CHU de Toulouse, hôpital Pierre-Paul-Riquet, Toulouse, France.
Clinique universitaire du sport, CHU de Toulouse, Toulouse, France.
Orthop Traumatol Surg Res. 2023 Dec;109(8S):103673. doi: 10.1016/j.otsr.2023.103673. Epub 2023 Aug 30.
Few studies have directly compared the outcomes of rotator cuff repair (RCR) with or without concomitant LHBT tenotomy or tenodesis. The aim of this literature review was to assess: (i) whether an adjuvant procedure on the LHBT at the time of RCR gives better functional results than RCR alone; and (ii) whether reoperation rates are higher after RCR alone or RCR+tenotomy or tenodesis.
A literature search was carried out on PubMed, MEDLINE, Embase, Web of Science and the Cochrane database for papers published in English or French between 1st January, 2010, and 31st December, 2021. Included studies compared the results of RCR alone with RCR+concomitant tenotomy or tenodesis in patients with tears of the supraspinatus tendon or rotator cuff.
A total of 626 articles were identified in the literature search and 168 were retained for more detailed examination. Forty-seven articles were read in their entirety and nine articles comparing RCR with or without concomitant tenotomy or tenodesis of the LHBT were retained for the analysis.
Nine articles comparing the results of RCR alone versus RCR+LHBT tenotomy or tenodesis were reviewed. The majority of patients were more than 50 years old and male. The rate of lesions to the LHBT in the studies included ranged from 26.8-60.2%. Eight of the nine studies compared the functional results of RCR alone versus RCR+tenotomy or tenodesis, with six reporting no significant difference, one reporting better outcomes after concomitant biceps surgery and one reporting worse outcomes after a biceps procedure.
This review did not provide a strong answer to our questions, owing to the heterogenicity of clinical evaluation and low level of evidence of the studies. However, it appears that in the absence of biceps pathology or in the presence of small lesions, the LHBT could be preserved. The rate of revision did not seem to be higher and cuff healing lower in this situation. Therefore, further randomized studies are required to identify the role of concomitant procedure of the biceps in case of small isolated supraspinatus repair.
III; systematic review.
很少有研究直接比较肩袖修复（RCR）伴或不伴 LHBT 切断术或紧缩术的结果。本文献综述的目的是评估：（i）RCR 时辅助 LHBT 手术是否比单独 RCR 获得更好的功能结果；以及（ii）单独 RCR 或 RCR+切断术或紧缩术的再手术率是否更高。
在 PubMed、MEDLINE、Embase、Web of Science 和 Cochrane 数据库中对 2010 年 1 月 1 日至 2021 年 12 月 31 日期间发表的英文或法文论文进行了文献检索。纳入的研究比较了单独 RCR 与 RCR+同时行冈上肌腱或肩袖撕裂的 LHBT 切断术或紧缩术的结果。
文献检索共确定了 626 篇文章，保留了 168 篇进行更详细的检查。阅读了 47 篇全文，保留了 9 篇比较 RCR 与或不与 LHBT 同时行切断术或紧缩术的文章进行分析。
共回顾了 9 篇比较单独 RCR 与 RCR+LHBT 切断术或紧缩术结果的文章。大多数患者年龄大于 50 岁且为男性。纳入研究中 LHBT 病变的发生率为 26.8%-60.2%。9 篇文章中的 8 篇比较了单独 RCR 与 RCR+切断术或紧缩术的功能结果，其中 6 篇报道无显著差异，1 篇报道同时行二头肌手术的结果更好，1 篇报道二头肌手术后结果更差。
由于研究的临床评估异质性和证据水平低，本综述并未为我们的问题提供明确的答案。然而，似乎在没有二头肌病变或病变较小的情况下，可以保留 LHBT。在这种情况下，再手术率似乎没有更高，肩袖愈合率也没有更低。因此，需要进一步的随机研究来确定二头肌在小型孤立性冈上肌腱修复时的辅助治疗作用。
III；系统评价。
