Top

European Journal of Orthopaedic Surgery & Traumatology

Published in:

01-12-2014 | Original Article

Arthroscopic repair of large and massive rotator cuff tears using the biceps-incorporating technique: mid-term clinical and anatomical results

Authors: Jong-Hun Ji, Mohamed Shafi, Jae-Jung Jeong, Sang-Eun Park

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 8/2014

Abstract

Introduction

The purpose of this study was to determine the anatomical and clinical outcomes of a biceps-incorporating rotator cuff repair without detaching the biceps origin from the glenoid in a large or massive rotator cuff tear, in which the biceps tendon could be incorporated into the cuff defect and help to provide tendon healing and prevent upward migration of the humeral head.

Materials and methods

Thirty-five consecutive patients with a mean age of 62 years (41–81 years) had primary arthroscopic repair of their large or massive rotator cuff in which biceps tendon incorporated into the cuff defect without detaching the biceps tendon from the glenoid was performed. Functional outcome was determined by the visual analog scale (VAS) for pain during motions, simple shoulder test (SST), the University of California, Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons scores (ASES) (mean follow-up, 24 months). The continuity of rotator cuff mechanism was evaluated using the magnetic resonance imaging (MRI) among all the patients after 2 years.

Results

At the final follow-up, mean VAS scores increased significantly from 7.1 to 2.0 points, ASES scores from 35 to 83, UCLA scores from 14 to 30, and SST scores from 4 to 9, respectively (p < 0.05). Moreover, the range of motion was significantly increased except the external rotation from preoperative 27° to postoperative 33° (p = 0.183). MRI evaluation showed that 22 of 35 patients (63 %) had heeled tendons and 7 patients (20 %) had partial re-tear. Of 35 patients, 6 (17 %) had a complete re-tear. Only 3 of these 6 patients were not satisfied with the result.

Conclusions

Using this simple biceps-incorporating rotator cuff repair technique, we achieved good clinical and moderate anatomical results, and prevent superior migration of the humeral head in a large or massive rotator cuff tear.

Level of evidence

Level IV retrospective review.

Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K (2004) The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 86-A:219–224PubMed

Klepps S, Bishop J, Lin J, Cahlon O, Strauss A, Hayes P, Flatow EL (2004) Prospective evaluation of the effect of rotator cuff integrity on the outcome of open rotator cuff repairs. Am J Sports Med 32:1716–1722PubMedCrossRef

Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL (2006) Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg 15(3):290–299PubMedCrossRef

Burkhart SS (1997) Partial repair of massive rotator cuff tears: the evolution of a concept. Orthop Clin North Am 28(1):125–132PubMedCrossRef

Duralde XA, Bair B (2005) Massive rotator cuff tears: the result of partial rotator cuff repair. J Shoulder Elbow Surg 14(2):121–127PubMedCrossRef

Elhassan B, Endres NK, Higgins LD, Warner JJ (2008) Massive irreparable tendon tears of the rotator cuff: salvage options. Instr Course Lect 57:153–166PubMed

Burkhart SS, Nottage WM, Ogilvie-Harris DJ, Kohn HS, Pachelli A (1994) Partial repair of irreparable rotator cuff tears. Arthroscopy 10–4:363–370CrossRef

Franceschi F, Longo UG, Ruzzini L, Papalia R, Rizzello G, Denaro V (2007) 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 31:537–545PubMedCentralPubMedCrossRef

George MS (2008) Arthroscopic biceps tenodesis incorporated into rotator cuff repair using suture anchors. Orthopedics 31:552–555PubMedCrossRef

10.

DeOrio JK, Cofield RH (1984) Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am 66:563–567PubMed

11.

Ellman H, Kay SP (1991) Arthroscopic subacromial decompression for chronic impingement. Two- to five-year results. J Bone Joint Surg Br 73:395–398PubMed

12.

Boileau P, Baque F, Valerio L, Ahrens P, Chuinard C, Trojani C (2007) Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am 89:747–757PubMedCrossRef

13.

Derwin KA, Baker AR, Spragg RK, Leigh DR, Iannotti JP (2006) Commercial extracellular matrix scaffolds for rotator cuff tendon repair. Biomechanical, biochemical, and cellular properties. J Bone Joint Surg Am 88:2665–2672PubMedCrossRef

14.

Warner JJ, IMt Parsons (2001) Latissimus dorsi tendon transfer: a comparative analysis of primary and salvage reconstruction of massive, irreparable rotator cuff tears. J Shoulder Elbow Surg 10(6):514–521PubMedCrossRef

15.

Cuff D, Pupello D, Virani N, Levy J, Frankle M (2008) Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency. J Bone Joint Surg Am 90–6:1244–1251CrossRef

16.

Frankle M, Levy JC, Pupello D, Siegal S, Saleem A, Mighell M, Vasey M (2006) The reverse shoulder prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients surgical technique. J Bone Joint Surg Am 88:178–190PubMed

17.

Kasten P, Loew M (2007) How to treat massive rotator cuff tears. Orthopade 36–9:855–861CrossRef

18.

Cho NS, Yi JW, Rhee YG (2009) Arthroscopic biceps augmentation for avoiding undue tension in repair of massive rotator cuff tears. Arthroscopy 25(2):183–191PubMedCrossRef

19.

Sano H, Mineta M, Kita A, Itoi E (2010) Tendon patch grafting using the long head of the biceps for irreparable massive rotator cuff tears. J Orthop Sci 15:310–316PubMedCrossRef

20.

Wolfgang GL (1974) Surgical repair of tears of the rotator cuff of the shoulder. Factors influencing the result. J Bone Joint Surg Am 56:14–26PubMed

21.

Rathbun JB, Macnab I (1970) The microvascular pattern of the rotator cuff. J Bone Joint Surg Br 52(3):540–553PubMed

22.

Kumar VP, Satku K, Balasubramaniam P (1989) The role of the long head of biceps brachii in the stabilization of the head of the humerus. Clin Orthop Relat Res 244:172–175PubMed

23.

Checchia SL, Doneux PS, Miyazaki AN, Silva LA, Fregoneze M, Ossada A, Tsutida CY, Masiole C (2005) Biceps tenodesis associated with arthroscopic repair of rotator cuff tears. J Shoulder Elbow Surg 14(2):138–144PubMedCrossRef

24.

Warner JJ, McMahon PJ (1995) The role of the long head of the biceps brachii in superior stability of the glenohumeral joint. J Bone Joint Surg Am 77:366–372PubMed

25.

Castagna A, Conti M, Markopoulos N, Borroni M, De Flaviis L, Giardella A et al (2008) Arthroscopic repair of rotator cuff tear with a modified Mason-Allen stitch: mid-term clinical and ultrasound outcomes. Knee Surg Sports Traumatol Arthrosc 16:497–503PubMedCrossRef

26.

Jost B, Pfirrmann CW, Gerber C, Switzerland Z (2000) Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg (Am) 82:304–314CrossRef

27.

Hanusch BC, Goodchild L, Finn P, Rangan A (2009) Large and massive tears of the rotator cuff: functional outcome and integrity of the repair after a mini-open procedure. J Bone Joint Surg Br 91:201–205PubMedCrossRef

28.

Gerber C, Fuchs B, Hodler J (2000) The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am 82(1):16–25PubMed

29.

Burks RT, Crim J, Brown N, Fink B, Greis PE (2009) A prospective randomized clinical trial comparing arthroscopic single- and double-row rotator cuff repair: magnetic resonance imaging and early clinical evaluation. Am J Sports Med 37(4):674–682PubMedCrossRef

30.

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 8:599–605PubMedCrossRef

31.

Prickett WD, Teefey SA, Galatz LM, Calfee RP, Middleton WD, Yamaguchi K (2003) Accuracy of ultrasound imaging of the rotator cuff in shoulders that are painful postoperatively. J Bone Joint Surg Am 85-A(6):1084–1089PubMed

Title: Arthroscopic repair of large and massive rotator cuff tears using the biceps-incorporating technique: mid-term clinical and anatomical results
Authors: Jong-Hun Ji
Mohamed Shafi
Jae-Jung Jeong
Sang-Eun Park
Publication date: 01-12-2014
Publisher: Springer Paris
Published in: European Journal of Orthopaedic Surgery & Traumatology / Issue 8/2014
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-013-1323-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Arthroscopic repair of large and massive rotator cuff tears using the biceps-incorporating technique: mid-term clinical and anatomical results

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 8/2014

Diagnosing joint infections: synovial fluid differential is more sensitive than white blood cell count

Cementless total knee arthroplasty in chronic inflammatory rheumatism

Correlation of synovial cytokine expression with quality of cells used for autologous chondrocyte implantation in human knees

Surgical versus non-surgical management for primary patellar dislocations: an up-to-date meta-analysis

Outcome of displaced distal tibial metaphyseal fractures in children between 6 and 15 years of age treated by elastic stable intramedullary nails

Reamed versus unreamed intramedullary locked nailing in tibial fractures