Wu Chenliang, Qiao Yi, Zhang Ling, Wang Cong, Chen Jiebo, Chen Chang'an, Xu Caiqi, Tsai Tsung-Yuan, Xu Junjie, Zhao Jinzhong
Department of Sports Medicine, Shanghai Sixth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shanghai University of Sport, Shanghai, China.
Am J Sports Med. 2025 Feb;53(2):427-436. doi: 10.1177/03635465241301778. Epub 2025 Jan 3.
Arthroscopic repair with the biceps rerouting (BR) technique has been determined to lead to promising clinical and biomechanical outcomes for treating large-to-massive rotator cuff tears (LMRCTs). However, the in vivo effects of BR on glenohumeral kinematics during functional shoulder movements have not been fully elucidated.
To investigate whether BR provides a better restoration of shoulder kinematics compared with conventional rotator cuff repair (RCR).
Controlled laboratory study.
Patients who underwent either repair with the BR technique (BR group) or RCR alone (RCR group) for treating LMRCTs between January 2021 and May 2022 were enrolled. They underwent a 1-year postoperative kinematic evaluation of bilateral shoulders by performing scapular-plane abduction with a dual fluoroscopic imaging system. Glenohumeral translation in the superior-inferior (S-I) and anterior-posterior (A-P) directions was assessed in shoulder abduction at 10° increments. Moreover, the mean, maximum, minimum, and range of glenohumeral translation were calculated throughout the entire movement.
A total of 9 patients were enrolled in each group for final analysis, and baseline characteristics were comparable between the groups. In the RCR group, compared with contralateral shoulders, the operative shoulders showed increased superior humeral head translation during lower abduction angles of 30° to 50° (all ≤ .004), with a greater maximum ( = .014) and a larger range ( = .002) for S-I translation throughout the entire movement. In the BR group, no significant differences between operative and contralateral shoulders were detected in any kinematic variables for S-I translation (all ≥ .132); however, the operative shoulders exhibited a larger maximum ( = .031), a smaller minimum ( = .008), and a larger range ( < .001) for A-P translation throughout the entire movement compared with the contralateral shoulders.
BR successfully reduced residual superior humeral head translation compared with conventional RCR and restored normal S-I glenohumeral kinematics in the treatment of LMRCTs. However, A-P glenohumeral kinematics was not fully restored after BR, and its effect on long-term clinical outcomes requires further investigation.
BR can be a promising technique to treat LMRCTs. However, its potential adverse effects on A-P glenohumeral kinematics should not be ignored, requiring further clinical evidence to determine long-term outcomes.
已确定采用肱二头肌重新布线（BR）技术进行关节镜修复可在治疗大型至巨大型肩袖撕裂（LMRCT）方面带来良好的临床和生物力学效果。然而，BR对功能性肩部运动期间盂肱关节运动学的体内影响尚未完全阐明。
研究与传统肩袖修复（RCR）相比，BR是否能更好地恢复肩部运动学。
对照实验室研究。
纳入2021年1月至2022年5月期间接受BR技术修复（BR组）或单纯RCR（RCR组）治疗LMRCT的患者。他们在术后1年通过使用双荧光透视成像系统进行肩胛平面外展，对双侧肩部进行运动学评估。在肩部外展以10°增量增加时，评估盂肱关节在上下（S-I）和前后（A-P）方向的平移。此外，计算整个运动过程中盂肱关节平移的平均值、最大值、最小值和范围。
每组共9例患者纳入最终分析，两组间基线特征具有可比性。在RCR组中，与对侧肩部相比，手术侧肩部在30°至50°的较低外展角度时，肱骨头向上平移增加（均≤.004），在整个运动过程中S-I平移的最大值更大（=.014）且范围更大（=.002）。在BR组中，在S-I平移的任何运动学变量中，手术侧与对侧肩部之间均未检测到显著差异（均≥.132）；然而，与对侧肩部相比，手术侧肩部在整个运动过程中A-P平移的最大值更大（=.031）、最小值更小（=.008）且范围更大（<.001）。
与传统RCR相比，BR在治疗LMRCT时成功减少了肱骨头残留向上平移，并恢复了正常的S-I盂肱关节运动学。然而，BR术后A-P盂肱关节运动学未完全恢复，其对长期临床结果的影响需要进一步研究。
BR可能是治疗LMRCT的一种有前景的技术。然而，其对A-P盂肱关节运动学的潜在不良影响不应被忽视，需要进一步的临床证据来确定长期结果。
