Jia Nathan W, Field Larry D
Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A.
Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A..
Arthroscopy. 2025 Aug;41(8):2705-2707. doi: 10.1016/j.arthro.2025.05.002.
The long head of the biceps has traditionally been ignored, tenodesed, or tenotomized during shoulder arthroscopy. However, more recently, it has been recognized as robust autograft tissue that may be mobilized or harvested to aid in a range of augmentation and reconstructive procedures. Several applications are included in this infographic. An intertendinous augmentation (biologic superior capsular reconstruction) technique is indicated in massive tears that are either partially or completely reparable. The intact biceps tendon is mobilized from the groove, transposed and secured to the greater tuberosity, and used as a convergence post to augment the repair. Anterior cable reconstruction is indicated in supraspinatus tears with a deficient anterior cable. The intact biceps tendon is tenotomized in the groove and its most proximal portion is used to reconstruct and incorporate the deficient anterior cable. The insertional augmentation ("sandwich") technique is indicated in tears with inadequate lateral mobility. The biceps tendon is released from its proximal insertion, redirected along the greater tuberosity, and incorporated into the lateral rotator cuff margin to augment and offload the repair. The biceps autograft superior capsular reconstruction ("snake") technique is indicated in massive irreparable tears. The intact biceps tendon is released as distally as possible to maximize autograft and arthroscopically routed back and forth between the glenoid and greater tuberosity to fashion an autograft superior capsular reconstruction. The autograft patch ("biceps smash") technique offers an alternative to biologic patches. The patch can augment partial rotator cuff tears without repair or reinforce cuff repairs with compromised, degenerative tissue. The proximal biceps tendon is harvested, processed extracorporeally, and reintroduced to the shoulder. Finally, in upper border subscapularis repairs with excessive tension or poor tissue quality, the biceps can be released at its proximal insertion and secured to the subscapularis tendon to supplement and offload the repair. Although far from an exhaustive list of all biceps tendon applications, these techniques are useful additions for the toolbox of a shoulder arthroscopist.
在肩关节镜检查过程中,肱二头肌长头传统上一直被忽视、进行肌腱固定或肌腱切断。然而,最近它被认为是一种强大的自体移植组织,可被移动或获取以辅助一系列增强和重建手术。本信息图中包含了几种应用。对于部分或完全可修复的巨大撕裂,可采用腱间增强(生物性上盂唇重建)技术。完整的肱二头肌肌腱从沟中游离出来,移位并固定到大结节上,用作汇聚柱以增强修复。对于前束缺损的冈上肌撕裂,可采用前束重建。完整的肱二头肌肌腱在沟内切断,其最近端部分用于重建并纳入缺损的前束。对于外侧活动度不足的撕裂,可采用插入式增强(“三明治”)技术。肱二头肌肌腱从其近端附着点松解,沿大结节重新定向,并纳入外侧旋转袖套边缘以增强并减轻修复部位的负荷。对于巨大不可修复的撕裂,可采用肱二头肌自体移植上盂唇重建(即“蛇形”)技术。完整的肱二头肌肌腱尽可能向远端松解,以最大化自体移植组织,然后通过关节镜在关节盂和大结节之间来回穿引,形成自体移植上盂唇重建。自体移植补片(“肱二头肌捣碎”)技术为生物补片提供了一种替代方案。该补片可增强部分旋转袖套撕裂而无需修复,或用受损、退变组织加强袖套修复。获取近端肱二头肌肌腱,体外处理后重新植入肩部。最后,在肩胛下肌上缘修复时,如果张力过大或组织质量差,可在肱二头肌近端附着点松解并固定到肩胛下肌腱上,以补充并减轻修复部位的负荷。尽管这些远非肱二头肌肌腱所有应用的详尽列表,但这些技术对于肩关节镜医生的工具库来说是有用的补充。
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