Golovachev Nikita, Ghayyad Kassem, Oshikoya Olamide, Huffman G Russell
Department of Orthopaedic Surgery, Rothman Orthopaedics Florida at AdventHealth, Orlando, FL, USA.
JSES Rev Rep Tech. 2024 Aug 6;4(4):727-732. doi: 10.1016/j.xrrt.2024.07.004. eCollection 2024 Nov.
Massive rotator cuff tears constitute approximately 20% of all rotator cuff tears. Poor tissue quality or significant retraction can lead to failure of the repair. The anterior rotator cuff cable is essential in transmitting force to the proximal humerus and serves as the main load-bearing structure within the supraspinatus. Utilizing the long head of the biceps tendon (LHBT) for anterior cable reconstruction in the setting of rotator cuff tears, known as biceps augmentation, has the potential for improved biomechanical and healing properties. Importantly, the proximal LHBT remains attached to the superior glenoid labrum, serving as a viable collagen scaffold, a structural scaffold for the cable, and potentially as a conduit for living tenocytes to migrate into the hypovascular region of the rotator cuff, promoting repair healing. Similar methods utilize the transfer of the intact LHBT into the rotator cuff without a biceps tenodesis. While this accomplishes the aforementioned goals, it may create a source of biceps pain in these patients, and it changes the length-tension relationship of the LHBT distal to the transfer site. In this technical note, we detail an anterior cable reconstruction employing an autologous LHBT to reinforce a repaired massive rotator cuff tear with concurrent subpectoral tenodesis of the LHBT to achieve goals of 1) rotator cuff augmentation and grafting and, importantly and 2) securing the LHBT in a subpectoral position to mitigate pain and maintain supination strength while maintaining the anatomic length-tension relationship of the biceps. We feel this approach is superior in ensuring sufficient tendon is retained for an effective transfer and allows for a subpectoral tenodesis to prevent biceps symptoms.
巨大肩袖撕裂约占所有肩袖撕裂的20%。组织质量差或明显回缩可导致修复失败。肩袖前束对于将力量传递至肱骨近端至关重要，并且是冈上肌内的主要承重结构。在肩袖撕裂的情况下利用肱二头肌长头肌腱（LHBT）进行前束重建，即所谓的肱二头肌增强术，有可能改善生物力学性能和愈合特性。重要的是，肱二头肌长头肌腱近端仍附着于肩胛盂上唇，可作为一个可行的胶原支架、束的结构支架，并且可能作为活的腱细胞迁移至肩袖低血运区域的管道，促进修复愈合。类似的方法是将完整的肱二头肌长头肌腱转移至肩袖而不进行肱二头肌固定术。虽然这实现了上述目标，但可能会给这些患者造成肱二头肌疼痛的来源，并且改变了转移部位远端肱二头肌长头肌腱的长度-张力关系。在本技术说明中，我们详细介绍了一种采用自体肱二头肌长头肌腱进行前束重建的方法，以加强修复的巨大肩袖撕裂，同时对肱二头肌长头肌腱进行胸大肌下固定术，以实现以下目标：1）肩袖增强和移植，并且重要的是2）将肱二头肌长头肌腱固定于胸大肌下位置，以减轻疼痛并维持旋后力量，同时保持肱二头肌的解剖长度-张力关系。我们认为这种方法在确保保留足够的肌腱以进行有效转移以及允许进行胸大肌下固定术以预防肱二头肌症状方面更具优势。
