Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, North Dist., Tainan, 70428, Taiwan.
J Orthop Surg Res. 2023 Aug 16;18(1):603. doi: 10.1186/s13018-023-04078-9.
The present study aimed to propose a modified intra-articular transtendinous looped biceps tenodesis (mTLBT) using a suture anchor and to compare the functional outcomes and incidence of Popeye deformities between biceps tenotomy and mTLBT.
Medical records of patients who underwent either tenotomy or mTLBT for the long head of the biceps tendon (LHBT) lesion between January 2016 and April 2021 were retrospectively reviewed. The inclusion criteria were patients aged 40-70 years with LHBT pathologies, such as superior labrum anterior to posterior (SLAP) lesions > type II, LHBT pulley system rupture with bicipital instability, and intra-articular LHBT tear. The exclusion criteria were full-thickness supraspinatus tears, frozen shoulder, shoulder fracture, and postoperative traumatic events that affected the operated shoulder. All patients were followed up for at least 1 year. Popeye deformity, bicipital cramping pain, visual analog scale (VAS) pain score, and functional outcome scores (University of California at Los Angeles [UCLA] and American Shoulder and Elbow Surgeons [ASES] scores) were recorded. Fisher's exact test and Chi-square test were used for categorical variables, whereas the Mann-Whitney U test was used for nonparametric variables.
The mTLBT and tenotomy groups included 15 and 40 patients, respectively. The incidence of Popeye deformity and biceps cramping pain in the tenotomy group (52.5% and 50%, respectively) was significantly higher than that in the mTLBT group (13.3% and 20%, respectively) (p = 0.009 and p = 0.045, respectively). The postoperative VAS, UCLA, and ASES scores were not significantly different between the two groups. One patient in the tenodesis group experienced metallic-anchor pullout.
mTLBT is an arthroscopic intra-articular top of the groove tenodesis that can be performed completely in the intra-articular space and is especially suitable for patients with an intact or partially torn rotator cuff. This technique is reliable for treating biceps pathologies as it results in similar functional outcome scores, lesser biceps cramping pain, and less frequent Popeye deformity compared to biceps tenotomy.
III.
本研究旨在提出一种改良关节内经腱双股肌腱固定术（mTLBT），使用缝线锚钉，并比较肱二头肌切断术和 mTLBT 治疗长头肱二头肌肌腱（LHBT）病变的功能结果和 Popeye 畸形的发生率。
回顾性分析 2016 年 1 月至 2021 年 4 月间因 LHBT 病变接受肱二头肌切断术或 mTLBT 的患者的病历资料。纳入标准为年龄 40-70 岁，LHBT 病变包括 SLAP 病变>II 型、LHBT 滑囊系统破裂伴肱二头肌不稳定、关节内 LHBT 撕裂；排除标准为全层冈上肌腱撕裂、冻结肩、肩骨折和影响手术肩的术后创伤事件。所有患者均随访至少 1 年。记录 Popeye 畸形、肱二头肌痉挛性疼痛、视觉模拟量表（VAS）疼痛评分和功能评分（加利福尼亚大学洛杉矶分校[UCLA]和美国肩肘外科医生协会[ASES]评分）。采用 Fisher 确切检验和卡方检验进行分类变量分析，采用 Mann-Whitney U 检验进行非参数变量分析。
mTLBT 组和切断术组分别纳入 15 例和 40 例患者。切断术组的 Popeye 畸形和肱二头肌痉挛性疼痛发生率（分别为 52.5%和 50%）明显高于 mTLBT 组（分别为 13.3%和 20%）（p=0.009 和 p=0.045）。两组术后 VAS、UCLA 和 ASES 评分无显著差异。1 例腱固定组患者发生金属锚钉拔出。
mTLBT 是一种关节内经腱顶沟的关节内固定术，可完全在关节内进行，特别适用于肩袖完整或部分撕裂的患者。与肱二头肌切断术相比，该技术治疗肱二头肌病变可靠，功能结果评分相似，肱二头肌痉挛性疼痛较少，Popeye 畸形发生率较低。
III 级。
