Biceps tenotomy or tenodesis in association with rotator cuff repair

is there an influence on functional results? A retrospective cohort study

Autores

Palavras-chave:

Tenotomy, Tenodesis, Rotator cuff

Resumo

BACKGROUND: Instability or tears of the long head of the biceps tendon (LHBT) may be present in more than 35% of rotator cuff repairs (RCR). OBJECTIVE: To compare clinical results from patients undergoing arthroscopic RCR, according to the procedure performed at the LHBT. DESIGN AND SETTING: Retrospective cohort study designed at the shoulder and elbow clinic of Instituto de Ortopedia e Traumatologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil. METHODS: Functional results among patients were compared using the American Shoulder and Elbow Surgeons (ASES) and University of California Los Angeles (UCLA) scales, according to the LHBT approach adopted: no procedure, tenotomy or tenodesis. RESULTS: We evaluated 306 shoulders (289 patients): 133 underwent no procedure at the LHBT, 77 tenotomy and 96 tenodesis. The ASES scale at 24 months showed no difference (P = 0.566) between the groups without LHBT procedure (median 90.0; interquartile range, IQR 29), tenotomy (median 90.0; IQR 32.1) or tenodesis (median 94.4; IQR 22.7); nor did the UCLA scale (median 33; IQR 7 versus median 31; IQR 8 versus median 33; IQR 5, respectively, P = 0.054). The groups differed in the preoperative functional assessment according to the ASES and UCLA scale, such that the tenodesis group started from higher values. However, there was no difference in pre and postoperative scores between the groups. CONCLUSION: Tenodesis or tenotomy of the LHBT, in the sample analyzed, did not influence the clinical results from RCR, as assessed using the ASES and UCLA scales.

Downloads

Não há dados estatísticos.

Biografia do Autor

Eduardo Angeli Malavolta, Universidade de Sao Paulo

MD, PhD. Attending Orthopedic Surgeon, Department of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.

Alana Caselato de Sousa, Universidade de São Paulo

MD. Attending Orthopedic Surgeon, Department of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR

Mauro Emilio Conforto Gracitelli, Universidade de Sao Paulo

MD. Attending Orthopedic Surgeon, Department of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.

Jorge Henrique Assunção, Universidade de São Paulo

MD. Attending Orthopedic Surgeon, Department of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.

Fernando Brandão de Andrade e Silva, Universidade de Sao Paulo

MD, PhD. Attending Orthopedic Surgeon, Department of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.

Arnaldo Amado Ferreira Neto, Universidade de São Paulo

MD, PhD. Head of the Shoulder and Elbow Group, Department of Orthopedics and Traumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.

Referências

Baptista E, Malavolta EA, Gracitelli MEC, et al. Diagnostic accuracy of MRI for detection of tears and instability of proximal long head of biceps tendon: an evaluation of 100 shoulders compared with arthroscopy. Skeletal Radiol. 2019;48(11):1723-33. PMID: 30937471; https://doi.org/10.1007/s00256-019-03214-z

Nascimento AT do, Claudio GK. Magnetic resonance imaging without contrast as a diagnostic method for partial injury of the long head of the biceps tendon. Rev Bras Ortop. 2016;52(1):40-5. PMID: 2819438; https://doi.org/10.1016/j.rboe.2016.12.003

Ahrens PM, Boileau P. The long head of biceps and associated tendinopathy. J Bone Joint Surg Br. 2007;89(8):1001-9. PMID: 17785735; https://doi.org/10.1302/0301-620X.89B8.19278

Leroux T, Chahal J, Wasserstein D, Verma NN, Romeo AA. A Systematic Review and Meta-analysis Comparing Clinical Outcomes After Concurrent Rotator Cuff Repair and Long Head Biceps Tenodesis or Tenotomy. Sports Health. 2015;7(4):303-7. PMID: 26137174; https://doi.org/10.1177/1941738114539627

Shang X, Chen J, Chen S. A meta-analysis comparing tenotomy and tenodesis for treating rotator cuff tears combined with long head of the biceps tendon lesions. PLoS One. 2017;12(10):e0185788. PMID: 29016616; https://doi.org/10.1371/journal.pone.0185788

Na Y, Zhu Y, Shi Y, et al. A meta-analysis comparing tenotomy or tenodesis for lesions of the long head of the biceps tendon with concomitant reparable rotator cuff tears. J Orthop Surg Res. 2019;14(1):370. PMID: 31729995; https://doi.org/10.1186/s13018-019-1429-x

Kukkonen J, Rantakokko J, Virolainen P, Aärimaa V. The effect of biceps procedure on the outcome of rotator cuff reconstruction. ISRN Orthop. 2013 Feb 13;2013:840965. PMID: 24967118; https://doi.org/10.1155/2013/840965

Samilson RL, Prieto V. Dislocation arthropathy of the shoulder. J Bone Joint Surg Am. 1983;65(4):456-60. PMID: 6833319.

Richards RR, An KN, Bigliani LU, et al. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg. 1994;3(6):347-52. PMID: 22958838; https://doi.org/10.1016/S1058-2746(09)80019-0

Knaut LA, Moser ADL, De Andrade Melo S, Richards RR. Tradução e adaptação cultural à língua portuguesa do American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) para avaliação da função do ombro. Rev Bras Reumatol. 2010;50(2):176-89. https://doi.org/10.1590/S0482-50042010000200007

Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68(8):1136-44. PMID: 3771595.

Oku EC, Andrade AP, Stadiniky SP, Carrera EF. Tradução e adaptação cultural do Modified-University of California at Los Angeles Shoulder Rating Scale para a língua portuguesa. Rev Bras Reumatol. 2006;46(4):246-52. https://doi.org/10.1590/S0482-50042006000400003

Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg. 1999;8(6):599-605. PMID: 10633896; https://doi.org/10.1016/s1058-2746(99)90097-6

Motley GS, Osbahr DC, Holovacs TF, Speer KP. An arthroscopic technique for confirming intra-articular subluxation of the long head of the biceps tendon: the ramp test. Arthroscopy. 2002;18(9):E46. PMID: 12426555; https://doi.org/10.1053/jars.2002.36465

Kukkonen J, Kauko T, Vahlberg T, Joukainen A, Aärimaa V. Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery. J Shoulder Elbow Surg. 2013;22(12):1650-5. PMID: 23850308; https://doi.org/10.1016/j.jse.2013.05.002

Biz C, Vinanti GB, Rossato A, Arnaldi E, Aldegheri R. Prospective study of three surgical procedures for long head biceps tendinopathy associated with rotator cuff tears. Muscles Ligaments Tendons J. 2012;2(2):133-6. PMID: 23738287.

Boileau P, Baqué F, Valerio L, et al. Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am. 2007;89(4):747-57. PMID: 17403796; https://doi.org/10.2106/JBJS.E.01097

Cho NS, Cha SW, Rhee YG. Funnel tenotomy versus intracuff tenodesis for lesions of the long head of the biceps tendon associated with rotator cuff tears. Am J Sports Med. 2014;42(5):1161-8. PMID: 24576743; https://doi.org/10.1177/0363546514523719

Fang J-H, Dai X-S, Yu X-N, et al. Lesions of the Long Head of the Biceps Tendon Concomitant with Rotator Cuff Tears: Tenotomy or Subpectoral Mini-open Tenodesis? A Comparative Short to Mid-term Follow-up Study. Orthop Surg. 2019;11(5):857-63. PMID: 31532924; https://doi.org/10.1111/os.12536

Ikemoto RY, Pileggi PE, Murachovsky J, et al. Tenotomy with or without tenodesis of the long head of the biceps using repair of the rotator cuff. Rev Bras Ortop. 2012;47(6):736-40. PMID: 27047893; https://doi.org/10.1016/S2255-4971(15)30031-8

Koh KH, Ahn JH, Kim SM, Yoo JC. Treatment of biceps tendon lesions in the setting of rotator cuff tears: prospective cohort study of tenotomy versus tenodesis. Am J Sports Med. 2010;38(8):1584–90. PMID: 20551285; https://doi.org/10.1177/0363546510364053

Zhang Q, Zhou J, Ge H’an, Cheng B. Tenotomy or tenodesis for long head biceps lesions in shoulders with reparable rotator cuff tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc. 2015;23(2):464-9. PMID: 23828089; https://doi.org/10.1007/s00167-013-2587-8

De Carli A, Vadalà A, Zanzotto E, et al. Reparable rotator cuff tears with concomitant long-head biceps lesions: tenotomy or tenotomy/tenodesis? Knee Surg Sports Traumatol Arthrosc. 2012;20(12):2553-8. PMID: 22349543; https://doi.org/10.1007/s00167-012-1918-5

Lee H-J, Jeong J-Y, Kim C-K, Kim Y-S. Surgical treatment of lesions of the long head of the biceps brachii tendon with rotator cuff tear: a prospective randomized clinical trial comparing the clinical results of tenotomy and tenodesis. J Shoulder Elbow Surg. 2016;25(7):1107-14. PMID: 27283370; https://doi.org/10.1016/j.jse.2016.02.006

Meraner D, Sternberg C, Vega J, et al. Arthroscopic tenodesis versus tenotomy of the long head of biceps tendon in simultaneous rotator cuff repair. Arch Orthop Trauma Surg. 2016;136(1):101-6. PMID: 26497981; https://doi.org/10.1007/s00402-015-2343-2

Godenèche A, Kempf J-F, Nové-Josserand L, et al. Tenodesis renders better results than tenotomy in repairs of isolated supraspinatus tears with pathologic biceps. J Shoulder Elbow Surg. 2018;27(11):1939-45. PMID: 29784596; https://doi.org/10.1016/j.jse.2018.03.030

Murthi AM, Vosburgh CL, Neviaser TJ. The incidence of pathologic changes of the long head of the biceps tendon. J Shoulder Elbow Surg. 2000;9(5):382-5. PMID: 11075320; https://doi.org/10.1067/mse.2000.108386

Franceschetti E, de Sanctis EG, Palumbo A, et al. The management of the repair: A comparative study of high vs. subpectoral tenodesis. J Sport Health Sci. 2020:S2095-2546(20)30102-2. PMID: 32791203; http://dx.doi.org/10.1016/j.jshs.2020.08.004

Russell RD, Knight JR, Mulligan E, Khazzam MS. Structural integrity after rotator cuff repair does not correlate with patient function and pain: a meta-analysis. J Bone Joint Surg Am. 2014;96(4):265-71. PMID: 24553881; https://doi.org/10.2106/JBJS.M.00265

Carvalho CD, Cohen C, Belangero PS, et al. Supraspinatus Muscle Tendon Lesion and Its Relationship with Long Head of the Biceps Lesion. Rev Bras Ortop (Sao Paulo). 2020;55(3):329-38. PMID: 32616979; https://doi.org/10.1055/s-0039-3402472

Downloads

Publicado

2022-03-03

Como Citar

1.
Malavolta EA, Sousa AC de, Gracitelli MEC, Assunção JH, Silva FB de A e, Ferreira Neto AA. Biceps tenotomy or tenodesis in association with rotator cuff repair: is there an influence on functional results? A retrospective cohort study. Sao Paulo Med J [Internet]. 3º de março de 2022 [citado 14º de março de 2025];140(2):237-43. Disponível em: https://periodicosapm.emnuvens.com.br/spmj/article/view/895

Edição

Seção

Artigo Original