Carvalho Filipe Ferreira, Nolte Philip-Christian, Pinheiro Joao, Guehring Thorsten, Egenolf Michael, Chatterjee Thomas
Evangelisches Krankenhaus, Clinic for Trauma and Orthopaedic Surgery, Bad Dürkheim, Germany.
Medical Faculty Heidelberg of Heidelberg University, Heidelberg, Germany.
JSES Int. 2022 Jun 20;6(5):820-827. doi: 10.1016/j.jseint.2022.05.010. eCollection 2022 Sep.
This study aimed to evaluate clinical, cosmetic, and strength midterm outcomes in arthroscopic biceps tenotomy and subpectoral biceps tenodesis using bicortical endobutton and interference screw.
In this retrospective study, inclusion criteria were long head of the biceps (LHB) pathologies treated either with tenotomy or an additional tenodesis. Postoperative assessment included Long Head of Biceps Score (LHBS), age-adjusted Constant-Murley Score, and Subjective Shoulder Value. Elbow flexion and forearm supination strength were measured. The presence of Popeye sign, cramps, and tenderness over the bicipital grove was evaluated. Statistical analysis of continuous variables without normal distribution was performed using Mann-Whitney U test. Grouped analysis was performed using 2-way analysis of variance. Binominal data were analyzed using chi-square test.
A total of 73 patients with a mean age of 63.1 ± 9.6 years and a mean follow-up of 4.2 ± 0.5 years were included. Tenotomy was performed in 34 and tenodesis in 39 patients. Tenodesis group displayed a significantly higher LHB score ( = .0006), but no significant differences were detected for the age-adjusted Constant-Murley Score and Subjective Shoulder Value. Tenodesis group showed a significantly lower rate of Popeye deformities ( = .0007) and tenderness over the bicipital groove ( = .004). Patients from the tenotomy group with biceps deformity showed a significantly higher mean contralateral supination strength ( = .002) but no significant difference in contralateral elbow flexion compared with patients without biceps deformity. There was one (1.4%) complication in the tenotomy group (postoperative shoulder stiffness).
Both techniques resulted in comparable outcome scores on preselected patients, with tenodesis leading to better LHB function. Tenodesis did not improve elbow flexion and forearm supination strength beyond the tenotomy; however, it reduced the frequency of biceps deformities and tenderness over the bicipital groove. Patients with a strong contralateral forearm supination strength could be at risk of developing a biceps deformity after tenotomy.
本研究旨在评估关节镜下肱二头肌肌腱切断术及使用双皮质内纽扣和干涉螺钉的胸小肌下肱二头肌肌腱固定术的临床、美容及中期功能结局。
在这项回顾性研究中，纳入标准为接受肌腱切断术或附加肌腱固定术治疗的肱二头肌长头（LHB）病变。术后评估包括肱二头肌长头评分（LHBS）、年龄校正的Constant-Murley评分及主观肩关节评分。测量肘关节屈曲和前臂旋后力量。评估“大力水手”征、痉挛及肱二头肌沟压痛情况。对非正态分布的连续变量进行统计分析时采用Mann-Whitney U检验。采用双向方差分析进行分组分析。对二项数据采用卡方检验进行分析。
共纳入73例患者，平均年龄63.1±9.6岁，平均随访4.2±0.5年。34例行肌腱切断术，39例行肌腱固定术。肌腱固定术组的LHB评分显著更高（P = 0.0006），但年龄校正的Constant-Murley评分及主观肩关节评分无显著差异。肌腱固定术组的“大力水手”畸形发生率（P = 0.0007）及肱二头肌沟压痛发生率（P = 0.004）显著更低。与无肱二头肌畸形的患者相比，肌腱切断术组有肱二头肌畸形的患者对侧旋后力量显著更高（P = 0.002），但对侧肘关节屈曲无显著差异。肌腱切断术组有1例（1.4%）并发症（术后肩关节僵硬）。
两种技术在预先选择的患者中产生了相当的结局评分，肌腱固定术使LHB功能更佳。肌腱固定术并未使肘关节屈曲和前臂旋后力量在肌腱切断术基础上进一步改善；然而，它降低了肱二头肌畸形的发生率及肱二头肌沟压痛情况。对侧前臂旋后力量较强的患者在肌腱切断术后可能有发生肱二头肌畸形的风险。
