K7L 2V7, Canada
| | - A Rezansoff
- Deparment of Surgery, University of Calgary, T2N 1N4, Canada; University of Calgary Sport Medicine Centre, T2N 1N4, Canada
| | - A Getgood
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, N6A 5C1, Canada.
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Monroe EJ, Brand JC. Editorial Commentary: Dynamic Anterior Stabilization via Biceps Tenodesis to the Glenoid Is an Option for Anterior Shoulder Instability With Subcritical Glenoid Bone Loss. Arthroscopy 2022; 38:1772-1773. [PMID: 35660176 DOI: 10.1016/j.arthro.2022.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/19/2022] [Indexed: 02/02/2023]
Abstract
A nuanced approach to treatment of anterior shoulder instability is encouraged, particularly in patients with subcritical glenoid bone loss. In patients with bone loss, recurrent instability after isolated arthroscopic Bankart repair has dampened enthusiasm for this procedure. Adjunctive treatment with remplissage or dynamic anterior stabilization via biceps tenodesis to the glenoid is an alternative to bone transfer procedures, which are effective but have higher complication rates. Dynamic anterior stabilization or tenodesis of the long head of the biceps to the 3-o'clock position on the glenoid through a subscapularis split is biomechanically superior to isolated Bankart repair for reducing anterior translation, even in the setting of minor glenoid bone loss due to a sling effect similar to that produced by the Latarjet procedure. A disadvantage is placement of a large implant into the small space of the anterior glenoid and creation of a soft-tissue defect in the capsule.
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Mohan K, Hintze JM, Morrissey D, Molony D. Incidence of avascular necrosis following biceps tenodesis during proximal humerus open reduction and internal fixation. Acta Orthop Belg 2021; 87:339-346. [PMID: 34529390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Avascular necrosis (AVN) may occur in up to 77% of proximal humeral fractures and can cause fixation failure. Risk factors include fracture position, calcar length and medial hinge integrity. We routinely perform intra-articular biceps tenotomy with tenodesis at the level of pectoralis major to facilitate fragment identification and potentially ameliorate post-operative pain relief. Concern exists that tenotomising the biceps damages the adjacent arcuate artery, potentially increasing the rate of AVN. The purpose of this study was to evaluate whether biceps tenodesis is associated with an increased risk of radiographically evident humeral head AVN. 61 fractures surgically treated over a 52-month period were retrospectively reviewed and radiographically assessed in accordance with Neer's classification, calcar-length and medial hinge integrity. 40, 20 and 1 were four-, three- and two-part fractures respectively. 37 had a calcar-length less than 8mm and 26 suffered loss of the medial hinge. The median radiographic follow-up was 23 months. There was radiographic evidence of humeral head AVN in only one case, comparing favourably to rates quoted in current literature. In our experience, intra-articular biceps tenotomy with the deltopectoral approach was thus not associated with a significantly increased risk of humeral head AVN, even in complex four-part fractures.
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Yeung M, Shin JJ, Lesniak BP, Lin A. Complications of Arthroscopic Versus Open Biceps Tenodesis in the Setting of Arthroscopic Rotator Cuff Repairs: An Analysis of the American Board of Orthopaedic Surgery Database. J Am Acad Orthop Surg 2020; 28:113-120. [PMID: 31977611 DOI: 10.5435/jaaos-d-19-00252] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The purpose of this study was to compare complication rates between arthroscopic versus open biceps tenodesis in the setting of arthroscopic rotator cuff repair and to determine the effect of fellowship training on complication rates. METHODS The American Board of Orthopaedic Surgery database was used to identify cases of arthroscopic and open biceps tenodesis in the setting of rotator cuff repair between 2012 and 2016. Surgical, medical, and anesthetic complications, location, fellowship training, surgery year, and patient demographic data were recorded. Overall and specific complication rates were calculated and analyzed. Chi-square or Fisher exact tests were used to determine statistical significance. RESULTS Altogether, 1,725 cases of arthroscopic biceps tenodesis and 1,637 cases of open biceps tenodesis with arthroscopic rotator cuff repair were analyzed. No significant difference was found between overall complication rates between arthroscopic (11.4%) versus open (13.1%) biceps tenodesis (P = 0.14). Although open tenodesis had statistically significant higher rates of wound healing issues (0.7% versus 0.2%, P = 0.02), hematoma/seroma formation (0.5% versus 0.1%, P = 0.02), nerve injury (1.5% versus 0.4%, P < 0.01), deep vein thrombosis (0.49% versus 0.12%, P ≤ 0.05), and general anesthetic complications (0.75% versus 0.06%, P = 0.03), these rates remain comparably low. Shoulder arthroscopy fellowship-trained surgeons were more likely to use arthroscopic techniques than non-fellowship-trained surgeons (P < 0.01) but had a higher complication rate (P = 0.01). DISCUSSION No differences were found in overall complication rates between open and arthroscopic biceps tenodesis in the setting of rotator cuff repairs. Although open techniques had statistically significant higher rates of nerve injury, wound complications, and hematoma/seroma formation, this may not reflect clinical significance because these complication rates remained <2% in both techniques. Higher complication rates were seen among fellowship-trained surgeons, which may reflect greater case complexity. Both open and arthroscopic biceps tenodesis in the setting of rotator cuff repair show low complication rates, and the technique should be based on surgeon preference and patient factors. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Marco Yeung
- From the Department of Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
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Baron SL, Shamah S, McGee AW, Alaia MJ, Feldman AJ, Jazrawi LM. Clinical Outcomes of Open Subpectoral Biceps Tenodesis with Cortical Button Fixation. Bull Hosp Jt Dis (2013) 2019; 77:238-243. [PMID: 31785136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Open subpectoral biceps tenodesis (OSBT) with cortical button fixation can deliver acceptable results for long head of the biceps (LHB) pathology with the benefit of smaller bone tunnel diameter and a potential reduced risk of postoperative humeral shaft fracture. However, functional outcomes and complications of a button-only technique with a small diameter tunnel in the subpectoral region have not been studied sufficiently. PURPOSE We sought to determine whether OSBT with cortical button fixation results in significant functional improvements from preoperative to final follow-up. The secondary purpose was to determine whether there is a lower risk of major postoperative complications. METHODS A retrospective review of patients who underwent OSBT with cortical button fixation at one institution was conducted with objective measurements and clinical outcomes collected with a minimum of 2 years of follow-up. Surgical data was collected for analysis. Objective measures obtained at follow-up included physical exam, strength testing using a handheld dynamometer, and Long-Head of the Biceps score. Clinical outcomes were measured using the following validated questionnaires preoperatively and postoperatively: American Shoulder and Elbow Surgeons score (ASES), Disabilities of the Arm, Shoulder and Hand score (DASH), and Oxford Shoulder Score (OSS). RESULTS Sixty-one patients with mean age of 53.1 ± 10.1 years at the time of surgery were enrolled in the study. Mean follow-up time was 42.4 ± 16.9 months (range: 24 to 64 months). The postoperative LHB score was 95.5 ± 6.1 (range: 77 to 100). All functional outcome measures (ASES, DASH, and OSS) demonstrated statistically significant improvements at final follow-up (p < 0.05 for each). At total of 92.5% of patients stated they would have the procedure again if necessary. Mean elbow flexion strength on the operative side measured 98.7% ± 15.9% (range: 74.1% to 142.3%) of the contralateral arm. The mean LHB tendon diameter was 5.7 ± 0.8 mm and mean tunnel diameter was 5.9 ± 0.7 mm. There were no cases of intraoperative or postoperative fracture, infection, or Popeye deformity noted during the follow-up period. CONCLUSION Subpectoral biceps tenodesis with cortical button fixation is a safe and effective surgical treatment option to relieve pain and restore function.
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Batailler C, Lustig S, Reynaud O, Neyret P, Servien E. Complications and revision surgeries in two extra-articular tenodesis techniques associated to anterior cruciate ligament reconstruction. A case-control study. Orthop Traumatol Surg Res 2018; 104:197-201. [PMID: 29292120 DOI: 10.1016/j.otsr.2017.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/23/2017] [Accepted: 10/02/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Numerous techniques of anterior cruciate ligament (ACL) reconstruction associated to extra-articular tenodesis (EAT) have been described, but there have been few comparative studies, especially in terms of complications and revision procedures. The present study sought to compare two ACL reconstruction techniques using the patellar tendon (KJ): associating EAT by fascia lata (KJL2) or by gracilis (KJG). The study hypothesis was that the KJL2 technique incurs no extra risk of complications or surgical revision compared to the KJG technique. METHOD A prospective case-control study compared 41 patients undergoing KJL2 and 41 controls undergoing KJG. Complications, reconstruction failure and revision procedures were assessed at a mean 13 months follow-up (range, 6-20 months). RESULTS The KJL2 group showed no extra risk of postoperative complications or reconstruction failure compared to the KJG group: 1 versus 2 re-tears, respectively, not requiring revision. Revision surgery was significantly more frequent in the KJG group (31.7% vs. 7.3%), notably for arthrolysis and meniscectomy. DISCUSSION The KJL2 technique is reliable, without greater risk of complications or early revision surgery than the KJG technique. LEVEL OF EVIDENCE III - Case-control study.
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Affiliation(s)
- C Batailler
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de La-Croix-Rousse, 69004 Lyon, France.
| | - S Lustig
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de La-Croix-Rousse, 69004 Lyon, France
| | - O Reynaud
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de La-Croix-Rousse, 69004 Lyon, France
| | - P Neyret
- Centre Albert-Trillat, 69004 Lyon, France
| | - E Servien
- Centre Albert-Trillat, groupement hospitalier Nord, 103, grande rue de La-Croix-Rousse, 69004 Lyon, France
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Mellano CR, Frank RM, Shin JJ, Jain A, Zuke WA, Mascarenhas R, Shewman E, Cole BJ, Romeo AA, Verma NN, Forsythe B. Subpectoral Biceps Tenodesis With PEEK Interference Screw: A Biomechanical Analysis of Humeral Fracture Risk. Arthroscopy 2018; 34:806-813. [PMID: 29287950 DOI: 10.1016/j.arthro.2017.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 09/03/2017] [Accepted: 09/03/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify the torsional load to fracture for subpectoral biceps tenodesis with interference screw fixation. METHODS We randomized 28 specimens from 14 matched-pair full-length humeri (mean age, 55.3 years) into 3 groups: (1) empty ream group (ERG), (2) screw-only group (SOG), and (3) screw-plus-biceps tendon group (SBG). In each group, 1 humerus of each matched pair was prepared according to group allocation and the contralateral humerus remained intact as a control. In the ERG, an 8-mm unicortical hole was reamed 1 cm proximal to the inferior border of the pectoralis major tendon insertion; in the SOG, the humerus was filled with an 8-mm × 12-mm PEEK (polyether ether ketone) screw; and in the SBG, the humerus was filled with a PEEK screw and the cadaveric long head of the biceps tendon. Humeri were tested under torsional displacement at a rate of 1°/s until fracture. Maximum torque, energy to maximum torque, and linear stiffness were used to assess humerus strength. RESULTS Compared with contralateral intact specimens, the maximum torque to fracture was reduced by 28% in the ERG (P = .005), 30% in the SOG (P = .014), and 20% in the SBG (P = .046). Energy to maximum torque was similarly reduced in the ERG (P = .007), SOG (P = .023), and SBG (P = .049). Stiffness was increased by 4% in the ERG (P = .498), 9% in the SOG (P = .030), and 4% in the SBG (P = .439). CONCLUSIONS Drilling an 8-mm unicortical hole in zone 3 of the bicipital tunnel for open subpectoral biceps tenodesis reduces the torsional load to humeral fracture up to 28% at time 0. The addition of a PEEK tenodesis screw alone reduced the maximum torque by 30%, and the addition of a screw with the long head of the biceps tendon reduced the maximum torque by 20%. The total load to fracture was reduced in all settings. Stiffness was not significantly different for the ERG and SBG, but stiffness was significantly higher for the SOG compared with the intact matched humeri at time 0. CLINICAL RELEVANCE When performing a biceps tenodesis, humeral fracture susceptibility is increased with an applied torsional load at time 0. Thus providers must be aware of this reduced integrity when a subpectoral biceps tenodesis is used.
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Affiliation(s)
- Christopher R Mellano
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Rachel M Frank
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jason J Shin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Akshay Jain
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - William A Zuke
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Randy Mascarenhas
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Elizabeth Shewman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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Grinac M, Brtková J, Kučera T, Šponer P. [Tear of the Distal Biceps Brachii Tendon - Correlation of Ultrasound and Operative Findings, Surgical Therapy Results]. Acta Chir Orthop Traumatol Cech 2018; 85:199-203. [PMID: 30257779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF THE STUDY When treating tears of the distal biceps brachii muscle tendon, we repeatedly noticed a difference between the preoperative ultrasound findings and the operative findings. The aim of the study was to retrospectively correlate these findings in order to determine the sensitivity of the ultrasound examination in everyday orthopaedic practice. Moreover, we compared the results and complications of surgical treatment through two operative techniques used at our department. MATERIAL AND METHODS In the 2004-2016 period 20 patients underwent a surgery at our department for total tear of the distal tendon of the biceps brachii muscle. In 18 patients an ultrasound examination was performed preoperatively. In 3 patients it was repeated. Therefore, there were a total of 21 ultrasound observations made in this group of patients. Excluded were the cases of chronic tendinoses or inveterated tears. The group was divided into two sub-groups. The first sub-group was composed of patients in whom the preoperative ultrasound examination was performed by a radiologist-specialist in the musculoskeletal system, the second sub-group was composed of patients examined by a non-specialist. The ultrasound findings were compared with the operative findings. With the use of a formula for the calculation of sensitivity of the test, the sensitivity of the ultrasound examination was determined for proper recognition of a complete tear of the tendon concerned. Also, we compared the results and complications of the two operative methods applied: the technique using bone anchor vs. the Boyd-Anderson technique of transosseous reinsertion. RESULTS The sensitivity of the ultrasound examination was 91% in examinations performed by a radiologist-specialist and 40% in examinations performed by no-specialists. Both the surgical techniques brought very good results in our group of patients. The reported complications included 2 cases of temporary radial nerve palsy, 1 case of formation of heterotopic ossifications. DISCUSSION The sensitivity of ultrasound is adequate according to the literature. In our group of patients, the same applied only to examinations performed by a radiologist-specialist in the musculoskeletal system. This is because the ultrasound examination of the distal biceps tendon is a highly specialised examination. When performed by a non-specialist, the result of examination obtained in our observations is rather misleading, thus could lead to an improper method of treatment. Partial tears of this tendon are very rare according to the literature. Indirect signs of the partial tear presence at this location detected by ultrasound resulted in most cases in an incorrect diagnosis, therefore the description of a partial tear visualised by the ultrasound should be reserved exclusively for cases when intact fibrils are clearly detected during the examination. For unclear cases, the MRI scan is indicated. The results of both the surgical techniques of reinsertion applied were very good. The method using the bone anchors is technically easier to perform. Nonetheless, it has its specifics. CONCLUSIONS To diagnose correctly the tear of the distal biceps muscle tendon it is essential to perform a thorough clinical examination and to obtain the medical history of the patient, especially the mechanism of injury. Sonography can be beneficial only provided the examination is carried out by a specialist in the musculoskeletal system, with the use of appropriate device and under standard conditions. For surgical treatment of this injury we prefer the technique using a bone anchor, namely particularly since it is technically easier to perform. The functional results are very good. Key words: distal biceps tendon, elbow, tendon tear, ultrasound, suture anchors.
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Affiliation(s)
- M Grinac
- Ortopedická klinika Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Hradec Králové
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Faruqui S, Kotob MA, Hanna CC, Foad A. The modified Norwegian method of biceps tenodesis: how well does it work? Knee Surg Sports Traumatol Arthrosc 2017; 25:3264-3269. [PMID: 27141868 DOI: 10.1007/s00167-016-4145-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/20/2016] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate clinical outcomes and complications in a series of patients who underwent the modified Norwegian method (MNM) of biceps tenodesis by a single shoulder surgeon. METHODS A retrospective review of charts from all patients who underwent the modified Norwegian method of biceps tenodesis by the senior author during a 5-year period between 2008 and 2013 was performed. After all patients were identified, informed consent was obtained and DASH and ASES surveys were administered. Inclusion criteria for the study were a minimum 2-year follow-up after MNM tenodesis and appropriate adherence to DASH and ASES survey protocol. Data obtained included: demographic data, time to follow-up, hand dominance, concomitant procedures, workman's compensation (WC) status, DASH and ASES surveys, and complications. A complication was defined as rupture of the tenodesis or post-operative infection. Residual shoulder pain was considered as treatment failure. The data were then analysed using statistical software. In this time period, 94 biceps tenodeses using the MNM technique were performed. Follow-up rate was 75/94 patients (80 %). Of 75 patients, 15 (20 %) had an isolated tenodesis performed. RESULTS There was no statistically significant difference in DASH or ASES scores when comparing isolated tenodesis patients to those who had concomitant procedures. WC patients had worse DASH and ASES scores (p = 0.016; p = 0.002). The complication rate was 2/75 (3 %), which were both ruptured tenodeses. Of 75 patients, 3 (4 %) experienced treatment failure with residual anterior shoulder pain. CONCLUSIONS There is debate in the literature regarding the optimal method of biceps tenodesis. This paper demonstrates that the MNM tenodesis appears to be a simple, efficient, and effective alternative to other methods of biceps tenodesis with subjective outcome scores and complication rates that parallel other methods previously described in the literature. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Sami Faruqui
- Department of Radiology, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52246, USA.
| | - Mohammad A Kotob
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Abdullah Foad
- Quality Care Clinic and Surgicenter, Clinton, IA, USA
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Yin L, Liao TC, Yang L, Powers CM. Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study. Clin Orthop Relat Res 2016; 474:2451-2461. [PMID: 27577067 PMCID: PMC5052208 DOI: 10.1007/s11999-016-5027-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/05/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral malalignment associated with patella alta may cause pain and arthritis; because of this, the condition sometimes is treated surgically. Two common procedures are tibial tubercle distalization with or without patellar tendon tenodesis. However, the biomechanical consequences of these interventions for patella alta are not clearly understood. QUESTIONS/PURPOSES We evaluated changes in patellofemoral joint contact mechanics after tibial tubercle distalization and tibial tubercle distalization combined with patella tendon tenodesis. Specifically, we asked: (1) Are there biomechanical differences between these two types of procedures? (2) Is there an ideal range to distalize the patella? METHODS Subject-specific finite-element models were created for 10 individuals with patella alta (mean Insall-Salvati ratio of 1.34 ± 0.05). Input parameters for the finite-element models included subject-specific joint geometry, quadriceps muscle forces, and weightbearing patellofemoral joint kinematics. Virtual operations were conducted to simulate the two procedures. For distalization, the tibial tubercle and patella were displaced distally 4 mm to 20 mm in 4-mm increments based on the original model. At each level of distalization, the patella tendon was attached back to its original insertion to simulate the additional tenodesis procedure. Cartilage stress, contact area, and contact forces were quantified and compared between procedures and distalization levels. RESULTS Distalization and distalization + tenodesis reduced patellofemoral joint stress compared with the baseline of 1.02 ± 0.11 MPa. Distalization led to lower cartilage stress than distalization + tenodesis, and the effect size was relatively large (0.88 ± 0.10 MPa vs 0.92 ± 0.10 MPa; mean difference, 0.04 MPa [95% CI, 0.02 MPa-0.05 MPa], p < 0.01; effect size of 1.64 [Cohen's d], with Insall-Salvati ratio decreased to 0.95). For both procedures, the trend of stress reduction plateaued when the Install-Salvati ratio approached 0.95. CONCLUSIONS Cartilage stress appears lower using distalization as opposed to distalization + tenodesis in this finite-element analysis simulation. An Insall-Salvati ratio of 0.95 may be an ideal level for distalization; further distalization does not show additional benefits. CLINICAL RELEVANCE This study suggests that distalization may result in less stress than distalization + tenodesis, therefore future clinical research might be preferentially directed toward evaluating isolated distalization procedures.
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Affiliation(s)
- Li Yin
- Center for Joint Surgery, Southwest Hospital, The Third Military Medical University, Chongqing, China
- Jacquelin Perry Musculoskeletal Biomechanics Research Lab, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar Street, CHP-155, Los Angeles, CA, 90089-9006, USA
| | - Tzu-Chieh Liao
- Jacquelin Perry Musculoskeletal Biomechanics Research Lab, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar Street, CHP-155, Los Angeles, CA, 90089-9006, USA
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, The Third Military Medical University, Chongqing, China
| | - Christopher M Powers
- Jacquelin Perry Musculoskeletal Biomechanics Research Lab, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar Street, CHP-155, Los Angeles, CA, 90089-9006, USA.
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Duchman KR, DeMik DE, Uribe B, Wolf BR, Bollier M. Open Versus Arthroscopic Biceps Tenodesis: A Comparison of Functional Outcomes. Iowa Orthop J 2016; 36:79-87. [PMID: 27528841 PMCID: PMC4910781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The proximal aspect of the long head of the biceps brachii (LHB) is a frequent source of anterior shoulder pain. Multiple techniques for LHB tenodesis have been described. However, comparative outcomes are lacking. The present study aims to compare functional results, patient reported outcomes, complications, and clinical failures for patients undergoing open versus arthroscopic LHB tenodesis. METHODS All patients who underwent open or arthroscopic LHB tenodesis from 2009-2012 at a single institution were identified. Patient demographics, comorbidities, and operative variables of interest, including concomitant procedures, were recorded. Minimum 1-year follow-up was required for inclusion. Outcomes, including patient reported outcomes, physical exam findings, and complications were compared between open and arthroscopic LHB tenodesis patients. RESULTS Overall, 45 patients (25 open, 20 arthroscopic) were available for analysis. In total, there was a single clinical failure in a patient who underwent arthroscopic LHB tenodesis. No other complications or failures were noted. Active shoulder forward elevation was increased in the open tenodesis group as compared to the arthroscopic tenodesis group (177.8 ± 9.3° vs. 171.3 ± 11.7°; p = 0.049). Otherwise, there was no difference in range of motion or strength. For both groups, both the SF-36 and ASES scores improved significantly from preoperative values. CONCLUSION Both open and arthroscopic LHB tenodesis provide good to excellent outcomes with few complications. Given the recent increased utilization of LHB tenodesis, future studies should use randomization and prospective data collection in order to determine if discrete patient populations are better served by either open or arthroscopic LHB tenodesis techniques.
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Affiliation(s)
- Kyle R Duchman
- Department of Orthopedics & Rehabilitation University of Iowa Hospitals and Clinics Iowa City, IA, USA
| | - David E DeMik
- Department of Orthopedics & Rehabilitation University of Iowa Hospitals and Clinics Iowa City, IA, USA
| | - Bastian Uribe
- Department of Orthopedics & Rehabilitation University of Iowa Hospitals and Clinics Iowa City, IA, USA
| | - Brian R Wolf
- Department of Orthopedics & Rehabilitation University of Iowa Hospitals and Clinics Iowa City, IA, USA
| | - Matthew Bollier
- Department of Orthopedics & Rehabilitation University of Iowa Hospitals and Clinics Iowa City, IA, USA
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Abstract
This article summarizes both the various techniques for an open subpectoral biceps tenodesis as well as the biomechanics associated with these procedures. It provides information regarding the indications and contraindications to support the surgeon's decision. Furthermore, a postoperative protocol as well as an outcome overview is presented to address postoperative care. A short summary of the recent literature regarding potential complications is included to provide further insight on this technique. The open subpectoral tenodesis of the long head of the biceps is a safe and reproducible technique with a low complication rate for patients with pathologies of the proximal biceps.
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Affiliation(s)
- Andreas Voss
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06034, USA
| | - Simone Cerciello
- Department of Geriatrics, Neurosciences and Orthopaedics, Policlinico Agostino Gemelli, Catholic University of Rome, Largo Francesco Vito 1, Rome 00135, Italy
| | - Justin Yang
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06034, USA
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaninger Street 22, Munich 81675, Germany
| | - Mark P Cote
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06034, USA
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, UConn Health, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06034, USA.
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Spiegl UJ, Smith SD, Euler SA, Millett PJ, Wijdicks CA. Biomechanical consequences of proximal biceps tenodesis stitch location: musculotendinous junction versus tendon only. Knee Surg Sports Traumatol Arthrosc 2015; 23:2661-6. [PMID: 24968871 DOI: 10.1007/s00167-014-3128-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to determine the biomechanical effects of placing the biceps tenodesis stitch at the musculotendinous junction versus in the tendon only. Placing the stitch at the musculotendinous junction was hypothesized to result in a significantly weaker repair than stitching in the tendon only. METHODS Testing was performed on two groups of six matched pairs of long head of the biceps (LHB) with enclosed musculotendinous junction and muscle belly. Specimens were randomly distributed between two groups. The same baseball whipstitch configuration was performed using the same suture material in both groups. In group 1, the stitch configuration started 1 cm proximal of the musculotendinous junction (tendon tissue only). For contralateral specimens, the baseball whipstitching included the distal 1 cm of the musculotendinous junction. Specimens were pulled to failure at a rate of 60 mm/min. Ultimate failure load and failure pattern were recorded. RESULTS Average ultimate failure load of group 2 was significantly higher than group 1 (mean increase 18.6 %, range -9.7 to 35.8 %; p = 0.046). A cut-through failure pattern was observed for all specimens in both groups. There were highly significant correlations between ultimate failure load and tendon thickness (p = 0.004, τ = 0.636), age of the specimen (p = 0.002, τ = 0.724), and gender (p = 0.004, τ = -0.739). No significant difference between the groups regarding tendon diameter was observed. CONCLUSIONS Baseball whipstitching of the LHB including the distal part of the tendon and the musculotendinous junction was stronger than sutures placed in the tendon alone. These results suggest that suture pattern affects initial strength of repair, and therefore may affect decisions regarding early post-operative rehabilitation or ultimate clinical outcomes. Inclusion of the musculotendinous junction should be considered clinically for improved time zero strength of the repair construct.
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Affiliation(s)
- Ulrich J Spiegl
- Steadman Philippon Research Institute, 181 W. Meadow Drive, Ste. #1000, Vail, CO, 81657, USA
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Tayrose GA, Karas SG, Bosco J. Biceps Tenodesis for Type II SLAP Tears. Bull Hosp Jt Dis (2013) 2015; 73:116-121. [PMID: 26517164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Tears of the superior glenoid labrum are a common cause of shoulder pain and disability, especially in overhead athletes such as pitchers, swimmers, and volleyball players. Type II SLAP lesions have been the most clinically important superior labral pathology, and the management of this lesion has been a very controversial topic. Currently, there are no high level studies in the literature to guide treatment. While the few level 3 and level 4 evidence studies that are available following arthroscopic repair of type II SLAP lesions all report reasonable overall patient satisfaction, persistent postoperative pain is common and associated with a low return to pre-injury level of sports participation. There has been a recent school of thought that biceps tenodesis, which maintains the length-tension relationship of the long head of biceps, should be the procedure of choice for patients with isolated type II SLAP lesions. The current paper reviews the role biceps tenodesis plays in the management of type II SLAP tears.
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Chen X, Ye R, Xu H, Lu J. [EFFECTIVENESS OF COMBINED TENODESIS FOR PROXIMAL LESIONS OF BICEPS TENDON WITH MASSIVE ROTATOR CUFF TEAR BY ARTHROSCOPY]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2015; 29:667-671. [PMID: 26466465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of the combined tenodesis for proximal lesions of biceps tendon with massive rotator cuff tear by arthroscopy. METHODS Between January 2011 and June 2013, 48 patients with massive rotator cuff tear and proximal lesions of biceps tendon underwent combined tenodesis under arthroscopy, and the clinical data were retrospectively analyzed. Of 48 cases, 22 were male and 26 were female with an average age of 46 years (range, 35-59 years); 12 cases had clear history of trauma. The disease duration ranged from 1 to 57 months (mean, 4.6 months). All cases suffered from moderate to severe shoulder pain, the strength and the range of motion (ROM) declined when compared with those of the other side. According to Goutallier classification standard, 3 cases were rated as grade 0, 18 cases as grade 1, and 27 cases as grade 2. The operation time and complication were recorded. The visual analogue scale (VAS) score, ROM, the strength of flexed elevation and elbow flexion, Constant-Murley score, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, Mayo elbow performance score (MEPS) were used to evaluate the effectiveness. RESULTS The operations were performed successfully, and incisions healed primarily. The operation time was 120-160 minutes (mean, 135 minutes). One case had shoulder joint swelling with wound bleeding, which was cured after proper treatment. All 48 patients were followed up 12-18 months (mean, 13.9 months). The results of MRI showed good healing of tendon at 6 months after operation. When compared with preoperative values, VAS score was significantly decreased (P < 0.05); the ROM in forward flexion, external rotation, and internal rotation, and the strength of flexed elevation were significantly increased (P < 0.05); and ASES score, Constant- Murley score, and UCLA score were significantly improved at 12 months after operation (P < 0.05). No significant difference was observed in MEPS score and elbow flexion strength (P > 0.05). CONCLUSION The technique of combined tenodesis under arthroscopy can obtain satisfactory clinical outcomes in treating proximal lesions of biceps tendon with massive rotator cuff tear.
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Offoha RU, Garzon-Muvdi J, Streiff MB, McFarland EG. Upper-extremity thrombosis in a patient after biceps tenodesis. Orthopedics 2014; 37:e1133-6. [PMID: 25437090 DOI: 10.3928/01477447-20141124-92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 05/13/2014] [Indexed: 02/03/2023]
Abstract
Deep venous thrombosis (DVT) of the upper extremity is uncommon compared with DVT of the lower extremity. Exertional DVT has been described in some athletes, especially in the dominant arm of baseball players. It is important for health care professionals to recognize the signs and symptoms of upper-extremity DVT, which can occur after exertion or after surgery of the upper extremity. Superficial venous thrombosis is also very uncommon in the upper extremity. This article describes a case of superficial venous thrombosis that mimicked DVT in the surgical (right) arm of a recreational baseball player after suprapectoral biceps tenodesis for a painful superior labrum anterior-posterior lesion. Although the superficial venous system of the upper arm has frequent connections to the deeper basilar system, it is uncommon for superficial venous thrombosis to occur concurrently with DVT. It is important for clinicians to understand the distinction between superficial venous thrombosis and DVT in the upper extremity because the physical findings, treatment, and prognosis for these 2 entities differ in the following ways: (1) superficial venous thrombosis may be accompanied by a cord, but DVT is associated with more generalized swelling; (2) superficial venous thrombosis requires symptomatic treatment only, whereas DVT requires anticoagulation; and (3) superficial venous thrombosis typically resolves with few sequelae, whereas upper-extremity DVT increases the risk of future DVT.
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Lee KB, Song SY, Paik SH, Shin WH. Delayed intra-articular migration of the IntraFix outer sheath after anterior cruciate ligament reconstruction: a case report. Knee 2011; 18:347-9. [PMID: 20800499 DOI: 10.1016/j.knee.2010.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Revised: 05/20/2010] [Accepted: 05/22/2010] [Indexed: 02/02/2023]
Abstract
We describe a case of foreign body synovitis caused by delayed intra-articular migration of the outer sheath 5 months after anterior cruciate ligament (ACL) reconstruction with a quadrupled tibialis allograft tendon using the IntraFix device for tibial fixation. The postoperative course was unremarkable. At 5 months after surgery, the patient experienced a sudden catching sensation and a slight pain without any obvious twisting or trauma. At 6 months after surgery, extension deficit was 20°. At arthroscopy, intra-articular migration of the outer sheath from the tibial tunnel and reactive synovitis were observed. The outer sheath in the joint and the inner screw in the tibial tunnel were removed successfully. The ACL graft was well incorporated under good tension. Patient was able to return to her previous level of all daily activities with no further episodes of swelling. To our knowledge, described here is the only case of foreign body synovitis due to intra-articular migration of the unbroken sheath.
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Affiliation(s)
- Kee-Byung Lee
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, South Korea
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Abstract
BACKGROUND The best location for biceps tenodesis is controversial as surgeons have begun to question whether tenodesis location affects the incidence of residual bicipital postoperative pain. An open distal tenodesis technique has been previously proposed to eliminate remaining symptoms at the bicipital groove. QUESTIONS/PURPOSES We asked the following questions: (1) Does a higher tenodesis in the biceps groove result in postoperative pain? And (2) can the tenodesis location be successfully moved more distally ("suprapectoral tenodesis") by an arthroscopic technique? METHODS We retrospectively reviewed 17 patients undergoing arthroscopic biceps tenodesis and evaluated their tenodesis location, either within the upper half of the groove (five) or in the lower half of the groove or shaft (12). Patient outcomes were assessed with visual analog scale scores for pain, American Shoulder and Elbow Surgeons scores, and Constant-Murley scores. Minimum followup was 12 months (mean, 28 months; range, 12-69 months). RESULTS Two patients had persistent pain at 12 months; both had a tenodesis in the upper half of the groove. The overall American Shoulder and Elbow Surgeons and Constant-Murley scores were improved at latest followup. CONCLUSIONS Arthroscopic suprapectoral biceps tenodesis represents a new technique for distal tenodesis. Our preliminary observations suggest a more distal tenodesis location may decrease the incidence of persistent postoperative pain at the bicipital groove, although additional research is needed to definitively state whether the proximal location is in fact more painful. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- David M. Lutton
- Department of Orthopaedic Surgery, Mount Sinai Hospital, 5 East 98th Street, Box 1188, New York, NY 10029 USA
| | - Konrad I. Gruson
- Department of Orthopaedic Surgery, Mount Sinai Hospital, 5 East 98th Street, Box 1188, New York, NY 10029 USA
| | - Alicia K. Harrison
- Department of Orthopaedic Surgery, Mount Sinai Hospital, 5 East 98th Street, Box 1188, New York, NY 10029 USA
| | - James N. Gladstone
- Department of Orthopaedic Surgery, Mount Sinai Hospital, 5 East 98th Street, Box 1188, New York, NY 10029 USA
| | - Evan L. Flatow
- Department of Orthopaedic Surgery, Mount Sinai Hospital, 5 East 98th Street, Box 1188, New York, NY 10029 USA
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Dillon MT, Lepore DJ. Heterotopic ossification after single-incision distal biceps tendon repair with an endobutton. J Surg Orthop Adv 2011; 20:198-201. [PMID: 22214146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Heterotopic ossification is rarely encountered following repair of a distal biceps tendon by an anterior approach. Although much less common than with a classic two-incision approach, a review of the literature demonstrates that heterotopic ossification may still occur following anterior single incision techniques. We describe only the second reported case to our knowledge of symptomatic heterotopic ossification following repair of a distal biceps tendon rupture with an EndoButton.
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Affiliation(s)
- Mark T Dillon
- Department of Orthopaedic Surgery, The Permanente Medical Group, Sacramento, CA 95825, USA.
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Reiff SN, Nho SJ, Romeo AA. Proximal humerus fracture after keyhole biceps tenodesis. Am J Orthop (Belle Mead NJ) 2010; 39:E61-E63. [PMID: 20844775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A biceps tenodesis is a common surgical procedure that is often carried out in conjunction with other surgical shoulder repairs to relieve biceps tendonitis. This case presents a 50-year-old woman who suffered a humerus fracture following an open keyhole biceps tenodesis. The potential reasons for the fracture as well as a brief analysis of the technique itself are presented. To our knowledge, this is the first case report of a humerus fracture following keyhole biceps tenodesis in the English-language literature.
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Affiliation(s)
- Stefanie N Reiff
- Department of Orthopedic Surgery, Rush University Medical Center, Rush Medical College of Rush University, Chicago, Illinois 60612, USA.
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Franceschi F, Longo UG, Ruzzini L, Papalia R, Rizzello G, Denaro V. To detach the long head of the biceps tendon after tenodesis or not: outcome analysis at the 4-year follow-up of two different techniques. Int Orthop 2006; 31:537-45. [PMID: 16947053 PMCID: PMC2267623 DOI: 10.1007/s00264-006-0206-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Revised: 05/18/2006] [Accepted: 05/23/2006] [Indexed: 10/24/2022]
Abstract
The aim of this study was to determine whether or not detaching the biceps tendon from the glenoid after tenodesis performed with the inclusion of the biceps in the rotator cuff suture results in an improved outcome. From 1999 to 2001, 22 patients had an arthroscopic rotator cuff repair and associated biceps tendon lesions that were repaired with two new arthroscopic techniques of tenodesis incorporating the biceps tendon in the rotator cuff suture. Patients were randomised into one of two groups: tenodesis without tenotomy (group 1) and tenodesis with tenotomy (group 2). Preoperative and postoperative functions were assessed by means of a modified UCLA rating scale and shoulder ROM. The mean follow-up period was 47.2 months (range 36- 59). In group 1 (tenodesis without tenotomy), eight patients had an excellent postoperative score and three a good postoperative score. The UCLA rating system used for evaluation showed a statistically significant improvement from the preoperative average rating of 10.5 (5-15) to the postoperative average score of 33 (29-35) (P<0.05). In group 2 (tenodesis with tenotomy), the UCLA rating system used for evaluation showed a statistically significant improvement from the preoperative rating of 11.1 to the postoperative score of 32.9 (P<0.05). No statistically significant difference in the total UCLA scores was found when comparing the repairs performed with or without tenotomy. Follow-up results with regard to ROM were not different between the two groups, and the range of motion was improved in all measured directions. In this series, every patient qualified as having good to excellent results according to the UCLA score. This study suggests that there is no difference between detaching and not detaching the biceps after including it in the repair.
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Affiliation(s)
- Francesco Franceschi
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Via Longoni, 83, 00155 Rome, Italy
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Via Longoni, 83, 00155 Rome, Italy
| | - Laura Ruzzini
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Via Longoni, 83, 00155 Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Via Longoni, 83, 00155 Rome, Italy
| | - Giacomo Rizzello
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Via Longoni, 83, 00155 Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, Via Longoni, 83, 00155 Rome, Italy
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Judd DB, Burkhalter W, Kim DH. Tethered lateral patellar dislocation as a complication after Galeazzi procedure. Am J Orthop (Belle Mead NJ) 2006; 35:373-5. [PMID: 16983868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Daniel B Judd
- Tripler Army Medical Center, Honolulu, HI 96818-4920, USA
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