Orthopedics. 2022 Jan-Feb;45(1):38-42. doi: 10.3928/01477447-20211124-02. Epub 2021 Dec 2.
Using a probe to retract the long head of the biceps tendon (LHBT) into the joint is common practice for visualizing the extra-articular portions during arthroscopy. However, extra-articular lesions may be missed in up to half of cases. Greater excursion of the LHBT may be achieved with an Allis clamp grasper. Our goal was to quantify portions of the extra-articular LHBT that could be visualized during shoulder arthroscopy with the Allis clamp and probe techniques. Shoulder arthroscopy was performed on 8 forequarter cadaveric specimens in the simulated beach chair position, and the most distal extent of the intra-articular LHBT was marked. The tendon was pulled into the joint with both techniques, and the additional exposed tendon portion was marked. An open approach was performed, and the locations of the 3 marks were assessed relative to total tendon length. Mean LHBT total length was 96.25 mm. Diagnostic arthroscopy allowed visualization of a mean of 21.75 mm of the intra-articular tendon (22.6% of the total length). The traditional probe technique provided visualization of 31.13 mm (32.8%). The Allis clamp technique provided visualization of 49.38 mm (52%) and increased visualization of the LHBT by 58.6% (<.0001). A mean of 46.87 mm (48%) of the LHBT remained unvisualized. The Allis clamp technique maximizes arthroscopic visualization of extra-articular LHBT. The distal 48% eludes evaluation, but can be visualized when combined with an open technique without the need to divide the transverse humeral ligament. The Allis clamp technique facilitates additional identification of LHBT pathology that could otherwise remain hidden during shoulder arthroscopy. Because the LHBT is a major source of pain in the shoulder, this technique may improve outcomes of shoulder arthroscopy and reduce the need for revision because of remnant anterior shoulder pain. [. 2022;45(1):38-42.].
使用探头将肱二头肌长头肌腱 (LHBT) 拉回关节内是关节镜下可视化关节外部分的常用方法。然而，多达一半的病例可能会错过关节外病变。使用 Allis 夹抓钳可以实现更大的 LHBT 活动度。我们的目标是量化使用 Allis 夹钳和探头技术在肩关节镜下可以看到的 LHBT 关节外部分。在前臂标本的模拟沙滩椅位进行肩关节镜检查，标记关节内 LHBT 的最远端。使用这两种技术将肌腱拉入关节，并标记额外暴露的肌腱部分。然后进行开放性手术，评估 3 个标记相对于肌腱总长度的位置。LHBT 总长度的平均值为 96.25mm。诊断性关节镜检查可观察到关节内肌腱的平均长度为 21.75mm（占总长度的 22.6%）。传统的探头技术可观察到 31.13mm（32.8%）。Allis 夹钳技术可观察到 49.38mm（52%），使 LHBT 的可视性增加了 58.6%（<.0001）。平均有 46.87mm（48%）的 LHBT 仍未被观察到。Allis 夹钳技术可最大限度地增加关节镜下观察 LHBT 关节外部分的可视性。远端 48%难以评估，但与无需切开横肱韧带的开放性技术相结合即可观察到。Allis 夹钳技术有助于进一步识别 LHBT 病变，否则这些病变在肩关节镜检查中可能会被隐藏。由于 LHBT 是肩部疼痛的主要来源，因此该技术可能会改善肩关节镜检查的结果，并减少因残余肩部前侧疼痛而需要进行翻修手术的可能性。[2022;45(1):38-42.]。
