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MUSCULOSKELETAL SURGERY

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28-02-2021 | Painful Arc | Original Article

Arthroscopic repair of massive rotator cuff tear. The role of the LHB distal tenotomy

Authors: C. Chillemi, S. Carli, M. Damo, R. Proietti, A. Gigante

Published in: MUSCULOSKELETAL SURGERY | Issue 3/2022

Abstract

Purpose

The aim of the study was to evaluate the results of an all arthroscopic technique for the treatment of massive rotator cuff tears using the long head of biceps as a graft to reconstruct the superior capsule and to reinforce the cuff.

Methods

A retrospective review of a consecutive series of arthroscopic repair of massive rotator cuff tears using the long head of biceps tendon was conducted. Twenty-five patients underwent surgery, and none were lost at follow-up. Minimum follow-up period was more than 12 months. Constant, UCLA and VAS scores as clinical outcome were analyzed. Time for surgical procedures was also registered. Two alternative procedures (transosseous or anchors) were employed to fix laterally the long head of biceps to the greater tuberosity and to reinforce the cuff. This choice was essentially determined by the bone quality of the greater tuberosity.

Results

All patients of both groups (Transosseous: 15 and Anchors: 10) showed a significant improvement of clinical and functional scores. Difference of the operative times between two procedures was statistically significant in favor of the anchor approach. No intraoperative complications were recorded. Postoperative shoulder stiffness was found in two male patients. In no case biceps tenodesis was performed: Popeye sign was easily detected in 16 patients but they did not complain any superior arm pain and weakness.

Conclusion

This technique represents a valid solution for treatment of massive rotator cuff tears resulting safe, easier and cost saving in comparison with other published techniques.

Ladermann A, Denard PJ, Collin P (2015) Massive rotator cuff tears: definition and treatment. Int Orthop 39(12):2403–2414. https://doi.org/10.1007/s00264-015-2796-5CrossRefPubMed

Chung SW, Kim JY, Kim MH, Kim SH, Oh JH (2013) Arthroscopic repair of massive rotator cuff tears: outcome and analysis of factors associated with healing failure or poor postoperative function. Am J Sports Med 41(7):1674–1683. https://doi.org/10.1177/0363546513485719CrossRefPubMed

Dang A, Davies M (2018) Rotator cuff disease: treatment options and considerations. Sports Med Arthrosc Rev 26(3):129–133. https://doi.org/10.1097/jsa.0000000000000207CrossRefPubMed

Kim IB, Kim MW (2016) Risk factors for retear after arthroscopic repair of full-thickness rotator cuff tears using the suture bridge technique: classification system. Arthroscopy 32(11):2191–2200. https://doi.org/10.1016/j.arthro.2016.03.012CrossRefPubMed

Mihata T, McGarry MH, Kahn T, Goldberg I, Neo M, Lee TQ (2016) Biomechanical role of capsular continuity in superior capsule reconstruction for irreparable tears of the supraspinatus tendon. Am J Sports Med 44(6):1423–1430. https://doi.org/10.1177/0363546516631751CrossRefPubMed

Han F, Kong CH, Hasan MY, Ramruttun AK, Kumar VP (2019) Superior capsular reconstruction for irreparable supraspinatus tendon tears using the long head of biceps: a biomechanical study on cadavers. Orthop Traumatol Surg Res 105(2):257–263. https://doi.org/10.1016/j.otsr.2018.10.023CrossRefPubMed

Szabo I, Boileau P, Walch G (2008) The proximal biceps as a pain generator and results of tenotomy. Sports Med Arthrosc Rev 16(3):180–186. https://doi.org/10.1097/JSA.0b013e3181824f1eCrossRefPubMed

Watson ST, Robbins CB, Bedi A, Carpenter JE, Gagnier JJ, Miller BS (2017) Comparison of outcomes 1 year after rotator cuff repair with and without concomitant biceps surgery. Arthroscopy 33(11):1928–1936. https://doi.org/10.1016/j.arthro.2017.05.009CrossRefPubMed

Boutsiadis A, Chen S, Jiang C, Lenoir H, Delsol P, Barth J (2017) Long head of the biceps as a suitable available local tissue autograft for superior capsular reconstruction: “the Chinese way.” Arthrosc Tech 6(5):e1559–e1566. https://doi.org/10.1016/j.eats.2017.06.030CrossRefPubMedPubMedCentral

10.

Chillemi C, Mantovani M, Gigante A (2018) Superior capsular reconstruction of the shoulder: the ABC (Arthroscopic Biceps Chillemi) technique. Eur J Orthop Surg Traumatol 28(6):1215–1223. https://doi.org/10.1007/s00590-018-2183-1CrossRefPubMed

11.

Kim YS, Lee HJ, Park I, Sung GY, Kim DJ, Kim JH (2018) Arthroscopic in situ superior capsular reconstruction using the long head of the biceps tendon. Arthrosc Tech 7(2):e97–e103. https://doi.org/10.1016/j.eats.2017.08.058CrossRefPubMedPubMedCentral

12.

Chiang CH, Shaw L, Chih WH, Yeh ML, Su WR (2019) Arthroscopic rotator cuff repair combined with modified superior capsule reconstruction as reinforcement by the long head of the biceps. Arthrosc Tech 8(10):e1223–e1231. https://doi.org/10.1016/j.eats.2019.06.012CrossRefPubMedPubMedCentral

13.

Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res 254:81–86

14.

Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8(6):599–605. https://doi.org/10.1016/s1058-2746(99)90097-6CrossRefPubMed

15.

Constant C, Murley A (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164CrossRef

16.

Amstutz HC, Sew AH, Clarke I (1981) UCLA anatomic total shoulder arthroplasty. Clin Orthop Relat Res 155:7–20CrossRef

17.

Heller GZ, Manuguerra M, Chow R (2016) How to analyze the visual analogue scale: myths, truths and clinical relevance. Scand J Pain 13:67–75. https://doi.org/10.1016/j.sjpain.2016.06.012CrossRefPubMed

18.

Castagna A, Gumina S, Garofalo R, Mantovani M, Kany J, Chillemi C (2019) Technique for a novel arthroscopic transosseous rotator cuff repair. Tech in Should Elb Surg 20(1):12–18CrossRef

19.

Chillemi C, Castagna A, Osimani M (2018) Arthroscopic transosseous rotator cuff repair: tips and tricks. Springer Chapter 8:77–104

20.

Chillemi C, Dei Giudici L, Mantovani M, Osimani M, Gumina S (2018) Rotator cuff failure after surgery: an all-arthroscopic transosseous approach. Musculoskelet Surg 102(Suppl 1):3–12. https://doi.org/10.1007/s12306-018-0560-xCrossRefPubMed

21.

Meraner D, Sternberg C, Vega J, Hahne J, Kleine M, Leuzinger J (2016) Arthroscopic tenodesis versus tenotomy of the long head of biceps tendon in simultaneous rotator cuff repair. Arch Orthop Trauma Surg 136(1):101–106. https://doi.org/10.1007/s00402-015-2343-2CrossRefPubMed

22.

Schmalzl J, Plumhoff P, Gilbert F et al (2019) Tendon-derived stem cells from the long head of the biceps tendon: inflammation does not affect the regenerative potential. Bone Joint Res 8(9):414–424. https://doi.org/10.1302/2046-3758.89.Bjr-2018-0214.R2CrossRefPubMedPubMedCentral

23.

Lee SC, Williams D, Endo Y (2018) The repaired rotator cuff: MRI and ultrasound evaluation. Curr Rev Musculoskeletal Med 11(1):92–101. https://doi.org/10.1007/s12178-018-9463-6CrossRef

24.

Millican CR, Lam PH, Murrell GAC (2020) Shoulder stiffness after rotator cuff repair: the fate of stiff shoulders up to 9 years after rotator cuff repair. J Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2019.11.020CrossRefPubMed

25.

Castagna A, Garofalo R, Maman E, Gray AC, Brooks EA (2019) Comparative cost-effectiveness analysis of the subacromial spacer for irreparable and massive rotator cuff tears. Int Orthop 43(2):395–403. https://doi.org/10.1007/s00264-018-4065-xCrossRefPubMed

Title: Arthroscopic repair of massive rotator cuff tear. The role of the LHB distal tenotomy
Authors: C. Chillemi
S. Carli
M. Damo
R. Proietti
A. Gigante
Publication date: 28-02-2021
Publisher: Springer Milan
Keyword: Painful Arc
Published in: MUSCULOSKELETAL SURGERY / Issue 3/2022
Print ISSN: 2035-5106
Electronic ISSN: 2035-5114
DOI: https://doi.org/10.1007/s12306-021-00705-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Arthroscopic repair of massive rotator cuff tear. The role of the LHB distal tenotomy

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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