Prodromo John, Mulcahey Mary K, Hong Raymond, David Tal S
Department of Orthopedic Surgery, Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, Pennsylvania.
Radiology Department, San Diego Imaging, San Diego, California.
Surg Technol Int. 2015 Nov;27:219-24.
Successful tenodesis of the proximal biceps relies on accurate reproduction of the native length-tension relationship of the long head of the biceps (LHB). While open tenodesis procedures can reproduce this relationship by referencing the position of the LHB musculotendinous junction (MTJ) to a visible anatomic landmark, arthroscopic suprapectoral tenodesis does not afford such advantage because the MTJ is usually not visible. No studies to date have evaluated the position of the MTJ of the LHB following arthroscopic suprapectoral biceps tenodesis.
Patients undergoing arthroscopic suprapectoral biceps tenodesis between January 2013 and May 2014 at one center were evaluated for inclusion. Patients included in the study underwent a postoperative MRI of bilateral shoulders. The distance from the superior portion of the humeral head to the LHB MTJ was measured bilaterally. The measurements from each matched pair were compared using a paired t-test to determine if arthroscopic suprapectoral biceps tenodesis anatomically restored the LHB length-tension relationship.
A total of 17 patients met the inclusion criteria. Fourteen of the seventeen patients underwent a postoperative MRI of bilateral shoulders. The distance from the superior portion of the humeral head to the LHB musculotendinous junction was significantly larger on the operative side when compared to the nonsurgical side (operative side mean 98.34 mm, standard deviation 13.38 mm; nonsurgical mean 87.26 mm, standard deviation 9.09; mean difference 11.08 mm; p=0.0105).
The musculotendinous junction of the LHB in patients who underwent arthroscopic suprapectoral biceps tenodesis was located significantly more distal than the contralateral control, as measured on MRI.
肱二头肌近端固定术成功的关键在于精确重现肱二头肌长头（LHB）的自然长度-张力关系。虽然开放固定术可通过将LHB肌肉肌腱结合部（MTJ）的位置与可见的解剖标志进行对照来重现这种关系，但关节镜下胸肌上固定术却没有这样的优势，因为MTJ通常不可见。迄今为止，尚无研究评估关节镜下胸肌上肱二头肌固定术后LHB的MTJ位置。
对2013年1月至2014年5月在一个中心接受关节镜下胸肌上肱二头肌固定术的患者进行纳入评估。纳入研究的患者术后接受了双侧肩部的MRI检查。双侧测量肱骨头顶部至LHB MTJ的距离。使用配对t检验比较每对匹配测量值，以确定关节镜下胸肌上肱二头肌固定术是否在解剖学上恢复了LHB的长度-张力关系。
共有17例患者符合纳入标准。17例患者中的14例术后接受了双侧肩部的MRI检查。与非手术侧相比，手术侧肱骨头顶部至LHB肌肉肌腱结合部的距离明显更大（手术侧平均98.34 mm，标准差13.38 mm；非手术侧平均87.26 mm，标准差9.09；平均差异11.08 mm；p = 0.0105）。
根据MRI测量，接受关节镜下胸肌上肱二头肌固定术的患者，其LHB的肌肉肌腱结合部位置明显比健侧更远。
