Department of Orthopedics, University of Groningen, University Medical Center Groningen, The Netherlands.
Department of Orthopedics, University of Groningen, University Medical Center Groningen, The Netherlands.
Arthroscopy. 2018 Apr;34(4):1297-1305. doi: 10.1016/j.arthro.2017.10.044. Epub 2018 Jan 17.
To improve surgical outcomes in patients with massive cuff defects, different techniques and augmentations are proposed. The biceps tendon is easily available as an autograft. Our aim was to conduct a qualitative systematic review of various methods and surgical techniques that use a biceps autograft (BAG) for rotator cuff repair. Functional outcomes are also reported. We hypothesized that by using a BAG to treat massive rotator cuff tears, a more anatomic and biomechanical reconstruction could be achieved compared with other techniques.
A qualitative systematic review was conducted (MEDLINE and Embase databases) to inventory surgical techniques for use of a BAG for rotator cuff repair. The following search terms were used for MEDLINE: biceps AND (augment* OR autograft* OR transplantation* OR (cuff AND graft*) OR biceps-incorporat*). Studies were included if the following criteria were fulfilled: description of surgical technique, only human subjects, functional outcomes noted, all study designs except technical notes, and no restrictions on study date. The quality of the studies was assessed in a standardized manner using a tool based on the Cochrane handbook.
We identified 981 studies; among these, 8 case series met the inclusion criteria. We identified 6 studies as high quality and 2 as medium quality. Different techniques for harvest and augmentation were used. Some studies left the proximal or distal portion intact, whereas others used it as a free graft. The clinical results of these studies showed significantly improved function, pain relief, and range of motion at follow-up, although this was not compared with a control group. The constructs were intact on magnetic resonance imaging in most patients (82%) within 2 years.
It can be concluded that use of a BAG is an option for augmentation in massive rotator cuff tears, although no definitive recommendations can be given. This is based on Level IV medium- and high-quality studies. LEVEL OF EVIDENCE: Level IV, systematic review of Level IV studies.
为了提高巨大肩袖缺损患者的手术效果，提出了不同的技术和增强方法。二头肌肌腱作为自体移植物很容易获得。我们的目的是对使用二头肌自体移植物（BAG）修复肩袖的各种方法和手术技术进行定性系统评价，并报告其功能结果。我们假设，与其他技术相比，使用 BAG 治疗巨大肩袖撕裂可以实现更解剖学和生物力学的重建。
进行了定性系统评价（MEDLINE 和 Embase 数据库），以盘点用于肩袖修复的 BAG 手术技术。以下搜索词用于 MEDLINE：二头肌和（增强或自体移植物或移植或（肩袖和移植物）或二头肌合并*）。如果满足以下标准，则纳入研究：描述手术技术，仅为人类受试者，记录功能结果，所有研究设计（除技术说明外），并且不受研究日期限制。使用基于 Cochrane 手册的工具以标准化方式评估研究质量。
我们确定了 981 项研究；其中，8 项病例系列符合纳入标准。我们确定了 6 项高质量研究和 2 项中等质量研究。使用了不同的收获和增强技术。一些研究保留了近端或远端部分完整，而其他研究则将其用作游离移植物。这些研究的临床结果显示，在随访时功能、疼痛缓解和运动范围明显改善，尽管这并未与对照组进行比较。在大多数患者（82%）中，在 2 年内磁共振成像上的构建物都是完整的。
可以得出结论，在巨大肩袖撕裂中使用 BAG 是增强的一种选择，尽管不能给出明确的建议。这是基于 IV 级中-高质量研究。证据水平：IV 级，IV 级研究的系统评价。
