6
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Distal Pullout Strengths of the Biceps Long Head Tendon for Different Adjacent Tissue and Tendon Pathologies during Rotator Cuff Repair

      research-article
      , , ,
      BioMed Research International
      Hindawi

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Purpose. Pathologies of the long head of the biceps tendon (LHBT) are frequently recognized in cases of rotator cuff tear. Recommendations for managing such pathologies remain debatable, and distal migration of tenotomized biceps is always a concern when only tenotomy is performed. Methods. Seventy patients of mean age 60.4 ± 6.9 years (range: 44 to 82 years) were included in this retrospective study. During subpectoral tenodesis in rotator cuff repair, pullout tensions were measured using a digital tensiometer. Measured tensions obtained were analyzed with respect to sex, tear involvement of the subscapularis, and the presence of a partial tear of LHBT, type II SLAP lesion, subluxation/dislocation of the biceps, or a pulley lesion. Results. Mean LHBT pullout tension for the 70 study subjects was 86.5 ± 42.1 N (26.7-240.5 N). Distal LHBT pullout tension was significantly greater for men than women (93.2 ± 42.7 N versus 73.7 ± 38.7 N, P = 0.041). However, LHBT pullout tensions were not significantly associated with different pathologies of surrounding tissues or of LHBTs (all Ps > 0.05). Conclusion. The study failed to show pullout tension differences associated with pathologies affect distal migration of a tenotomized LHBT. Gender was the only factor found to affect LHBT pullout strength. Risk of distal migration of tenotomized LHBT could not be predicted with intraoperative arthroscopic pathologic findings.

          Related collections

          Most cited references40

          • Record: found
          • Abstract: found
          • Article: not found

          Results of a second attempt at surgical repair of a failed initial rotator-cuff repair.

          Twenty-seven patients with twenty-seven involved shoulders underwent a second attempt at repair of an initial rotator-cuff repair that had failed. Factors associated with the failure of the initial repair included a massive or large tendon tear, damage to the deltoid origin at the original surgery, and possibly inadequate postoperative external support. Seven patients required a third operation because of continuing pain or weakness. The remaining twenty patients were followed for a minimum of two years (average, forty-eight months) and seventeen of them were examined at an average of forty-six months (range, twenty-six to 118 months) after surgery. Postoperatively, although seventeen patients (63 per cent) still had moderate or severe pain, sixteen (76 per cent) of the twenty-one patients who were operated on to relieve pain reported that the pain was substantially diminished. Active abduction increased an average of 8 degrees, but only seven shoulders gained more than 30 degrees of active abduction. Nineteen shoulders remained moderately or markedly weak in abduction. Over-all, four patients (17 per cent) had a good result; six (25 per cent), a fair result; and fourteen (58 per cent), a poor result. These results suggest that the surgeon should be quite hesitant to propose a second attempt at rotator cuff repair to a patient, as although pain may be diminished, active movement is unlikely to improve.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases.

            The purpose of this study is to evaluate the objective, subjective, and radiographic results of arthroscopic biceps tenotomy in selected patients with rotator cuff tears. Three hundred seven arthroscopic biceps tenotomies were performed in patients with full- thickness rotator cuff tears. Patients were selected for arthroscopic tenotomy if the tear was thought to be irreparable or if the patient was older and not willing to participate in the rehabilitation required after rotator cuff repair. Patients were evaluated clinically and radiographically at a mean of 57 months' follow-up (range, 24-168 months). The mean Constant score increased from 48.4 points preoperatively to 67.6 points postoperatively ( P < .0001). Eighty-seven percent of patients were satisfied or very satisfied with the result. The acromiohumeral interval decreased by a mean of 1.3 mm during the follow-up period and was associated with a longer duration of follow-up ( P < .0001). Preoperatively, 38% of patients had glenohumeral arthritis; postoperatively, 67% of patients had glenohumeral arthritis. Concomitant acromioplasty was statistically associated with better subjective and objective results only in patients with an acromiohumeral distance greater than 6 mm. Fatty infiltration of the rotator cuff musculature had a negative influence on both the functional and radiographic results ( P < .0001). Arthroscopic biceps tenotomy in the treatment of rotator cuff tears in selected patients yields good objective improvement and a high degree of patient satisfaction. Despite these improvements, arthroscopic tenotomy does not appear to alter the progressive radiographic changes that occur with long-standing rotator cuff tears.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears.

              Lesions of the long head of the biceps tendon are often associated with massive rotator cuff tears and may be responsible for shoulder pain and dysfunction. The purpose of this study was to evaluate the clinical and radiographic outcomes of isolated arthroscopic biceps tenotomy or tenodesis as treatment for persistent shoulder pain and dysfunction due to an irreparable rotator cuff tear associated with a biceps lesion. We conducted a retrospective study of sixty-eight consecutive patients (mean age [and standard deviation], 68 +/- 6 years) in whom a total of seventy-two irreparable rotator cuff tears had been treated arthroscopically with biceps tenotomy or tenodesis. A simple tenotomy was performed in thirty-nine cases, and a tenodesis was performed in thirty-three. No associated acromioplasty was performed. All patients were evaluated clinically and radiographically by an independent observer at a mean of thirty-five months postoperatively. Fifty-three patients (78%) were satisfied with the result. The mean Constant score improved from 46.3 +/- 11.9 points preoperatively to 66.5 +/- 16.3 points postoperatively (p < 0.001). A healthy-appearing teres minor on preoperative imaging was associated with significantly increased postoperative external rotation (40.4 degrees +/- 19.8 degrees compared with 18.1 degrees +/- 18.4 degrees ) and a significantly higher Constant score (p < 0.05 for both) compared with the values for the patients with an absent or atrophic teres minor preoperatively. Three patients with pseudoparalysis of the shoulder did not benefit from the procedure and did not regain active elevation above the horizontal level. In contrast, the fifteen patients with painful loss of active elevation recovered active elevation. The acromiohumeral distance decreased 1.1 +/- 1.9 mm on the average, and glenohumeral osteoarthritis developed in only one patient. The results did not differ between the tenotomy and tenodesis groups (mean Constant score, 61.2 +/- 18 points and 72.8 +/- 12 points, respectively). The "Popeye" sign was clinically apparent in twenty-four (62%) of the shoulders that had been treated with a tenotomy; of the sixteen patients who noticed it, none were bothered by it. Both arthroscopic biceps tenotomy and arthroscopic biceps tenodesis can effectively treat severe pain or dysfunction caused by an irreparable rotator cuff tear associated with a biceps lesion. Shoulder function is significantly inferior if the teres minor is atrophic or absent. Pseudoparalysis of the shoulder and severe rotator cuff arthropathy are contraindications to this procedure. Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.
                Bookmark

                Author and article information

                Contributors
                Journal
                Biomed Res Int
                Biomed Res Int
                BMRI
                BioMed Research International
                Hindawi
                2314-6133
                2314-6141
                2018
                9 September 2018
                : 2018
                : 4267163
                Affiliations
                Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Republic of Korea
                Author notes

                Academic Editor: Ashraf S. Gorgey

                Author information
                http://orcid.org/0000-0002-6848-350X
                Article
                10.1155/2018/4267163
                6151217
                1fdda8cc-ec96-4b32-9a25-97aaa08a3edf
                Copyright © 2018 Young Jun Kim et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 December 2017
                : 19 July 2018
                : 19 August 2018
                Categories
                Research Article

                Comments

                Comment on this article