Yu Jiong, Yin Yu, Chen Wenxuan, Mi Jingyi
Suzhou Medical College, Soochow University, Suzhou, Jiangsu, China; Department of Sports Medicine, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China.
Department of Sports Medicine, Peking University Third Hospitals, Beijing, China.
J Shoulder Elbow Surg. 2025 Mar;34(3):699-709. doi: 10.1016/j.jse.2024.07.002. Epub 2024 Aug 14.
Emerging evidence suggests that the long head of the biceps (LHBT) may play a role in stabilizing the glenohumeral joint, and this has led to controversy around the efficacy of biceps tenotomy for superior labral anterior and posterior (SLAP) lesions. Therefore, the aim of this finite element analysis (FEA) study was to determine the stress absorption and humeral head translation restriction effects of the LHBT within the glenohumeral joint during the late cocking and deceleration phases of overhead throwing with a view to resolving the controversy around tenotomy.
Eight FEA models were created using computed tomography and magnetic resonance imaging data from normal glenohumeral joints. The models represented 4 LHBT conditions: uninjured, subpectoral tenodesis, tenotomy, and type II SLAP lesions. The late cocking and deceleration phases of the overhead throwing were simulated for each model. The impacts of the 4 LHBT conditions on glenohumeral joint stress absorption and humeral head displacement restriction were studied based on 1) stress and related distributions on the cartilage, labrum, capsule, and LHBT; and 2) humeral head translation variation.
The FEA analysis showed that the magnitude of the contact stress on the articular cartilage, labrum, and capsule was the lowest in the uninjured models, followed by the subpectoral tenodesis, tenotomy, and type II SLAP lesion models. Humeral head translation was the most restricted in the subpectoral tenodesis models, followed by the tenotomy and type II SLAP lesion models.
FEA demonstrated that the LHBT plays a significant role in stress absorption and displacement restriction in the late cocking and deceleration phases of overhead throwing. Subpectoral tenodesis of the LHBT exhibited lesser amount of stress and humeral head translation than those of tenotomy, thereby making it a better option for patients who engage in overhead throwing.
新出现的证据表明，肱二头肌长头（LHBT）可能在稳定盂肱关节方面发挥作用，这引发了关于肱二头肌切断术治疗上盂唇前后部（SLAP）损伤疗效的争议。因此，本有限元分析（FEA）研究的目的是确定在过顶投掷的后期引臂和减速阶段，LHBT在盂肱关节内的应力吸收和肱骨头平移限制作用，以期解决围绕切断术的争议。
使用来自正常盂肱关节的计算机断层扫描和磁共振成像数据创建了八个FEA模型。这些模型代表了4种LHBT情况：未受伤、胸小肌下固定术、切断术和II型SLAP损伤。对每个模型模拟了过顶投掷的后期引臂和减速阶段。基于以下两点研究了4种LHBT情况对盂肱关节应力吸收和肱骨头位移限制的影响：1）软骨、盂唇、关节囊和LHBT上的应力及相关分布；2）肱骨头平移变化。
FEA分析表明，在未受伤模型中，关节软骨、盂唇和关节囊上的接触应力大小最低，其次是胸小肌下固定术、切断术和II型SLAP损伤模型。在胸小肌下固定术模型中，肱骨头平移受到的限制最大，其次是切断术和II型SLAP损伤模型。
FEA表明，LHBT在过顶投掷的后期引臂和减速阶段的应力吸收和位移限制中起重要作用。LHBT的胸小肌下固定术比切断术表现出更小的应力和肱骨头平移，因此对于从事过顶投掷的患者来说是更好的选择。
