Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan; Sports Medicine and Joint Center, Funabashi Orthopaedic Hospital, 1-833 Hazama, Funabashi, Chiba, 274-0822, Japan.
Tokyo Sports & Orthopaedic Clinic, 4-29-9 Kami-ikebukuro, Toshima, Tokyo, 170-0012, Japan.
J Orthop Sci. 2022 Jul;27(4):786-791. doi: 10.1016/j.jos.2021.04.012. Epub 2021 May 31.
Recently, to treat the long head of the biceps tendon lesions in addition to rotator cuff repair has been recommended. However, the differences in clinical outcomes between biceps tenotomy and tenodesis for middle-aged and elderly females remains unclear. The purpose of this study was to compare the outcomes of biceps tenotomy and soft-tissue tenodesis that were performed concurrently with arthroscopic rotator cuff repair in ≥60-year-old females.
Female shoulders that underwent arthroscopic rotator cuff repair in our institute in 2016 were retrospectively reviewed. This study included 66 shoulders with concurrent biceps tenotomy or soft-tissue tenodesis: tenotomy group, 41 shoulders; soft-tissue tenodesis group, 25 shoulders. Clinical scores, biceps pain (visual analogue scale, VAS), Popeye deformity, and biceps strength (%contralateral side) were compared between the two groups.
The mean age was significantly higher in the tenotomy group than the soft-tissue tenodesis group (72 ± 4 and 68 ± 6 years, respectively; P = 0.002). There were no significant differences in post-operative JOA and UCLA scores between the groups. VAS for biceps pain was significantly higher at postoperative 6 months in the tenotomy group than the soft-tissue tenodesis group (2.9 ± 2.5 and 1.7 ± 1.6, respectively, P = 0.03), though there were no significant differences at postoperative 3, 12, and ≥24 months. Subjective evaluation of Popeye deformity was not significantly different between the groups. Postoperative biceps strength was significantly lower in the tenotomy group than the soft-tissue tenodesis group (89.9% and 102.8%, respectively, P = 0.02).
Both biceps tenotomy and soft-tissue tenodesis concurrent with rotator cuff repair in ≥60-year-old female patients resulted in good outcomes. Shoulders with soft-tissue tenodesis demonstrated earlier improvement in postoperative biceps pain and better postoperative biceps strength than those with tenotomy. There were no differences in objective and subjective Popeye deformity between tenotomy and soft-tissue tenodesis. The LHB procedures, tenotomy or tenodesis, can be selected depending on surgeons' preference.
最近，除了肩袖修复之外，还建议治疗长头肱二头肌肌腱病变。然而，对于中年和老年女性，肱二头肌肌腱切断术与肌腱固定术的临床结果仍不清楚。本研究的目的是比较≥60 岁女性同期行关节镜下肩袖修复的肱二头肌切断术和软组织固定术的结果。
回顾性分析 2016 年在我院行关节镜下肩袖修复的女性肩部。本研究包括 66 例同时行肱二头肌切断术或软组织固定术的肩部：切断术组 41 例，软组织固定术组 25 例。比较两组临床评分、肱二头肌疼痛（视觉模拟评分，VAS）、Popeye 畸形和肱二头肌力量（%对侧）。
切断术组的平均年龄明显高于软组织固定术组（72±4 岁和 68±6 岁；P=0.002）。两组术后 JOA 和 UCLA 评分无显著差异。术后 6 个月时，切断术组的肱二头肌疼痛 VAS 明显高于软组织固定术组（分别为 2.9±2.5 和 1.7±1.6，P=0.03），但术后 3、12 和≥24 个月时无显著差异。两组 Popeye 畸形的主观评价无显著差异。术后肱二头肌力量明显低于软组织固定术组（分别为 89.9%和 102.8%，P=0.02）。
≥60 岁女性患者行肩袖修复同期行肱二头肌切断术和软组织固定术均可获得良好的结果。与切断术相比，软组织固定术术后肱二头肌疼痛改善更早，术后肱二头肌力量更好。切断术和软组织固定术在客观和主观 Popeye 畸形方面无差异。可以根据术者的偏好选择 LHB 手术，即切断术或固定术。
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