Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Illinois Bone and Joint Institute LLC, Chicago, Illinois, USA.
Orthop J Sports Med. 2014 Oct 23;2(10):2325967114553558. doi: 10.1177/2325967114553558. eCollection 2014 Oct.
Pathology of the long head of the biceps (LHB) is a well-recognized cause of shoulder pain in the adult population and can be managed surgically with tenotomy or tenodesis.
To compare the biomechanical strength of an all-arthroscopic biceps tenodesis technique that places the LHB distal to the bicipital groove in the suprapectoral region with a more traditional mini-open subpectoral tenodesis. This study also evaluates the clinical outcomes of patients who underwent biceps tenodesis using the all-arthroscopic technique.
Controlled laboratory study and case series; Level of evidence, 4.
For the biomechanical evaluation of the all-arthroscopic biceps tenodesis technique, in which the biceps tendon is secured to the suprapectoral region distal to the bicipital groove with an interference screw, 14 fresh-frozen human cadaveric shoulders (7 matched pairs) were used to compare load to failure and displacement at peak load with a traditional open subpectoral location. For the clinical evaluation, 49 consecutive patients (51 shoulders) with a mean follow-up of 2.4 years who underwent an all-arthroscopic biceps tenodesis were evaluated using the American Shoulder and Elbow Surgeons (ASES) score preoperatively and at last follow-up, as well as the University of California, Los Angeles (UCLA) Shoulder Score at last follow-up.
On biomechanical evaluation, there was no significant difference in peak failure load, displacement at peak load, or displacement after cyclic testing between the arthroscopic suprapectoral and mini-open subpectoral groups. In the clinical evaluation, the mean preoperative ASES score was 65.4, compared with 87.1 at last follow-up. The mean UCLA score at last follow-up was 30.2. Forty-eight (94.1%) patients reported satisfaction with the surgery. In subgroup analysis comparing patients who had a rotator cuff repair or labral repair at time of tenodesis with patients who did not have either of these procedures, there were no significant differences in UCLA or ASES scores.
The excellent biomechanical strength as well as the high rate of satisfaction after surgery and high ASES and UCLA postoperative scores make this technique a novel option for treatment of biceps tendon pathology.
长头肱二头肌（LHB）的病理学是成年人肩部疼痛的一个公认原因，可以通过肌腱切断术或肌腱固定术进行手术治疗。
比较一种全关节镜肱二头肌固定术技术，该技术将 LHB 放置在肩前区的肱二头肌沟上方，与更传统的小切开肱二头肌下固定术相比，比较其生物力学强度。本研究还评估了使用全关节镜技术进行肱二头肌固定术的患者的临床结果。
对照实验室研究和病例系列；证据水平，4 级。
为了评估全关节镜肱二头肌固定术技术的生物力学，在该技术中，肱二头肌肌腱用干扰螺钉固定在肱二头肌沟上方的肩前区，使用 14 个新鲜冷冻的人体尸体肩关节（7 对匹配）来比较失效时的负载和峰值负载时的位移，与传统的开放式肱二头肌下位置进行比较。在临床评估中，对 49 例（51 肩）连续患者进行了评估，平均随访 2.4 年，术前和末次随访时采用美国肩肘外科医师协会（ASES）评分，末次随访时采用加利福尼亚大学洛杉矶分校（UCLA）肩部评分。
在生物力学评估中，关节镜肩前区和小切开肱二头肌下组在峰值失效负载、峰值负载时的位移或循环测试后的位移方面没有显著差异。在临床评估中，平均术前 ASES 评分为 65.4，而末次随访时为 87.1。末次随访时的平均 UCLA 评分为 30.2。48 例（94.1%）患者对手术表示满意。在比较同时行肩袖修复或盂唇修复与未行这些手术的患者的 UCLA 或 ASES 评分的亚组分析中，两组间无显著差异。
这种技术具有出色的生物力学强度，手术后满意度高，ASES 和 UCLA 评分高，因此是治疗肱二头肌肌腱病变的一种新选择。
