Biceps tenodesis versus biceps tenotomy for biceps tendinitis without rotator cuff tears.
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ABSTRACT:
SUBMITTER: Hassan S
PROVIDER: S-EPMC6383069 | biostudies-literature | 2019 Mar-Apr
REPOSITORIES: biostudies-literature
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Project description:Optimal treatment of the diseased long head of the biceps (LHB) tendon during rotator cuff repair remains a topic of debate: tenotomy or tenodesis. A recent meta analysis revealed no difference in strength or functional outcome between treatments. The included studies varied in methodological quality, and only two were randomized controlled trials (RCTs). As strong evidence in favor of either tenotomy or tenodesis is still lacking, we designed this randomized controlled trial to compare functional outcomes after tenotomy and tenodesis when performed in adjunct to arthroscopic rotator cuff repair.Patients older than 50 years with a supraspinatus and/or infraspinatus tendon rupture sized smaller than 3 cm, who are encountered with LHB pathology, will be randomized to either LHB tenotomy or LHB tenodesis. Clinical and patient-reported data will be collected pre-operatively, 6 weeks, 3 months and 1 year after surgery. Primary outcome is overall shoulder function evaluated with the Constant score at 1 year after surgery. As additional measures of shoulder function, two patient reported outcomes (the Dutch Oxford Shoulder Test and the Disabilities of the Arm Shoulder and Hand questionnaire) will be assessed. Other evaluations include cosmetic appearance evaluated by the "Popeye" deformity, elbow flexion strength, arm cramping pain, MRI-based location of the biceps tendon, quality of life, and duration of surgery. To detect non-inferiority with a one-sided, two-sample t-test with 80 % power and a significance level (alpha) of 0.025, the required sample size is 98 patients.Treatment of LHB tendon lesions is performed differently around the world and meta analyses do not provide conclusive evidence in favor of one of these treatments. This study will strengthen evidence on the risks and benefits of LHB tenotomy and tenodesis in adjunct to a rotator cuff repair, which is important for managing patient expectations.Dutch Trial Register ( NTR3255 ) January 12, 2012, ClinicalTrials.gov (ID NCT02655848 ) January 14, 2016, retrospectively registered.
| S-EPMC5004307 | biostudies-literature
Project description:The purpose of this meta-analysis was to assess whether there were differences in the outcomes between tenotomy and tenodesis in treating LHBT lesions combined with rotator cuff repairs.Using Medline, Embase, and Cochrane, we searched for articles comparing tenotomy and tenodesis combined with rotator cuff repair which were published before April 2016 with the terms "biceps", "tenotomy", "tenodesis", and "rotator cuff". The controlled clinical studies that met the inclusion and exclusion criteria were assessed for quality of methodology by utilizing the Coleman score.On the basis of the inclusion and exclusion criteria, ten articles (903 patients) were included in this meta-analysis. The Coleman score ranged between 40 and 89 in the included studies. The results showed that the incidence of the popeye sign (OR, 2.777, P = 0.000) were higher in tenotomy group compared with tenodesis group when concomitant rotator cuff repair. Statistically significant difference in favor of tenodesis was observed for Constant score (SMD, -0.230, P = 0.025). As for the arm cramping pain, patient satisfaction, VAS score, ASES score and UCLA increased score, the strength and the range of motion, there were no significant differences between tenodesis and tenotomy of the LHBT, corresponding to the currently available results in the literature.Based on this meta-analysis, both tenotomy and tenodesis are effective in pain relief and function improvement in patients with repairable rotator cuff tears. No significant differences in post-operative functional outcome between tenotomy and tenodesis for the treatment of LHBT lesions were observed except for a lower Constant score and higher risk of Popeye deformity in tenotomy.
| S-EPMC5633150 | biostudies-literature
Project description:With a range of tear characteristics such as chronicity, degree of fatty atrophy, and number of tendons involved as well as varying patient-specific characteristics including age, injury mechanism, and expectations after treatment to consider, proper and successful treatment of a rotator cuff tear is multifactorial and, consequently, challenging. Although conservative management of a rotator cuff tear may be successful, a more severe tear with involvement of more tendons may warrant surgical intervention. Furthermore, additional pathology including biceps tendinopathy may result in greater patient morbidity and an even more complex treatment decision-making process and surgical technique. The purpose of this Technical Note is to describe our preferred surgical technique for the treatment of a rotator cuff tear involving 2 rotator cuff tendons in conjunction with a lesion of the long head of the biceps tendon.
| S-EPMC5795267 | biostudies-literature
Project description:Objectives: While short and mid-term clinical outcomes following implantation of an arthroscopic subacromial balloon spacer for massive, irreparable rotator cuff tears (MIRCTs) have been favorable [1], little is known about the effects of concomitant procedures on clinical outcomes and early post- operative recovery. The purpose of this study was to determine the effects of concomitant proximal biceps surgery on short and mid-term outcomes following partial rotator cuff repair or subacromial balloon spacer implantation using the InSpace? device (Stryker; Kalamazoo, MI; Figure 1). Methods: We conducted a retrospective review of prospectively collected data from a previously published randomized, clinical trial comparing the InSpace? device to partial rotator cuff repair in the management of symptomatic MIRCTs (ClinicalTrials.gov Identifier: NCT02493660) [1]. Study participants with posterosuperior MIRCTs (as defined by MRI diagnosis of ≥2 tendon involvement and ≥5 cm of retraction from the tendon insertion) treated operatively with subacromial balloon spacer implantation or partial rotator cuff repair and concomitant biceps tenotomy or tenodesis were considered for this study. The primary outcome in this study was the achievement of minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for the American Shoulder and Elbow (ASES) score at 6 weeks and 24 months postoperatively. Established MCID and SCB thresholds from the literature were used, requiring a ≥11.1-point increase in ASES score for MCID achievement and a ≥17.5-point increase for SCB achievement [2]. Fisher’s exact test was used to compare MCID and SCB achievement rates between groups. Results: A total of 103 patients were included in this analysis, of which 48 patients were in the InSpace? cohort and 55 were in the partial rotator cuff repair cohort (Table 1). At 6 weeks post-operatively, a larger percentage of patients who received InSpace? with concomitant biceps tenotomy achieved MCID on ASES compared to those receiving a concomitant tenodesis, though this result was not statistically significant (64.3% vs 42.1%, p = 0.15) (Table 1). Similarly, a larger percentage of patients who underwent arthroscopic partial rotator cuff repair with biceps tenotomy achieved MCID on ASES compared to those undergoing partial repair with biceps tenodesis, though this was not statistically significant (56.3% vs 40.9%, p = 0.41). Similar trends were seen for SCB achievement rates at 6 weeks (Table 2). Notably, SCB achievement rates were significantly greater for patients undergoing InSpace? with biceps tenotomy versus partial repair with biceps tenodesis (p = 0.04). At 24 months, ASES MCID achievement rates for the InSpace? with biceps tenotomy group were similar to the InSpace? with biceps tenodesis group (96.2% vs 86.7%, p = 0.54) (Table 1). Similarly, there was no significant difference between the partial repair with concomitant tenodesis and tenotomy groups (100% vs 92.9%, p = 0.51). Similar trends were seen for SCB achievement rates at this time point (Table 2). Notably, there was no longer a significant difference in SCB achievement rates between the InSpace? with biceps tenotomy group and partial repair with biceps tenodesis group (p = 1.00). Conclusions: The primary goal of treatment during arthroscopic implantation of a subacromial balloon spacer is pain relief in the setting of relatively well-maintained function. Although all patients in this study received standardized post-operative rehabilitation, including 4-week sling use, our results suggest that providers seeking accelerated rehabilitation for their patients may consider concomitant biceps tenotomy for biceps pathology to avoid prolonged immobilization, decrease risk of stiffness, and provide earlier achievement of clinically significant outcomes on patient-reported outcome measures.
| S-EPMC10392242 | biostudies-literature
Project description:ContextA comparison of clinical outcomes after long head of biceps (LHB) tenotomy or tenodesis performed concurrently with rotator cuff repair (RCR) is of interest to physicians and patients.ObjectiveA systematic review of clinical outcome studies examining LHB tenotomy or tenodesis performed concurrently with RCR. Secondarily, perform a meta-analysis of data from comparative studies.Data sourcesMEDLINE (1946 to week 30 of 2013) and EMBASE (1980 to week 30 of 2013).Study selectionLevels 1 through 4 studies reporting clinical outcomes of concurrent RCR and LHB tenotomy or tenodesis with minimum 1-year follow-up.Study designSystematic review and meta-analysis.Level of evidenceLevel 4.Data extractionTwo independent reviewers identified eligible studies and applied the exclusion criteria. Clinical outcome data, including functional outcome score(s), biceps deformity and cramping, and patient satisfaction, were extracted. Clinical outcome data from included studies were pooled (weighted according to study size) and reported. A meta-analysis was performed only on outcomes extracted from comparative studies (? = 0.05).ResultsTwelve studies (N = 565 patients; mean age, 61.3 years; 46.3% men) were included. Of these, 6 (N = 263) included RCR and LHB tenotomy and 9 (N = 302) included RCR and LHB tenodesis. A meta-analysis was performed on 3 comparative studies (levels 1 and 2), demonstrating that the postoperative Constant score at a mean follow-up of 25.5 months was significantly greater after tenodesis (92.8 [tenodesis] vs 90.6 [tenotomy], P < 0.01); however, this difference was less than the reported minimal clinically important difference of 10.4 points. Similarly, the rate of biceps deformity was significantly less after tenodesis (15.5% [tenotomy] vs 3.9% [tenodesis], P < 0.01); however, most patients were not bothered by it. There were no significant differences in the rate of biceps cramping or patient satisfaction.ConclusionAlthough the postoperative Constant score and rate of biceps deformity favor LHB tenodesis statistically, the clinical significance appears negligible.
| S-EPMC4481674 | biostudies-literature
Project description:Surgical repair of massive and chronic rotator cuff tears is difficult due to tendon retraction and severe atrophy, and the resultant retear rate in the structurally weak tendons is high. Commercially available patches and bioinductive scaffolds have been used to provide strength and superior healing environment in partial and complete rotator cuff tears. Biological biceps autograft has been used for superior capsular reconstruction, and the subacromial bursa has been shown to have significant pluripotent stem cell potency for tendon healing. We describe our technique for combined use of the long biceps tendon (LBT) and vasculature-preserved subacromial bursa as autografts in rotator cuff repair augmentation. The technique involves obtaining a LBT graft of sufficient length using a "traction and tenodesis" technique. The subacromial bursa is mobilized as a continuous layer (vascular bursal duvet) by maintaining its medial and lateral vascularity. All-suture anchors are used to minimize the insertion apertures (3 mm) in tuberosity. The bursa is advanced laterally, and the mobilized cuff is repaired together as a biceps-cuff-bursa composite unit. Combined use of the biceps and bursa as biological autografts has the advantage of structural and regenerative augmentation, and the autografts are easily accessible without added cost.
| S-EPMC8556760 | biostudies-literature
Project description:Treatment of concomitant long head of the biceps pathology in the setting of rotator cuff repair is often required. When a tenodesis of the biceps is used, additional anchors and surgical dissection are typically required. This adds additional surgical time, morbidity of additional surgical dissection, and additional anchor load and cost. We describe a novel technique for arthroscopic biceps tenodesis that uses the anterior lateral row anchor of a double-row rotator cuff repair to simultaneously secure the biceps tenodesis and rotator cuff tear. This technique provides a simple, reproducible, cost-effective means of performing a simultaneous biceps tenodesis and double-row rotator cuff repair.
| S-EPMC3678666 | biostudies-other
Project description:PurposeTo evaluate the reoperations, complications, and costs up to 5 years following arthroscopic rotator cuff repair (RCR) alone, with acromioplasty (acro), with biceps tenodesis (BT), or with both acro and BT.MethodsWe queried the MarketScan database to identify patients who underwent RCR from 2007 to 2016. Patients were stratified into groups based on concomitant procedures (acro and/or BT) performed on the same day as index RCR. Reoperations, complications, and costs were followed for 5 years post-index procedure. Patients without laterality codes were excluded. A multivariate logistic regression analysis was used to control for confounding factors.ResultsThis study identified 147,838 patients (mean age, 53.1 years; standard deviation, 8.3 years) who underwent primary RCR. Patients were stratified into 4 groups: (1) RCR only, (2) RCR + acro, (3) RCR + BT, and (4) RCR + acro + BT. Patients in the RCR only group experienced the highest rate of unadjusted overall postoperative complications (17.2%) versus the other groups (RCR + acro 16.4%, RCR + BT 15.1%, RCR + acro + BT 16.2%, P < .0161). The RCR only group also experienced a significantly greater number of reoperations on the ipsilateral shoulder (P < .0001), whereas the RCR + acro + BT had the highest costs at all timepoints. In the regression analysis, there was no significant differences between complications and reoperations between any groups. After adjusting for covariates, the performance of a BT with an RCR and acromioplasty led to increased costs (odds ratio, 1.47, 1.37-1.59, P < .001).ConclusionsConcomitant biceps tenodesis does lead to higher total healthcare costs, both in the shorter and longer terms. When adjusting for confounding factors, the performance of concomitant biceps tenodesis with rotator cuff repair does not lead to a difference in postoperative complication rate or risk for revision surgery.Level of evidenceLevel IV, economic analysis.
| S-EPMC7451851 | biostudies-literature
Project description:Despite the development in shoulder surgery, massive irreparable rotator cuff tears still remain challenging for orthopaedic surgeons. Many surgical methods are addressed to this kind of pathology, but each of them has its own limitations. We decided to fuse the ideas of superior capsular reconstruction, "GraftJacket" technique, and partial rotator cuff repair. In this way, the technique using the long head biceps tendon simultaneously as a vascularized bridge between rotator cuff remnants and greater tubercle and as a depressor for the humeral head was created. This Technical Note describes the technique.
| S-EPMC5984293 | biostudies-other
Project description:BackgroundStudies to date comparing biceps tenodesis methods in the setting of concomitant rotator cuff repair (RCR) have demonstrated relatively equivalent pain and functional outcomes.PurposeTo compare biceps tenodesis constructs, locations, and techniques in patients who underwent RCR using a large multicenter database.Study designCohort study; Level of evidence, 3.MethodsA global outcome database was queried for patients with medium- and large-sized tears who underwent biceps tenodesis with RCR between 2015 and 2021. Patients ≥18 years of age with a minimum follow-up of 1 year were included. The American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, visual analog scale for pain, and Veterans RAND 12-Item Health Survey (VR-12) scores were compared at 1 and 2 years of follow-up based on construct (anchor, screw, or suture), location (subpectoral, suprapectoral, or top of groove), and technique (inlay or onlay). Nonparametric hypothesis testing was used to compare continuous outcomes at each time point. The proportion of patients achieving the minimal clinically important difference (MCID) at the 1- and 2-year follow-ups were compared between groups using chi-square tests.ResultsA total of 1903 unique shoulder entries were analyzed. Improvement in VR-12 Mental score favored anchor and suture fixations at 1 year of follow-up (P = .042) and the onlay tenodesis technique at 2 years of follow-up (P = .029). No additional tenodesis comparisons demonstrated statistical significance. The proportion of patients with improvement exceeding the MCID did not differ based on tenodesis methods for any outcome score assessed at the 1- or 2-year follow-up.ConclusionBiceps tenodesis with concomitant RCR led to improved outcomes regardless of tenodesis fixation construct, location, or technique. A clear optimal tenodesis method with RCR remains to be determined. Surgeon preference and experience with various tenodesis methods as well as patient clinical presentation should continue to guide surgical decision-making.
| S-EPMC10288396 | biostudies-literature