Park Ji Soon, Kim Sae Hoon, Jung Ho Jin, Lee Ye Hyun, Oh Joo Han
Department of Orthopaedic Surgery, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, United Arab Emirates.
Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Am J Sports Med. 2017 Feb;45(2):440-448. doi: 10.1177/0363546516667577. Epub 2016 Oct 22.
Several methods are used to perform biceps tenodesis in patients with superior labrum-biceps complex (SLBC) lesions accompanied by a rotator cuff tear. However, limited clinical data are available regarding the best technique in terms of clinical and anatomic outcomes.
To compare the clinical and anatomic outcomes of the interference screw (IS) and suture anchor (SA) fixation techniques for biceps tenodesis performed along with arthroscopic rotator cuff repair.
Randomized controlled trial; Level of evidence, 2.
A total of 80 patients who underwent arthroscopic rotator cuff repair with SLBC lesions were prospectively enrolled and randomly divided according to the tenodesis method: the IS and SA groups. Functional outcomes were evaluated with the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Constant score, Korean Shoulder Score (KSS), and long head of the biceps (LHB) score at least 2 years after surgery. The anatomic status of tenodesis was estimated using magnetic resonance imaging or ultrasonography, and the anatomic failure of tenodesis was determined when the biceps tendon was not traced in the intertubercular groove directly from the insertion site of the IS or SA.
Thirty-three patients in the IS group and 34 in the SA group were monitored for more than 2 years. All postoperative functional scores improved significantly compared with the preoperative scores (all P < .001) and were not significantly different between the groups, including the LHB score (all P > .05). Nine anatomic failures of tenodesis were observed: 7 in the IS group and 2 in the SA group ( P = .083). In a multivariate analysis using logistic regression, IS fixation ( P = .003) and a higher (ie, more physically demanding) work level ( P = .022) were factors associated with the anatomic failure of tenodesis significantly. In patients with tenodesis failure, the LHB score ( P = .049) and the degree of Popeye deformity by the patient and examiner ( P = .004 and .018, respectively) were statistically different compared with patients with intact tenodeses.
Care must be taken while performing biceps tenodesis in patients with a higher work level; IS fixation appears to pose a higher risk in terms of the anatomic failure of tenodesis than SA fixation, although functional outcomes were not different.
对于伴有肩袖撕裂的上盂唇-肱二头肌复合体（SLBC）损伤患者，有多种方法可用于进行肱二头肌固定术。然而，关于哪种技术在临床和解剖学结果方面最佳的临床数据有限。
比较在关节镜下肩袖修复术同时进行肱二头肌固定术时，干涉螺钉（IS）和缝线锚钉（SA）固定技术的临床和解剖学结果。
随机对照试验；证据等级，2级。
前瞻性纳入80例行关节镜下肩袖修复术合并SLBC损伤的患者，并根据固定术方法随机分为两组：IS组和SA组。术后至少2年，采用视觉模拟疼痛评分（VAS）、美国肩肘外科医师（ASES）评分、简易肩关节测试（SST）、Constant评分、韩国肩关节评分（KSS）以及肱二头肌长头（LHB）评分评估功能结果。使用磁共振成像或超声评估固定术的解剖学状态，当从IS或SA的植入部位在结节间沟中无法追踪到肱二头肌腱时，确定固定术的解剖学失败。
IS组33例患者和SA组34例患者接受了超过2年的随访。与术前评分相比，所有术后功能评分均显著改善（所有P <.001），且两组之间无显著差异，包括LHB评分（所有P >.05）。观察到9例固定术的解剖学失败：IS组7例，SA组2例（P =.083）。在使用逻辑回归的多变量分析中，IS固定（P =.003）和较高（即对身体要求更高）的工作水平（P =.022）是与固定术解剖学失败显著相关的因素。在固定术失败的患者中，与固定术完整的患者相比，LHB评分（P =.049）以及患者和检查者评估的“大力水手”畸形程度（分别为P =.004和.018）在统计学上存在差异。
对于工作水平较高的患者，进行肱二头肌固定术时必须谨慎；尽管功能结果无差异，但在固定术的解剖学失败方面，IS固定似乎比SA固定具有更高的风险。
