Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Clin Orthop Surg. 2020 Sep;12(3):371-378. doi: 10.4055/cios19168. Epub 2020 Jun 24.
Lesions of the long head of the biceps tendon (LHBT) are one of the most common pathologies in patients with a rotator cuff tear. Although various procedures have been shown to be effective for treating LHBT lesions during rotator cuff repair, no consensus has been reached regarding the most effective treatment. The purpose of this study was to compare the outcomes of tenotomy vs subpectoral tenodesis of the LHBT in arthroscopic rotator cuff repair.
The records of 135 patients who underwent arthroscopic rotator cuff repair with biceps tenotomy or subpectoral tenodesis for a partial LHBT tear of > 50% were initially reviewed. Finally, 77 patients (38 patients with tenotomy and 39 patients with subpectoral tenodesis) with an intact rotator cuff, who underwent a functional evaluation at 1 year postoperatively, were enrolled in this retrospective study.
The average follow-up was 13.3 ± 4.36 months (13.2 ± 1.4 months in the tenotomy group and 13.6 ± 2.7 months in the subpectoral tenodesis group; = 0.416). Demographic and surgical data were not significantly different between the 2 groups. Preoperatively, biceps groove tenderness, Speed's test, and Yergason test results were positive in 27.3%, 27.3%, and 10.4% of the study subjects, respectively. Compared with preoperative values, all functional scores including shoulder muscle power were significantly improved postoperatively, and no significant intergroup difference was observed (all > 0.05). A visible Popeye deformity was not encountered in either group at the final follow-up. Eight patients in the tenotomy group and 7 patients in the subpectoral tenodesis group complained of mild anterior shoulder pain ( = 0.731), and 4 patients in each group complained of groove tenderness ( = 0.969). No surgical or postoperative complication occurred in either group.
Both biceps tenotomy and subpectoral tenodesis performed during rotator cuff repair improved pain and function and resulted in comparable clinical outcomes. Residual symptoms associated with the remnant LHBT in the groove may not be a problem after adhesion of LHBT.
肱二头肌长头腱（LHBT）病变是肩袖撕裂患者最常见的病症之一。虽然各种手术方法已被证明对肩袖修复术中 LHBT 病变的治疗有效，但对于最有效的治疗方法尚未达成共识。本研究的目的是比较关节镜下肩袖修复术中 LHBT 切断术与 LHBT 下经皮固定术的疗效。
对 135 例行关节镜下肩袖修复术的患者进行了回顾性分析，这些患者因部分 LHBT 撕裂>50%而行肱二头肌切断术或 LHBT 下经皮固定术。最终，77 例（肱二头肌切断术组 38 例，LHBT 下经皮固定术组 39 例）肩袖完整的患者接受了术后 1 年的功能评估，被纳入本回顾性研究。
平均随访时间为 13.3±4.36 个月（肱二头肌切断术组 13.2±1.4 个月，LHBT 下经皮固定术组 13.6±2.7 个月；=0.416）。两组的人口统计学和手术数据无显著差异。术前，27.3%、27.3%和 10.4%的研究对象肱二头肌沟压痛、Speed 试验和 Yergason 试验阳性。与术前相比，所有功能评分（包括肩部肌肉力量）均显著改善，且两组间无显著差异（均>0.05）。在末次随访时，两组均未发现明显的 Popeye 畸形。肱二头肌切断术组 8 例和 LHBT 下经皮固定术组 7 例患者诉轻度前肩部疼痛（=0.731），两组各有 4 例患者诉沟压痛（=0.969）。两组均未发生手术或术后并发症。
在肩袖修复术中行肱二头肌切断术和 LHBT 下经皮固定术均可改善疼痛和功能，并获得相似的临床疗效。在 LHBT 残留在沟内发生粘连后，与 LHBT 残留相关的残留症状可能不是问题。
