Gahlot Nitesh, Kumar Rajnish Rajesh, Rathore Kuldeep
All India Institute of Medical Sciences Jodhpur, Jodhpur, India.
Eur J Orthop Surg Traumatol. 2025 Feb 25;35(1):75. doi: 10.1007/s00590-025-04196-6.
Biceps tenodesis techniques can be grouped into open or arthroscopic according to surgical approach, and into subpectoral or suprapectoral according to location of fixation. The purpose of this meta-analysis is to critically analyse the current evidence with regard to comparing two methods of biceps tenodesis, viz subpectoral vs supratenodesis.
Primary electronic search was conducted on MEDLINE (PubMed), Embase, Scopus, and Cochrane Library databases for published literature from year of inception to August 2024. The current review included any prospective or retrospective English studies that evaluated the outcomes of suprapectoral versus subpectoral. Primary outcomes of interest were American shoulder and elbow society (ASES) score, constant score (CS), UCLA score, SST score, VAS, and complications. The secondary outcomes of interest was range of movements.
Thirteen studies were included in our quantitative analysis, comprising three RCTs and ten non-randomized comparative studies. ASES score was slightly higher in most of studies in favour of subpectoral tenodesis [95% CI (- 1.35, 0.10); I = 43%] (P > 0.05). We found no statistically significant difference between the two groups (P = 0.81), although the subpectoral tenodesis group had slightly higher mean CS 95% CI (- 0.95, 0.85), p = 0.81, I = 0%]. Our meta-analysis found a slightly higher SST in suprapectoral tenodesis group [95% CI (- 0.18, 0.49); I = 0%], while higher UCLA scores [P = 0.98; 95% CI (- 0.52, 0.50); I = 45%] in the subpectoral group (P > 0.05). Higher overall complication rate was noted with suprapectoral tenodesis group [OR 2.65; 95% CI (1.57, 4.45), I = 49%] (P = 0.0002).
Both the techniques of biceps tenodesis have shown comparable functional outcomes in most of the trials. On performing meta-analysis, suprapectoral tenodesis was associated with higher rate postoperative complications. Hence, it is advisable to choose subpectoral tenodesis, as and when possible.
根据手术入路，肱二头肌固定技术可分为开放或关节镜手术，根据固定位置可分为胸下或胸上。本荟萃分析的目的是严格分析目前关于比较两种肱二头肌固定方法（即胸下与胸上固定）的证据。
在MEDLINE（PubMed）、Embase、Scopus和Cochrane图书馆数据库中进行了初步电子检索，以获取从数据库建立年份到2024年8月发表的文献。本次综述纳入了任何评估胸上与胸下固定效果的前瞻性或回顾性英文研究。感兴趣的主要结局指标为美国肩肘协会（ASES）评分、常数评分（CS）、加州大学洛杉矶分校（UCLA）评分、简易肩痛测试（SST）评分、视觉模拟评分（VAS）和并发症。感兴趣的次要结局指标为活动范围。
13项研究纳入了我们的定量分析，包括3项随机对照试验和10项非随机对照研究。大多数研究中，ASES评分略高，支持胸下固定[95%置信区间（-1.35，0.10）；I² = 43%]（P > 0.05）。我们发现两组之间无统计学显著差异（P = 0.81），尽管胸下固定组的平均CS略高[95%置信区间（-0.95，0.85），P = 0.81，I² = 0%]。我们的荟萃分析发现胸上固定组的SST略高[95%置信区间（-0.18，0.49）；I² = 0%]，而胸下固定组的UCLA评分更高[P = 0.98；95%置信区间（-0.52，0.50）；I² = 45%]（P > 0.05）。胸上固定组的总体并发症发生率更高[比值比2.65；95%置信区间（1.57，4.45），I² = 49%]（P = 0.0002）。
在大多数试验中，两种肱二头肌固定技术的功能结局相当。进行荟萃分析时，胸上固定术后并发症发生率更高。因此，尽可能选择胸下固定为宜。
