Prisma Health, Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.
Prisma Health, Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA.
J Shoulder Elbow Surg. 2024 Jun;33(6S):S31-S36. doi: 10.1016/j.jse.2024.03.007. Epub 2024 Mar 23.
Both inlay and onlay arthroscopic biceps tenodesis (ABT) are common procedures performed during rotator cuff repair. The inlay method involves creating a bone socket in the bicipital groove to secure the long head of the biceps tendon using an interference screw. The onlay method utilizes a suture anchor to secure the long head of the biceps tendon on the surface of the bicipital groove. Little is known on the long-term differences in patient-reported outcomes between these 2 techniques. The primary purpose of this study was to compare patient-reported outcomes of inlay vs. onlay ABT with a minimum follow-up of 2 years. Secondary aims were to evaluate the impact of rotator cuff tear size on outcomes and compare rates of complications between the 2 techniques.
A retrospective chart review was performed to identify patients who had an ABT during a full-thickness rotator cuff repair. Any symptom specific to the biceps were noted, including pain and cramping, Popeye deformity, or revision surgery. Complication rates were compared between groups. The visual analog scale pain score, American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, and Veteran's RAND-12 score (VR-12) scores were compared at 2 years. The impact of rotator cuff tear size was analyzed by categorizing into small/medium or large/massive based on operative reports and arthroscopic images.
There were 165 patients identified (106 in the inlay group and 59 in the onlay group). No revision surgeries were performed secondary to the biceps tendon in either group. Eleven patients (10%) in the inlay group complained of biceps pain or cramping compared to 2 patients (3%) in the onlay group (P = .11). One Popeye deformity was noted in each group (P = .67). No significant differences were found between groups for visual analog scale (P = .41), ASES functional (P = .61), ASES index (P = .91), Single Assessment Numeric Evaluation (P = .09), VR-12 Physical Component Score (P = .77), or VR-12 Mental Component Score (P = .09). Rotator cuff tear size within the groups also did not demonstrate statistical significance.
No clinical differences or complications were found at minimum 2-year follow-up between inlay and onlay ABT in patients undergoing rotator cuff repair when controlling for tear size. The clinical relevance suggests either technique is effective and can be based on surgeon preference.
在肩袖修复过程中，内窥镜下肱二头肌肌腱内固定（ABT）的镶嵌和覆盖法都是常见的手术。镶嵌法涉及在二头肌沟中创建一个骨槽，使用干涉螺钉固定长头肱二头肌肌腱。覆盖法利用缝合锚将长头肱二头肌肌腱固定在二头肌沟表面。关于这两种技术的患者报告结果的长期差异知之甚少。本研究的主要目的是比较镶嵌法与覆盖法 ABT 的患者报告结果，随访时间至少为 2 年。次要目的是评估肩袖撕裂大小对结果的影响，并比较两种技术的并发症发生率。
回顾性图表审查，以确定在全层肩袖修复过程中接受 ABT 的患者。记录任何与二头肌相关的特定症状，包括疼痛和痉挛、“大力水手畸形”或翻修手术。比较两组之间的并发症发生率。比较 2 年时的视觉模拟评分（VAS）疼痛评分、美国肩肘外科医师协会（ASES）评分、单项评估数值评分（Single Assessment Numeric Evaluation，SANE）和退伍军人 RAND-12 评分（Veteran's RAND-12 score，VR-12）。根据手术报告和关节镜图像，将肩袖撕裂大小分为小/中或大/巨大，分析其对结果的影响。
共确定 165 例患者（镶嵌组 106 例，覆盖组 59 例）。两组均无因二头肌肌腱而进行的翻修手术。镶嵌组 11 例（10%）患者诉肱二头肌疼痛或痉挛，而覆盖组 2 例（3%）（P=0.11）。每组各有 1 例出现“大力水手畸形”（P=0.67）。两组间 VAS 评分（P=0.41）、ASES 功能评分（P=0.61）、ASES 指数评分（P=0.91）、SANE 评分（P=0.09）、VR-12 生理成分评分（P=0.77）或 VR-12 心理成分评分（P=0.09）均无显著差异。当控制撕裂大小后，组内肩袖撕裂大小也无统计学意义。
在控制撕裂大小的情况下，在接受肩袖修复的患者中，2 年随访时，镶嵌法与覆盖法 ABT 之间未发现临床差异或并发症。这一临床结果表明，这两种技术均有效，可根据外科医生的偏好进行选择。
