Selim Naser M, Badawy Ehab R
Knee Surgery-Arthroscopy and Sports Injuries Unit, Orthopedic Department, Mansoura University, Mansoura, Egypt.
Arthrosc Tech. 2021 Feb 24;10(2):e457-e467. doi: 10.1016/j.eats.2020.10.024. eCollection 2021 Feb.
Despite the different treatment options for irreparable and massive rotator cuff tears (RCTs), there is no optimal treatment. Thirty percent of total RCTs can be classified as irreparable because of the massive tear size and severe muscle atrophy. The reported treatment failure rate is approximately 40% for massive RCTs. RCTs may be treated conservatively or surgically depending on pain, disability, and functional demands. The surgical treatment options are many, but decision making is a challenge; the real challenge is to apply the correct procedure for the correct indication in each patient. The long head of the biceps tendon (LHBT) was used for augmentation to bridge the gap in immobile, massive RCTs. An arthroscopic biceps-incorporating technique was used for repair of large and massive RCTs, avoiding undue tension on the rotator cuff (RC). Recently, the LHBT was used for superior capsular reconstruction. This article describes the use of the LHBT for reconstruction of massive and irreparable RCTs through the following steps: (1) open exposure of the RCT, (2) debridement and subacromial decompression, (3) biceps tenotomy at the LHBT's origin on the glenoid, (4) LHBT and RC cuff mobilization, (5) passage of the LHBT through the mobilized RC and reflection onto itself, (6) tuberoplasty, and (7) fixation of the RC complex at the RC footprint.
尽管对于不可修复的大面积肩袖撕裂（RCT）有不同的治疗选择，但尚无最佳治疗方法。由于撕裂面积大且肌肉严重萎缩，所有RCT中有30%可归类为不可修复。据报道，大面积RCT的治疗失败率约为40%。根据疼痛、功能障碍和功能需求，RCT可采用保守治疗或手术治疗。手术治疗选择众多，但决策具有挑战性；真正的挑战是针对每个患者的正确适应症应用正确的手术方法。肱二头肌长头肌腱（LHBT）被用于增强，以桥接无法活动的大面积RCT中的间隙。一种关节镜下结合肱二头肌的技术被用于修复大型和大面积RCT，避免对肩袖（RC）施加过度张力。最近，LHBT被用于上盂唇重建。本文通过以下步骤描述LHBT用于重建大面积不可修复RCT的方法：（1）开放暴露RCT，（2）清创和肩峰下减压，（3）在LHBT位于关节盂的起点处进行肱二头肌肌腱切断术，（4）LHBT和RC袖带松动，（5）将LHBT穿过松动的RC并自身折返，（6）结节成形术，以及（7）将RC复合体固定在RC足迹处。
