Berhouet Julien, Jacquot Adrien, Gadéa François, Guery Jacques, Joudet Thierry, Bonnevialle Nicolas, Ohl Xavier, Neyton Lionel, Gasse Nicolas, Barth Johannes, Antoni Maxime, Dordain Franck, Gallinet David, Charousset Christophe
Orthopedic and Trauma Surgery, CHRU Tours Hospital, Tours, France.
Clinique Louis Pasteur, Nancy, France.
J Bone Joint Surg Am. 2025 May 7;107(9):e41. doi: 10.2106/JBJS.24.00423. Epub 2025 Mar 27.
The aim of this study was to determine whether preserving a normal-appearing long head of the biceps (LHB) tendon leads to better Constant-Murley scores (CMS) than releasing it in patients undergoing arthroscopic repair of an isolated stage-1 supraspinatus tendon tear.
Patients (40 to 70 years old) who were undergoing arthroscopic repair of a minor supraspinatus tendon tear and who had a macroscopically normal LHB were randomized to LHB preservation or LHB release during a prospective clinical trial. The surgeon was free to choose whether to perform tenodesis in patients undergoing LHB release. The primary outcome was the involved shoulder's function based on the absolute CMS score at 6 and 24 months. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) shoulder score and Subjective Shoulder Value (SSV). A post-hoc analysis of prospectively collected data was done using 1:1 propensity score matching without replacement. This resulted in 2 age- and sex-matched groups of 95 patients each. Race and ethnicity data were not collected.
At 24 months, the mean CMS was significantly better in the LHB release group (mean and standard deviation, 86.8 ± 8.3) than in the LHB preservation group (82.9 ± 10.0) (p = 0.003), 97% of the patients in the LHB release group and 88% in the LHB preservation group had more than the minimal clinically important difference (MCID) for the CMS in rotator cuff repair (p = 0.048), 15% in the LHB preservation group and 3% in the LHB release group (p = 0.01) had an absolute CMS below 70, and the ASES was significantly higher in the LHB release group (91.4 ± 19.2) than in the LHB preservation group (83.6 ± 25.0) (p = 0.02). There were 4 reoperations in the LHB preservation group and no reoperations in the LHB release group.
Based on our findings, a macroscopically normal-appearing biceps tendon should be released when treating stage-1 supraspinatus tendon tears.
Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
本研究的目的是确定在接受关节镜下孤立性1期冈上肌腱撕裂修复的患者中，保留外观正常的肱二头肌长头（LHB）肌腱是否比切断该肌腱能带来更好的Constant-Murley评分（CMS）。
在一项前瞻性临床试验中，将接受轻微冈上肌腱撕裂关节镜修复且LHB宏观上正常的患者（40至70岁）随机分为LHB保留组或LHB切断组。对于LHB切断组的患者，外科医生可自行决定是否进行肌腱固定术。主要结局是基于6个月和24个月时的绝对CMS评分评估患侧肩部的功能。次要结局包括美国肩肘外科医师学会（ASES）肩部评分和主观肩部价值（SSV）。使用1:1倾向评分匹配且无替换的方法对前瞻性收集的数据进行事后分析。这产生了两组年龄和性别匹配的患者，每组各95例。未收集种族和民族数据。
在24个月时，LHB切断组的平均CMS（均值和标准差，86.8±8.3）显著优于LHB保留组（82.9±10.0）（p = 0.003），LHB切断组97%的患者和LHB保留组88%的患者在肩袖修复中的CMS超过最小临床重要差异（MCID）（p = 0.048），LHB保留组15%的患者和LHB切断组3%的患者绝对CMS低于70，且LHB切断组的ASES评分（91.4±19.2）显著高于LHB保留组（83.6±25.0）（p = 0.02）。LHB保留组有4例再次手术，LHB切断组无再次手术。
根据我们的研究结果，在治疗1期冈上肌腱撕裂时，应切断宏观上外观正常的肱二头肌肌腱。
治疗性II级。有关证据水平的完整描述，请参阅作者指南。
