Modified Superior Capsule Reconstruction Using the Long Head of the Biceps Tendon as Reinforcement to Rotator Cuff Repair Lowers Retear Rate in Large to Massive Reparable Rotator Cuff Tears

Massive or irreparable rotator cuff tears remain a challenging with a high failure rates of the tendon re-tear after surgical treatment in sports medicine practice. Superior capsular reconstruction with either fascia lata autograft or a dermal allograft patch has been described to prevent superior humeral head migration and restore the shoulder muscle force couples to achieve the promising results. A modified and simplified surgical procedure using long head biceps tendon (LHBT) autograft as superior capsular reconstruction (LHBT-SCR) to facilitate the massive rotator cuff repair has been descripted as ”Chinese Way” by a team of French surgeons and Chinese surgeons. The surgical technic has been used in China more than 300 cases. The procedure of this LHBT-SCR has been approved with the advantage of least technical demands, simplifies the original demanding, short the surgical time, satisfy the results and patient acceptance. A multi-center prospective studies with large cohort populations and long-term follow-up has been established in China for its effectiveness. The present will introduce the technic in detail.

Download Full-text

Long Head of the Biceps Tendon Tenotomy versus Subpectoral Tenodesis in Rotator Cuff Repair

Clinics in Orthopedic Surgery ◽

10.4055/cios19168 ◽

2020 ◽

Vol 12 (3) ◽

pp. 371

Author(s):

Jangwoo Kim ◽

Ji Hoon Nam ◽

Yuna Kim ◽

Jong Seop Kim ◽

Sae Hoon Kim

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Biceps Tendon ◽

Long Head ◽

Cuff Repair

Download Full-text

What happens to the long head of the biceps tendon after arthroscopic rotator cuff repair?

The Bone & Joint Journal ◽

10.1302/0301-620x.102b9.bjj-2020-0076.r1 ◽

2020 ◽

Vol 102-B (9) ◽

pp. 1194-1199

Author(s):

Hyo-Jin Lee ◽

Eung-Sic Kim ◽

Yang-Soo Kim

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Biceps Brachii ◽

Morphological Changes ◽

Biceps Tendon ◽

Cross Sectional ◽

Postoperative Changes ◽

Long Head ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Aims The purpose of this study was to identify the changes in untreated long head of the biceps brachii tendon (LHBT) after a rotator cuff tear and to evaluate the factors related to the changes. Methods A cohort of 162 patients who underwent isolated supraspinatus with the preservation of LHBT was enrolled and evaluated. The cross-sectional area (CSA) of the LHBT on MRI was measured in the bicipital groove, and preoperative to postoperative difference was calculated at least 12 months postoperatively. Second, postoperative changes in the LHBT including intratendinous signal change, rupture, dislocation, or superior labral lesions were evaluated with seeking of factors that were correlated with the changes or newly developed lesions after rotator cuff repair. Results The postoperative CSA (12.5 mm2 (SD 8.3) was significantly larger than preoperative CSA (11.5 mm2 (SD 7.5); p = 0.005). In total, 32 patients (19.8%) showed morphological changes in the untreated LHBT 24 months after rotator cuff repair. Univariate regression analysis revealed that the factor chiefly related to the change in LHBT status was an eccentric LHBT position within the groove found on preoperative MRI (p = 0.011). Multivariate analysis using logistic regression also revealed that an eccentric LHBT position was a factor related to postoperative change in untreated LHBTs (p = 0.011). Conclusion The CSA of the LHBT inside the biceps groove increased after rotator cuff repair. The preoperative presence of an eccentrically positioned LHBT was associated with further changes of the tendon itself after rotator cuff repair. Cite this article: Bone Joint J 2020;102-B(9):1194–1199.

Download Full-text

Patch-Augmented Rotator Cuff Repair and Superior Capsule Reconstruction

The Open Orthopaedics Journal ◽

10.2174/1874325001610010315 ◽

2016 ◽

Vol 10 (1) ◽

pp. 315-323 ◽

Cited By ~ 17

Author(s):

M. Petri ◽

J.A. Greenspoon ◽

S.G. Moulton ◽

P.J. Millett

Keyword(s):

Rotator Cuff ◽

Shoulder Arthroplasty ◽

Rotator Cuff Repair ◽

Treatment Options ◽

Rotator Cuff Tears ◽

Long Term Results ◽

Complication Rates ◽

Younger Patients ◽

Superior Capsule Reconstruction ◽

Cuff Repair

Background: Massive rotator cuff tears in active patients with minimal glenohumeral arthritis remain a particular challenge for the treating surgeon. Methods: A selective literature search was performed and personal surgical experiences are reported. Results: For patients with irreparable rotator cuff tears, a reverse shoulder arthroplasty or a tendon transfer are often performed. However, both procedures have rather high complication rates and debatable long-term results, particularly in younger patients. Therefore, patch-augmented rotator cuff repair or superior capsule reconstruction (SCR) have been recently developed as arthroscopically applicable treatment options, with promising biomechanical and early clinical results. Conclusion: For younger patients with irreparable rotator cuff tears wishing to avoid tendon transfers or reverse total shoulder arthroplasty, both patch-augmentation and SCR represent treatment options that may delay the need for more invasive surgery.

Download Full-text

Partial Rotator Cuff Repair With Superior Capsular Reconstruction Using the Biceps Tendon Is as Effective as Superior Capsular Reconstruction Using a Tensor Fasciae Latae Autograft in the Treatment of Irreparable Massive Rotator Cuff Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120922526 ◽

2020 ◽

Vol 8 (6) ◽

pp. 232596712092252 ◽

Cited By ~ 1

Author(s):

Baris Kocaoglu ◽

Goktug Firatli ◽

Tekin Kerem Ulku

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Biceps Tendon ◽

Rotator Cuff Tears ◽

Massive Rotator Cuff Tears ◽

Superior Capsular Reconstruction ◽

Functional Scores ◽

Tensor Fasciae Latae ◽

Cuff Repair

Background: Several treatment options are available for stable massive rotator cuff tears, including partial repair with or without tissue augmentation, tendon transfer, superior capsular reconstruction (SCR), and reverse shoulder arthroplasty. Purpose/Hypothesis: The purpose of this study was to compare the outcomes and effectiveness of partial rotator cuff repair with SCR using the long head of the biceps tendon (PRCR-SCRB) and SCR with a tensor fasciae latae autograft (SCRTF) for the treatment of rotator cuff tears with severe fatty degeneration. The hypothesis of this study was that SCRTF would be superior to PRCR-SCRB in functional and anatomic outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 26 consecutive patients with massive and fatty degenerative rotator cuff tears were treated surgically. Patients were divided into either the PRCR-SCRB group (n = 14) or SCRTF group (n = 12). Functional outcomes were assessed at final follow-up, and the acromiohumeral distance (AHD) was measured. Results: All functional scores significantly improved in both groups at final follow-up. The PRCR-SCRB group showed better overall outcomes in terms of the visual analog scale for pain; American Shoulder and Elbow Surgeons score; and Quick Disabilities of the Arm, Shoulder and Hand, but these differences were not statistically significant. Better outcomes were found for only the AHD for the PRCR-SCRB group without statistical significance ( P = .4). No statistical difference was found in terms of retear rate. Conclusion: PRCR-SCRB had comparable outcomes and improvement in AHD compared with SCRTF without the need for additional graft harvesting.

Download Full-text

Will Preoperative Atrophy and Fatty Degeneration of the Shoulder Muscles Improve after Rotator Cuff Repair in Patients with Massive Rotator Cuff Tears?

Advances in Orthopedics ◽

10.1155/2012/195876 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 29

Author(s):

Hiroshi Yamaguchi ◽

Naoki Suenaga ◽

Naomi Oizumi ◽

Yoshihiro Hosokawa ◽

Fuminori Kanaya

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Fatty Degeneration ◽

Rotator Cuff Tears ◽

Massive Rotator Cuff Tear ◽

Cuff Tear ◽

Before And After ◽

Magnetic Resonance Imaging Mri ◽

Cuff Repair ◽

Retear Rate

Recently, retear rate after repair for massive cuff tear have been improved through devised suture techniques. However, reported retear rate is relevant to preoperative atrophy and fatty degeneration. The purpose of this study was to investigate whether preoperative atrophy and fatty degeneration of rotator cuff muscles improve by successful repair. Twenty-four patients with massive rotator cuff tear were evaluated on the recovery of atrophy and fatty degeneration of supraspinatus and infraspinatus muscle after surgery. Atrophy was classified by the occupation ratio and fatty degeneration by modified Goutallier's classification. Both were assessed on magnetic resonance imaging (MRI) before and after the operation. When the cuff was well repaired, improvement of the atrophy and fatty degeneration were observed in a half and a one-fourth of the cases, respectively. In retear cases, however, atrophy and fatty degeneration became worse. Improvement of atrophy and fatty degeneration of the rotator cuff muscles may be expected in the cases with successful achievement of rotator cuff repair for large and massive tear.

Download Full-text

Clinical outcome comparison of suprapectoral and subpectoral tenodesis of the long head of the biceps with concomitant rotator cuff repair: A systematic review

Shoulder & Elbow ◽

10.1177/1758573221989089 ◽

2021 ◽

pp. 175857322198908

Author(s):

Selim Ergün ◽

Yiğit Umur Cırdı ◽

Said Erkam Baykan ◽

Umut Akgün ◽

Mustafa Karahan

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Case Reports ◽

Biceps Tendon ◽

Case Series ◽

Biceps Tenodesis ◽

Long Head Of Biceps ◽

Long Head ◽

Cuff Repair ◽

Popeye Deformity

Background Simultaneous repairs of rotator cuff and biceps tenodesis can be managed by tenodesis of long head of biceps tendon to a subpectoral or suprapectoral area. This review investigated long head of biceps tendon tenodesis with concomitant rotator cuff repair and evaluated the clinical outcomes and incidences of complications based on tenodesis location. Methods Medline, Cochrane, and Embase databases were searched for published, randomized or nonrandomized controlled studies and prospective or retrospective case series with the phrases “suprapectoral,” “subpectoral,” “tenodesis,” and “long head of biceps tendon”. Those with a clinical evidence Level IV or higher were included. Non-English manuscripts, review articles, commentaries, letters, case reports, and sole long head of biceps tendon tenodesis articles were excluded. Results From 481 studies, 13 were chosen. In total, 1194 subpectoral and 2520 suprapectoral tenodesis cases were investigated. Postoperative Constant-Murley and American Shoulder and Elbow Surgeons mean scores showed similar good results. In terms of complication incidences, while transient nerve injuries were more commonly seen in patients with subpectoral tenodesis, persistent bicipital pain and Popeye deformity are mostly seen in patients with suprapectoral tenodesis. Discussion Biceps tenodesis to suprapectoral or subpectoral area with concomitant rotator cuff repair demonstrated similar outcomes. Popeye deformity and persistent bicipital pain were higher in suprapectoral area and transient neuropraxia was found to be higher in subpectoral area. Level of evidence: IV.

Download Full-text