From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL (Dr. Jackson); the OrthoCarolina, Charlotte, NC (Mr. Meade, Dr. Young, Dr. Hamid, Dr. Piasecki, Dr. Fleischli, and Dr. Saltzman); the Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC (Mr. Meade, Dr. Young, Dr. Hamid, Dr. Piasecki, Dr. Fleischli, and Dr. Saltzman); the American University of the Caribbean School of Medicine, Cupecoy, Sint Maarten (Mr. Coombes); and the Department of Orthopedics, Columbia University Medical Center, New York, NY (Dr. Trofa).
J Am Acad Orthop Surg Glob Res Rev. 2022 Dec 9;6(12). doi: 10.5435/JAAOSGlobal-D-22-00255. eCollection 2022 Dec 1.
Proximal biceps tenodesis is a common surgical treatment of tendinosis of the long head of the biceps tendon. Two of the most common techniques incorporate onlay and inlay fixation methods, which can be done arthroscopically or open and in a variety of anatomic locations. The purpose of this meta-analysis was to compare the clinical outcomes between onlay versus inlay humeral fixation for biceps tenodesis for long head of the biceps tendon pathology.
A literature search was conducted using PubMed, EMBASE, and Cochrane Library. Only studies reporting outcomes and complications after onlay and inlay biceps tenodeses were included.
Six studies with a total of 418 patients (252 onlay, 166 inlay) with a mean age of 56.84 years were included. Visual analog pain scale scores, Constant score, and American Shoulder and Elbow Surgeons shoulder score did not differ. "Popeye" deformity was found in 17 patients (7.80%) in the onlay group and in 15 patients (11.28%) in the inlay group (odds ratio, 0.28; P = 0.07). No difference in postoperative cramping or failure rates was found.
Both onlay and inlay biceps tenodeses result in improved clinical outcomes and are at low risk of Popeye deformities, with no statistically significant differences between either method. Additional studies are required to assess the clinical significance of these differences.
肱二头肌近侧肌腱固定术是治疗长头肱二头肌肌腱病的常见手术治疗方法。两种最常见的技术包括骨膜下和嵌入式固定方法，可以通过关节镜或开放性手术在各种解剖部位进行。本荟萃分析的目的是比较肱二头肌长头肌腱病的骨膜下与嵌入式肱骨头固定的临床结果。
使用 PubMed、EMBASE 和 Cochrane Library 进行文献检索。仅包括报告骨膜下和嵌入式肱二头肌固定术的结果和并发症的研究。
共纳入 6 项研究，总计 418 例患者（骨膜下 252 例，嵌入式 166 例），平均年龄为 56.84 岁。视觉模拟疼痛评分、Constant 评分和美国肩肘外科医生肩部评分没有差异。在骨膜下组中发现 17 例（7.80%）“大力水手”畸形，在嵌入式组中发现 15 例（11.28%）（比值比，0.28；P = 0.07）。术后抽筋或失败率无差异。
骨膜下和嵌入式肱二头肌固定术均可改善临床结果，且“大力水手”畸形风险低，两种方法之间无统计学差异。需要进一步研究来评估这些差异的临床意义。
