Kawashima Kenji, Terabayashi Nobuo, Asano Hiromi, Akiyama Haruhiko
Department of Orthopaedic Surgery, Yamauchi Hospital, Gifu, Japan.
Gifu University Graduate School of Medicine, Gifu, Japan.
Arthrosc Sports Med Rehabil. 2021 Dec 23;4(2):e425-e434. doi: 10.1016/j.asmr.2021.10.020. eCollection 2022 Apr.
To describe a modified arthroscopic technique of long head of biceps transposition (LHBT) for superior capsular augmentation; to investigate the outcomes and effectiveness of LHBT in patients with irreparable rotator cuff tears; and to compare the results with those of arthroscopic partial repair (APR) after a 2-year minimum follow-up.
We retrospectively reviewed patients who underwent arthroscopic repair of large to massive superior rotator cuff tears. The inclusion criteria were an irreparable rotator cuff with inability of the tendon to reach the original footprint and postoperative follow-up for a minimum of 2 years. We investigated 22 patients followed up for 30.7 months (mean); 10 patients underwent isolated partial repair and 12 patients underwent LHBT combined with partial repair. The acromiohumeral interval (AHI) was measured using anteroposterior radiographs. Cuff integrity was defined using Sugaya's classification 2 years postoperatively. Clinical outcomes were assessed preoperatively and during postoperative follow-up (minimum 2 years) using the American Shoulder and Elbow Surgeons and University of California, Los Angeles shoulder rating scales.
Postoperative functional scores significantly improved in both groups. In the LHBT group, both American Shoulder and Elbow Surgeons and University of California, Los Angeles scores significantly improved postoperatively from 52.0 ± 14.6 to 89.3 ± 10.4 points ( = .002) and 15.2 ± 2.2 to 32.5 ± 2.6 points ( = .002), respectively. In addition, the AHI at the final follow-up was significantly greater in the LHBT group (7.5 ± 2.0 mm) than in the APR group (5.8 ± 1.9 mm) ( = .032). The retear rate, forward flexion, and postoperative functional scores at the final follow-up were better in the LHBT group; however, the intergroup differences were not statistically significant.
Arthroscopic LHBT for irreparable rotator cuff tears showed comparable clinical outcomes and improvement in postoperative AHI compared with APR after a minimum 2-year follow-up.
Level III, retrospective comparative trial.
描述一种改良的关节镜下肱二头肌长头转位（LHBT）技术用于上盂唇增强；研究LHBT在不可修复的肩袖撕裂患者中的疗效和有效性；并在至少2年的随访后将结果与关节镜下部分修复（APR）的结果进行比较。
我们回顾性分析了接受关节镜修复巨大至 massive 上肩袖撕裂的患者。纳入标准为不可修复的肩袖，肌腱无法到达原始附着点，且术后随访至少2年。我们调查了22例患者，平均随访30.7个月；10例患者接受单纯部分修复，12例患者接受LHBT联合部分修复。使用前后位X线片测量肩峰下间隙（AHI）。术后2年使用 Sugaya 分类法定义肩袖完整性。术前和术后随访（至少2年）期间使用美国肩肘外科医师协会和加利福尼亚大学洛杉矶分校肩袖评分量表评估临床结果。
两组术后功能评分均显著改善。在LHBT组中，美国肩肘外科医师协会和加利福尼亚大学洛杉矶分校的评分术后分别从52.0±14.6显著提高到89.3±10.4分（P =.002）和从15.2±2.2显著提高到32.5±2.6分（P =.002）。此外，LHBT组末次随访时的AHI（7.5±2.0mm）显著大于APR组（5.8±1.9mm）（P =.032）。LHBT组末次随访时的再撕裂率、前屈和术后功能评分更好；然而，组间差异无统计学意义。
在至少2年的随访后，关节镜下LHBT治疗不可修复的肩袖撕裂与APR相比，临床结果相当，术后AHI有所改善。
III级，回顾性比较试验。
