Forsythe Brian, Berlinberg Elyse J, Khazi-Syed Daanish, Patel Harsh H, Forlenza Enrico M, Okoroha Kelechi R, Williams Brady T, Yanke Adam B, Cole Brian J, Verma Nikhil N
Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A..
Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.; Massachusetts General Hospital, Boston, Massachusetts, U.S.A.
Arthroscopy. 2025 May;41(5):1302-1313.e2. doi: 10.1016/j.arthro.2024.07.037. Epub 2024 Aug 20.
To assess the relation between tendon migration, as measured by radiostereometric analysis, and patient-reported outcome measures (PROMs) after biceps tenodesis (BT); to determine the likelihood of achieving clinically significant outcomes (CSOs) after BT; and to identify factors that impact CSO achievement.
Patients undergoing arthroscopic suprapectoral or open subpectoral BT at a single, high-volume academic medical center were prospectively enrolled. A tantalum bead sutured to the tenodesis construct was used as a radiopaque marker. Biceps tendon migration was measured on calibrated radiographs at 12 weeks postoperatively. PROMs (Constant-Murley, Single Assessment Numeric Evaluation [SANE], and Patient-Reported Outcomes Measurement Information System-Upper Extremity [PROMIS-UE] scores) were collected preoperatively and at minimum 2-year follow-up.
Of 115 patients enrolled, 94 (82%) were included (median age, 52 years; median body mass index, 31.4). At a mean follow-up of 2.9 years, the median Constant-Murley, SANE, and PROMIS-UE scores were 33 (interquartile range [IQR], 26-35), 90 (IQR, 80-99), and 47 (IQR, 42-58), respectively. Median tantalum bead migration was 6.5 mm (IQR, 1.8-13.8 mm). There were significant correlations between migration and Constant-Murley score (r = 0.222; β = -0.554 [95% confidence interval (CI), -1.027 to -0.081]; P = .022), SANE score (r = 0.238; β = -0.198 [95% CI, -0.337 to -0.058]; P = .006), and PROMIS-UE score (r = 0.233; β = -0.406 [95% CI, -0.707 to -0.104]; P = .009). On univariable analysis, higher body mass index was associated with achievement of substantial clinical benefit (unadjusted odds ratio [OR], 1.078 [95% CI, 1.007 to 1.161]; P = .038). Greater bead migration was negatively associated with achievement of the minimal clinically important difference (unadjusted OR, 0.969 [95% CI, 0.943 to 0.993]; P = .014) and patient acceptable symptomatic state (unadjusted OR, 0.965 [95% CI, 0.937 to 0.989]; P = .008) on all 3 instruments.
A 1-cm increase in post-tenodesis biceps tendon migration was associated with a decrease in the Constant-Murley, SANE, and PROMIS-UE scores of 6, 2, and 4 points, respectively, at a mean of 2.9 years after surgery. Most patients achieved CSOs for these PROMs by latest follow-up, and greater biceps tendon construct migration was negatively associated with the likelihood of CSO achievement.
Level IV, retrospective case series.
通过放射立体测量分析评估肱二头肌固定术（BT）后肌腱移位与患者报告的结局指标（PROMs）之间的关系；确定BT后实现临床显著结局（CSOs）的可能性；并识别影响CSO实现的因素。
前瞻性纳入在一家大型学术医疗中心接受关节镜下胸大肌上或开放性胸大肌下BT的患者。将一颗钽珠缝合到固定结构上作为不透射线标记物。术后12周在校准的X线片上测量肱二头肌肌腱移位情况。术前及至少随访2年时收集PROMs（Constant-Murley评分、单评估数值评定[SANE]以及患者报告结局测量信息系统上肢[PROMIS-UE]评分）。
纳入的115例患者中，94例（82%）被纳入分析（中位年龄52岁；中位体重指数31.4）。平均随访2.9年时，Constant-Murley、SANE和PROMIS-UE评分的中位数分别为33分（四分位间距[IQR]，26 - 35）、90分（IQR，80 - 99）和47分（IQR，42 - 58）。钽珠移位的中位数为6.5 mm（IQR，1.8 - 13.8 mm）。移位与Constant-Murley评分（r = 0.222；β = -0.554[95%置信区间（CI），-1.027至-0.081]；P = 0.022）、SANE评分（r = 0.238；β = -0.198[95% CI，-0.337至-0.058]；P = 0.006）以及PROMIS-UE评分（r = 0.233；β = -0.406[95% CI，-0.707至-0.104]；P = 0.009）之间存在显著相关性。单因素分析显示，较高的体重指数与获得显著临床益处相关（未调整优势比[OR]，1.078[95% CI，1.007至1.161]；P = 0.038）。更大的钽珠移位与在所有3种测量工具上达到最小临床重要差异（未调整OR，0.969[95% CI，0.943至0.993]；P = 0.014）以及患者可接受的症状状态（未调整OR，0.965[95% CI，0.937至0.989]；P = 0.008）呈负相关。
术后平均2.9年时，肱二头肌肌腱移位每增加1 cm，Constant-Murley、SANE和PROMIS-UE评分分别降低6分、2分和4分。大多数患者在末次随访时实现了这些PROMs的CSOs，并且更大的肱二头肌肌腱结构移位与CSO实现的可能性呈负相关。
IV级，回顾性病例系列研究。
