Subpectoral biceps tenodesis with BicepsButton fixation in the young population: which technique works best?

Male Humans Adult Tenodesis / methods Retrospective Studies Rotator Cuff Injuries / surgery Arthroscopy / methods Muscle, Skeletal / surgery
EndoButton Subpectoral cosmesis length-tension relationship tenodesis unicortical

Journal

Journal of shoulder and elbow surgery
ISSN: 1532-6500
Titre abrégé: J Shoulder Elbow Surg
Pays: United States
ID NLM: 9206499

Informations de publication

Date de publication:
Jun 2023
Historique:
received: 05 08 2022
revised: 05 11 2022
accepted: 09 12 2022
medline: 19 5 2023
pubmed: 10 1 2023
entrez: 9 1 2023
Statut: ppublish

Résumé

Injuries of the long head of the biceps (LHB) tendon are a prevalent source of anterior shoulder pain and are commonly treated with tenodesis. Not only a stable fixation of the LHB but also anatomic restoration of the length-tension relationship plays a central role in providing satisfactory functional and cosmetic outcomes, especially in young patients. We report the clinical outcomes of 2 different subpectoral tenodesis techniques using unicortical button fixation. Patients aged ≤ 50 years who were treated between April 2015 and January 2020 with 1 of the 2 following subpectoral tenodesis techniques were retrospectively selected and enrolled to undergo a follow-up examination at least 2 years after surgery: subpectoral in situ tenodesis followed by resection of the intra-articular portion leaving a residual tendon stump in the bicipital groove (group I) vs. tenotomy followed by resection of the stump and subpectoral tenodesis (group II). Patients who underwent concomitant rotator cuff repair, subsequent shoulder surgery, or contralateral biceps surgery were excluded. Clinical outcomes were evaluated using the LHB score and the Constant-Murley Score (CMS), as well as measurements of isometric elbow flexion and forearm supination strength. Sonographic evaluation included assessment of the integrity of the LHB and tenodesis, examination for signs of inflammation within the sulcus or around the tendon, and measurements of the distalization of the myotendinous junction of the LHB compared with the nonoperative side. A total of 34 patients comprising group I (24 men; mean age at time of surgery, 40.3 years; mean follow-up period, 57.2 months) and 24 patients comprising group II (19 men; mean age at time of surgery, 39.8 years; mean follow-up period, 51.9 months) were evaluated. The total CMS, as well as the scores for each CMS subcategory, did not reveal significant differences between the groups. The overall LHB score was on average 10 points higher in group I (mean, 94 points) than in group II (mean, 84 points) (P = .016). Regarding the LHB score subcategories, group I showed significantly better results for patient-dependent cosmesis (mean, 15 points in group I vs. 12 points in group II; P = .005) and examiner-dependent cosmesis (mean, 14 points in group I vs. 10 points in group II; P = .001). This finding was substantiated by a significantly higher distalization of the myotendinous junction in group II (mean, 3.0 cm in group I vs. 3.8 cm in group II; P = .030). This study shows that subpectoral in situ tenodesis of the LHB followed by arthroscopic resection of the intra-articular portion provides higher LHB scores and better cosmetic outcomes compared with proximal intra-articular tenotomy followed by subpectoral tenodesis.

Sections du résumé

BACKGROUND BACKGROUND
Injuries of the long head of the biceps (LHB) tendon are a prevalent source of anterior shoulder pain and are commonly treated with tenodesis. Not only a stable fixation of the LHB but also anatomic restoration of the length-tension relationship plays a central role in providing satisfactory functional and cosmetic outcomes, especially in young patients. We report the clinical outcomes of 2 different subpectoral tenodesis techniques using unicortical button fixation.
METHODS METHODS
Patients aged ≤ 50 years who were treated between April 2015 and January 2020 with 1 of the 2 following subpectoral tenodesis techniques were retrospectively selected and enrolled to undergo a follow-up examination at least 2 years after surgery: subpectoral in situ tenodesis followed by resection of the intra-articular portion leaving a residual tendon stump in the bicipital groove (group I) vs. tenotomy followed by resection of the stump and subpectoral tenodesis (group II). Patients who underwent concomitant rotator cuff repair, subsequent shoulder surgery, or contralateral biceps surgery were excluded. Clinical outcomes were evaluated using the LHB score and the Constant-Murley Score (CMS), as well as measurements of isometric elbow flexion and forearm supination strength. Sonographic evaluation included assessment of the integrity of the LHB and tenodesis, examination for signs of inflammation within the sulcus or around the tendon, and measurements of the distalization of the myotendinous junction of the LHB compared with the nonoperative side.
RESULTS RESULTS
A total of 34 patients comprising group I (24 men; mean age at time of surgery, 40.3 years; mean follow-up period, 57.2 months) and 24 patients comprising group II (19 men; mean age at time of surgery, 39.8 years; mean follow-up period, 51.9 months) were evaluated. The total CMS, as well as the scores for each CMS subcategory, did not reveal significant differences between the groups. The overall LHB score was on average 10 points higher in group I (mean, 94 points) than in group II (mean, 84 points) (P = .016). Regarding the LHB score subcategories, group I showed significantly better results for patient-dependent cosmesis (mean, 15 points in group I vs. 12 points in group II; P = .005) and examiner-dependent cosmesis (mean, 14 points in group I vs. 10 points in group II; P = .001). This finding was substantiated by a significantly higher distalization of the myotendinous junction in group II (mean, 3.0 cm in group I vs. 3.8 cm in group II; P = .030).
CONCLUSION CONCLUSIONS
This study shows that subpectoral in situ tenodesis of the LHB followed by arthroscopic resection of the intra-articular portion provides higher LHB scores and better cosmetic outcomes compared with proximal intra-articular tenotomy followed by subpectoral tenodesis.

Identifiants

DOI: 10.1016/j.jse.2022.12.008 PMID: 36621749
pubmed: 36621749
pii: S1058-2746(23)00005-8
doi: 10.1016/j.jse.2022.12.008
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1196-1206

Informations de copyright

Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Auteurs

Raphael Trefzer (R)

Shoulder and Elbow Surgery, Schulthess Klinik, Zürich, Switzerland; Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.

Stefan Diermayr (S)

Department for Rheumatology, Schulthess Klinik, Zürich, Switzerland.

Marco Etter (M)

Department for Rheumatology, Schulthess Klinik, Zürich, Switzerland.

Marije de Jong (M)

Research and Development, Schulthess Klinik, Zürich, Switzerland.

Martina Wehrli (M)

Research and Development, Schulthess Klinik, Zürich, Switzerland.

Laurent Audigé (L)

Research and Development, Schulthess Klinik, Zürich, Switzerland.

Markus Scheibel (M)

Shoulder and Elbow Surgery, Schulthess Klinik, Zürich, Switzerland; Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Charité Medicine University, Berlin, Germany.

Florian Freislederer (F)

Shoulder and Elbow Surgery, Schulthess Klinik, Zürich, Switzerland. Electronic address: florian.freislederer@kws.ch.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Subpectoral biceps tenodesis with BicepsButton...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Subpectoral biceps tenodesis with BicepsButton...
questionsmedicales.fr › Procédures de chirurgie opératoire › Techniques de fermeture des plaies › Techniques de suture › Ténodèse › Subpectoral biceps tenodesis with BicepsButton...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Subpectoral biceps tenodesis with BicepsButton...
questionsmedicales.fr › Plaies et blessures › Traumatismes des tendons › Lésions de la coiffe des rotateurs › Subpectoral biceps tenodesis with BicepsButton...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures orthopédiques › Arthroscopie › Subpectoral biceps tenodesis with BicepsButton...
questionsmedicales.fr › Tissus › Muscles › Muscle strié › Muscles squelettiques › Subpectoral biceps tenodesis with BicepsButton...