Department of Orthopaedic Surgery, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Latina, Italy.
Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Istituto Chirurgico Ortopedico Traumatologico (ICOT), Sapienza University of Rome, Latina, Italy.
Musculoskelet Surg. 2022 Sep;106(3):269-277. doi: 10.1007/s12306-021-00705-y. Epub 2021 Feb 28.
The aim of the study was to evaluate the results of an all arthroscopic technique for the treatment of massive rotator cuff tears using the long head of biceps as a graft to reconstruct the superior capsule and to reinforce the cuff.
A retrospective review of a consecutive series of arthroscopic repair of massive rotator cuff tears using the long head of biceps tendon was conducted. Twenty-five patients underwent surgery, and none were lost at follow-up. Minimum follow-up period was more than 12 months. Constant, UCLA and VAS scores as clinical outcome were analyzed. Time for surgical procedures was also registered. Two alternative procedures (transosseous or anchors) were employed to fix laterally the long head of biceps to the greater tuberosity and to reinforce the cuff. This choice was essentially determined by the bone quality of the greater tuberosity.
All patients of both groups (Transosseous: 15 and Anchors: 10) showed a significant improvement of clinical and functional scores. Difference of the operative times between two procedures was statistically significant in favor of the anchor approach. No intraoperative complications were recorded. Postoperative shoulder stiffness was found in two male patients. In no case biceps tenodesis was performed: Popeye sign was easily detected in 16 patients but they did not complain any superior arm pain and weakness.
This technique represents a valid solution for treatment of massive rotator cuff tears resulting safe, easier and cost saving in comparison with other published techniques.
本研究旨在评估一种全关节镜技术治疗巨大肩袖撕裂的效果，该技术使用肱二头肌长头作为移植物重建上囊并加强肩袖。
对连续的使用肱二头肌长头肌腱进行关节镜修复巨大肩袖撕裂的患者进行回顾性研究。25 例患者接受了手术，随访中无失访病例。最小随访时间超过 12 个月。对Constant、UCLA 和 VAS 评分等临床结果进行分析。同时记录手术时间。两种替代手术（经骨或锚定）用于将肱二头肌长头固定在大结节外侧并加强肩袖。这种选择主要取决于大结节的骨质质量。
两组（经骨：15 例和锚定：10 例）的所有患者均表现出临床和功能评分的显著改善。两种手术方法的手术时间差异有统计学意义，锚定方法更有优势。术中无并发症发生。两名男性患者术后出现肩关节僵硬。在任何情况下都没有进行肱二头肌肌腱固定术：16 例患者出现了 Popeye 征，但他们没有主诉上肢疼痛和无力。
与其他已发表的技术相比，该技术是治疗巨大肩袖撕裂的有效方法，安全、简单且节省成本。
