Midwest Orthopaedics at Rush, Chicago, Illinois, USA.
Rush University Medical Center, Chicago, Illinois, USA.
Am J Sports Med. 2023 Sep;51(11):2869-2880. doi: 10.1177/03635465231187030. Epub 2023 Aug 7.
Studies suggest that similar clinical results are achieved via arthroscopic and open biceps tenodesis (BT) techniques.
To quantify the postoperative migration of the BT construct between arthroscopic suprapectoral BT (ASPBT) and open subpectoral BT (OSPBT) techniques via interference screw (IS) or single-suture suture anchor (SSSA) fixation using radiostereometric analysis.
Cohort study; Level of evidence, 2.
Distal migration of the biceps tendon after OSPBT with a polyetheretherketone IS, OSPBT with 1 SSSA, ASPBT with polyetheretherketone IS, and ASPBT with 2 SSSAs was measured prospectively. Patients with symptomatic biceps tendinopathy and preoperative patient-reported outcome measures (PROMs) including Constant-Murley subjective, Single Assessment Numeric Evaluation, or Patient-Reported Outcomes Measurement Information System-Upper Extremity scores were included. A tantalum bead was sutured on the proximal end of the long head of the biceps tendon before fixation of tendon tissue. Anteroposterior radiographs were performed immediately postoperatively, at 1 week, and at 3 months. Bead migration was measured, and preoperative PROMs were compared with those at latest follow-up.
Of 115 patients, 94 (82%) were available for final follow-up. IS fixation yielded the least tendon migration with no difference between the open and arthroscopic approaches (4.31 vs 5.04 mm; = .70). Fixation with 1 suture anchor demonstrated significantly greater migration than that achieved with an IS at both 1 week (6.47 vs 0.1 mm, 6.47 vs 1.75 mm, < .001;) and 3 months (14.76 vs 4.31 mm, 14.76 vs 5.04 mm, < .001) postoperatively. Two-suture anchor fixation yielded significantly greater migration than IS fixation at 1 week (7.02 vs 0.1 mm, < .001; 7.02 vs 1.75 mm, = .003) but not 3 months postoperatively (8.06 vs 4.31 mm, = .10; 8.06 vs 5.04 mm, = .07). Four patients with suture anchor fixation (3 patients in the OSPBT 1 SSSA group, 9.4%, and 1 patient in the ASPBT 2 SSSAs group, 3.8%) developed a Popeye deformity, whereas no Popeye deformities occurred in the IS groups. Mean 3-month bead migration in patients with and without a Popeye deformity was 60.8 and 11.2 mm, respectively ( < .0001). PROMs did not differ among groups at final follow-up.
Interference screw fixation yielded the least tendon migration whether achieved arthroscopically or open. The available data indicated that fixation with 1 SSSA but not 2 SSSAs resulted in significantly greater migration than that achieved with an IS. Despite variations in tendon migration, PROMs were similar among all groups. When SSSAs are used, tendon migration may be minimized by using ≥2 anchors.
研究表明，关节镜下和开放肱二头肌肌腱切断术（BT）技术可达到相似的临床效果。
通过放射立体测量分析，定量比较关节镜上肱二头肌肌腱切断术（ASPBT）和开放下肱二头肌肌腱切断术（OSPBT）中经干扰螺钉（IS）或单缝线锚钉（SSSA）固定后 BT 结构的术后迁移。
队列研究；证据水平，2。
前瞻性测量 OSPBT 联合聚醚醚酮 IS、OSPBT 联合 1 个 SSSA、ASPBT 联合聚醚醚酮 IS 和 ASPBT 联合 2 个 SSSA 后肱二头肌肌腱的远端迁移。纳入有症状肱二头肌肌腱病和术前患者报告的结局测量（PROM），包括 Constant-Murley 主观评分、单评估数字评估或患者报告的结果测量信息系统-上肢评分。在肌腱组织固定前，将钽珠缝合在长头肱二头肌肌腱的近端。术后立即、1 周和 3 个月行前后位 X 线片。测量珠的迁移，并比较术前 PROM 与最新随访时的 PROM。
115 例患者中，94 例（82%）可进行最终随访。IS 固定导致肌腱迁移最小，且关节镜与开放入路之间无差异（4.31 比 5.04 mm； =.70）。与 IS 相比，1 个缝线锚钉固定的肌腱迁移明显更大，1 周和 3 个月时差异均有统计学意义（6.47 比 0.1 mm，6.47 比 1.75 mm， <.001；14.76 比 4.31 mm，14.76 比 5.04 mm， <.001）。双缝线锚钉固定的肌腱迁移在 1 周时明显大于 IS 固定（7.02 比 0.1 mm， <.001；7.02 比 1.75 mm， =.003），但 3 个月时无差异（8.06 比 4.31 mm， =.10；8.06 比 5.04 mm， =.07）。4 例缝线锚钉固定患者（3 例 OSPBT 1 SSSA 组，9.4%，1 例 ASPBT 2 SSSAs 组，3.8%）出现 Popeye 畸形，而 IS 组无 Popeye 畸形。有 Popeye 畸形和无 Popeye 畸形患者的 3 个月时平均珠迁移分别为 60.8 和 11.2 mm，差异有统计学意义（ <.0001）。最终随访时各组 PROM 无差异。
无论采用关节镜还是开放方法，IS 固定导致的肌腱迁移最小。现有数据表明，1 个 SSSA 固定而非 2 个 SSSAs 固定导致的肌腱迁移明显大于 IS 固定。尽管肌腱迁移存在差异，但所有组的 PROM 相似。当使用 SSSAs 时，使用≥2 个锚钉可使肌腱迁移最小化。
