Biceps Tenodesis Versus Tenotomy with Fast Rehabilitation Protocol—A Functional Perspective in Chronic Tendinopathy

The study aimed to evaluate the results after arthroscopic tenodesis and tenotomy of the biceps tendon (LHBT), coupled in tenotomy modality with a personalized postoperative rehabilitation protocol. The study included patients who underwent arthroscopic biceps tenotomy or tenodesis due to chronic biceps tendinopathy. Postoperatively, a standard rehabilitation program was prescribed to the tenodesis group and personalized was introduced in the tenotomy group, respectively. The outcomes were assessed using the American Shoulder and Elbow Surgeons scale (ASES), clinical tests that are dedicated to biceps tendinopathy, the occurrence of a Popeye deformity, night pain, and return to previous sporting activities. A cohort of 67 patients was enrolled in the final follow-up examination (mean 27 months) of which 40 patients underwent tenotomy (60%), and 27 patients (40%) underwent tenodesis. The mean ASES score improved from 48.1 to 87.8 in the tenotomy group and from 44 to 72.7 in the tenodesis group during the follow-up (p < 0.0001). The tenotomy group had better mean postoperative ASES scores than the tenodesis group (p < 0.0001). Positive clinical tests for biceps pathology were noticed more often in patients after LHB tenodesis (p = 0.0541). The Popeye deformity occurred more often in the tenotomy group; however, no patient complained of the visual appearance of the arm contour (p = 0.0128). Moreover, the frequency of night pain decreased in the tenotomy group (p = 0.0059). Return to previous sporting activities was more frequent in the tenotomy group (p = 0.0090). Arthroscopic biceps tenotomy is a reproducible, simple procedure, and augmented by a rapid rehabilitation protocol that provides promising clinical outcomes, reduces shoulder pain, and allows the patient to return to previous sporting activities, even in population older than 50 years.

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The rein-type arthroscopic capsular suture for triangular fibrocartilage complex foveal tears: midterm results for 90 patients

Journal of Hand Surgery (European Volume) ◽

10.1177/17531934211024177 ◽

2021 ◽

pp. 175319342110241

Author(s):

I-Ning Lo ◽

Kuan-Jung Chen ◽

Tung-Fu Huang ◽

Yi-Chao Huang

Keyword(s):

Simple Procedure ◽

Distal Radioulnar Joint ◽

Triangular Fibrocartilage Complex ◽

Joint Stability ◽

Level Of Evidence ◽

Radioulnar Joint ◽

High Satisfaction ◽

Ultrasound Assessment ◽

Triangular Fibrocartilage

We describe an arthroscopic rein-type capsular suture that approximates the triangular fibrocartilage complex to the anatomical footprint, and report the results at a minimum 12 month follow-up. The procedure involves two 3-0 polydioxanone horizontal mattress sutures inserted 1.5 cm proximal to the 6-R and 6-U portals to obtain purchase on the dorsal and anterior radioulnar ligaments, respectively. The two sutures work as a rein to approximate the triangular fibrocartilage complex to the fovea. Ninety patients with Type IB triangular fibrocartilage complex injuries were included retrospectively. The 12-month postoperative Modified Mayo Wrist scores, Disabilities of Arm, Shoulder and Hand scores and visual analogue scale for pain showed significant improvements on preoperative values. Postoperative range of wrist motion, grip strength and ultrasound assessment of the distal radioulnar joint stability were comparable with the normal wrist. The patients had high satisfaction scores for surgery. There were minor complications of knot irritation. No revision surgery for distal radioulnar joint instability was required. It is an effective and technically simple procedure that provides a foveal footprint contact for the triangular fibrocartilage complex. Level of evidence: IV

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SLAP Tears

Video Journal of Sports Medicine ◽

10.1177/26350254211000754 ◽

2021 ◽

Vol 1 (3) ◽

pp. 263502542110007

Author(s):

Steven B. Cohen ◽

John R. Matthews

Keyword(s):

Rotator Cuff ◽

Shoulder Arthroscopy ◽

Biceps Tendon ◽

Full Range ◽

Contralateral Side ◽

Highly Active ◽

Slap Repair ◽

Biceps Tenotomy ◽

Labral Tears ◽

Anterior Posterior

Background: Superior labral tears are frequently encountered during shoulder arthroscopy. Outcomes following superior labral anterior-posterior (SLAP) repairs in young athletes have been well documented. Superior labral repairs in older patient population continue to remain controversial due to concerns of postoperative complications including persistent preoperative symptoms, pain, stiffness, and higher rates of revision surgery. Indications: We present a case of a highly active 38-year-old woman who failed 1½ years of nonoperative management of a type IIB SLAP tear with extension to the posterior labrum. Her symptoms continued to limit her hobbies and work. Technique: A knotless single-anchor SLAP repair was performed along with debridement of the posterior frayed labrum. No biceps tenotomy or tenodesis was performed after full evaluation of the tendon failed to demonstrate evidence of synovitis, tendinopathy, or tear. The patient also did not have any concomitant shoulder pathology, including a rotator cuff tear or chondral lesion. Results: At 6 months, the patient had regained full range of motion similar to the contralateral side. She had returned to her normal activities and sports, including tennis. Discussion/Conclusion: Successful outcomes following SLAP repairs in patients over 35 years can be achieved, but treatment should be individualized with particular attention to concomitant pathology involving the rotator cuff, chondral surface, or biceps tendon which may require tenodesis or tenotomy.

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Measurements of Tendon Movement Within the Bicipital Groove After Suprapectoral Intra-articular Biceps Tenodesis in a Cadaveric Model

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120977538 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097753

Author(s):

Brian J. Kelly ◽

Alan W. Reynolds ◽

Patrick J. Schimoler ◽

Alexander Kharlamov ◽

Mark Carl Miller ◽

...

Keyword(s):

Biceps Tendon ◽

Full Range ◽

Elbow Flexion ◽

Biceps Tenodesis ◽

Bicipital Groove ◽

Biceps Tenotomy ◽

Flexion Extension ◽

Before And After ◽

Long Head ◽

Scapular Motion

Background: Lesions of the long head of the biceps can be successfully treated with biceps tenotomy or tenodesis when surgical management is elected. The advantage of a tenodesis is that it prevents the potential development of a cosmetic deformity or cramping muscle pain. Proponents of a subpectoral tenodesis believe that “groove pain” may remain a problem after suprapectoral tenodesis as a result of persistent motion of the tendon within the bicipital groove. Purpose/Hypothesis: To evaluate the motion of the biceps tendon within the bicipital groove before and after a suprapectoral intra-articular tenodesis. The hypothesis was that there would be minimal to no motion of the biceps tendon within the bicipital groove after tenodesis. Study Design: Controlled laboratory study. Methods: Six fresh-frozen cadaveric arms were dissected to expose the long head of the biceps tendon as well as the bicipital groove. Inclinometers and fiducials (optical markers) were used to measure the motions of the scapula, forearm, and biceps tendon through a full range of shoulder and elbow motions. A suprapectoral biceps tenodesis was then performed, and the motions were repeated. The motion of the biceps tendon was quantified as a function of scapular or forearm motion in each plane, both before and after the tenodesis. Results: There was minimal motion of the native biceps tendon during elbow flexion and extension but significant motion during all planes of scapular motion before tenodesis, with the most motion occurring during shoulder flexion-extension (20.73 ± 8.21 mm). The motion of the biceps tendon after tenodesis was significantly reduced during every plane of scapular motion compared with the native state ( P < .01 in all planes of motion), with a maximum motion of only 1.57 mm. Conclusion: There was a statistically significant reduction in motion of the biceps tendon in all planes of scapular motion after the intra-articular biceps tenodesis. The motion of the biceps tendon within the bicipital groove was essentially eliminated after the suprapectoral biceps tenodesis. Clinical Relevance: This arthroscopic suprapectoral tenodesis technique can significantly reduce motion of the biceps tendon within the groove in this cadaveric study, possibly reducing the likelihood of groove pain in the clinical setting.

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Plate Fixation for Irreducible Proximal Humeral Fractures in Children and Adolescents—A Single-Center Case Series of Six Patients

Children ◽

10.3390/children8080635 ◽

2021 ◽

Vol 8 (8) ◽

pp. 635

Author(s):

Florian Freislederer ◽

Susanne Bensler ◽

Thomas Specht ◽

Olaf Magerkurth ◽

Karim Eid

Keyword(s):

Closed Reduction ◽

Biceps Tendon ◽

Plate Fixation ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Constant Murley Score ◽

Fractures In Children ◽

Initial Surgery ◽

Conjoint Tendon

Background: Recommended treatment for severely displaced proximal humeral fractures in children is the closed reduction and percutaneous fixation by K-wires or intramedullary nailing. Methods: From January 2016 to January 2017 6, 21 children/adolescents (range 8 to 16 years) with proximal humeral fractures were treated surgically for severe displacement. In these six patients, several attempts of closed reduction were unsuccessful, and an open reduction was performed. The humeral head was fixed with a 3.5 mm T-plate without affecting the growth plate. Plate removal was performed at a mean interval of 132 days after initial surgery. Two years after initial surgery, the clinical outcome was assessed by the Constant–Murley score and QuickDASH score (including sport/music and work) and the shoulder joint was evaluated with a standardized sonographic examination for the rotator cuff and the conjoint tendon. Results: In all six patients, dorsal displacement of the fracture was irreducible due to the interposition of tendinous or osseous structures. Intraoperatively, the interposed structures were the long biceps tendon in two, periosteal tissue in two, a bony fragment in one, and the long biceps tendon together with the conjoint tendon in one case. At mean follow-up of 26 months (range 22 months to 29 months), patients showed very good clinical results with an excellent mean Constant–Murley score of 97.5 (range 91 to 100) and mean QuickDASH score (including sport/music and work) of 5.5 (range 0–20.8). An X-ray follow-up 6 weeks after surgery demonstrated early consolidation and correct alignment in all patients. A sonographic evaluation at 2 years post injury showed that the biceps and the conjoined tendon were intact in all patients. Conclusions: If a proximal humeral fracture is not reducible by closed means, a tissue entrapment (most likely biceps tendon) should be considered. Treatment with an open reduction and plate fixation yields very good clinical and radiological results and preserves interposed structures as the biceps and conjoint tendon.

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The Impact of Smoking on Clinical Results Following the Rotator Cuff and Biceps Tendon Complex Arthroscopic Surgery

Journal of Clinical Medicine ◽

10.3390/jcm10040599 ◽

2021 ◽

Vol 10 (4) ◽

pp. 599

Author(s):

Jan Zabrzyński ◽

Gazi Huri ◽

Maciej Gagat ◽

Łukasz Łapaj ◽

Alper Yataganbaba ◽

...

Keyword(s):

Rotator Cuff ◽

Functional Outcomes ◽

Shoulder Arthroscopy ◽

Smoking Status ◽

Biceps Tendon ◽

Arthroscopic Surgery ◽

Rotator Cuff Tears ◽

Shoulder Injuries ◽

The Impact

The purpose of this study was to investigate the association of smoking and functional outcomes after arthroscopic treatment of complex shoulder injuries: rotator cuff tears (RCTs) with biceps tendon (LHBT) tears. This retrospective case-control study has been conducted on a cohort of patients who underwent shoulder arthroscopy between 2015 and 2017 due to complex injury treatment. The outcomes were assessed using the American Shoulder and Elbow Surgeons Score (ASES), the University of California at Los Angeles (UCLA) Shoulder Score, need for non-steroid anti-inflammatory drugs (NSAIDs) consumption and the visual analog scale (VAS). Complications and changes in smoking status were also noted. A cohort of 59 patients underwent shoulder arthroscopy, due to complex LHBT pathology and RCTs, and were enrolled in the final follow-up examination; with mean duration of 26.03 months. According to smoking status, 27 of patients were classified as smokers, and the remaining 32 were non-smokers. In the examined cohort, 36 patients underwent the LHBT tenotomy and 23 tenodesis. We observed a relationship between smoking status and distribution of various RCTs (p < 0.0001). The mean postoperative ASES and UCLA scores were 80.81 and 30.18 in the smoker’s group and 84.06 and 30.93 in the non-smoker’s group, respectively. There were no statistically significant differences in pre/postoperative ASES and postoperative UCLA scores between smokers and non-smokers (p > 0.05). The VAS was significantly lower in the non-smokers’ group (p = 0.0021). Multi-tendon injuries of the shoulder are a serious challenge for surgeons, and to obtain an excellent functional outcome, we need to limit the negative risk factors, including smoking. Furthermore, there is a significant association between smoking and the occurrence of massive rotator cuff tears, and the pain level measured by the VAS. Simultaneous surgical treatment of RC and LHBT lesions in the smoker population allowed us to obtain the functional outcomes approximated to non-smokers in the long-term follow-up. Of course, we cannot assert that smoking is the real cause of all complications, however, we may assume that this is a very important, negative factor in shoulder arthroscopy.

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A Minimally-Invasive, Simple, Rapid, and Effective Surgical Technique for the Treatment of Ingrown Toenails: A Reminder of the Original Winograd Procedure

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010278 ◽

2021 ◽

Vol 18 (1) ◽

pp. 278

Author(s):

Jahyung Kim ◽

Sanghyeon Lee ◽

Jeong Seok Lee ◽

Sung Hun Won ◽

Dong Il Chun ◽

...

Keyword(s):

Patient Outcomes ◽

Simple Procedure ◽

Wedge Resection ◽

Operation Time ◽

University Hospital ◽

Wound Infections ◽

Germinal Matrix ◽

One Year ◽

Ingrown Toenails

(1) Background: Ingrown toenail is a common disorder of the toe that induces severe toe pain and limits daily activities. The Winograd method, the most widely used operative modality for ingrown toenails, has been modified over years to include wedge resection of the nail fold and complete ablation of the germinal matrix. We evaluated the outcomes of original Winograd procedure without wedge resection with electrocautery-aided matrixectomy. (2) Methods: We retrospectively analyzed the outcomes of patients who underwent surgery for ingrown toenails at a university hospital for two years from November 2015 to October 2017. Surgery was performed in 76 feet with a mean operation time of 9.34 min. (3) Results: The minimal interval from surgery to return to regular activities was 13.26 (range 7 to 22) days. Recurrence and postoperative wound infections were found in 3 (3.95%) and 2 (2.63%) patients, respectively. Evaluation of patient satisfaction at one-year follow-up showed that 40 (52.63%) patients were very satisfied, 33 (43.42%) were satisfied, 3 (3.95%) were dissatisfied, and none of them were very dissatisfied. The average follow-up duration was 14.66 (range 12 to 25) months. (4) Conclusions: Therefore, it is believed that this less-invasive and simple procedure could be easily performed by clinicians, with satisfactory patient outcomes.

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Return of an Intact Hook Test Result: Clinical Assessment of Biceps Tendon Integrity After Surgical Repair

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119827311 ◽

2019 ◽

Vol 7 (2) ◽

pp. 232596711982731 ◽

Cited By ~ 1

Author(s):

Graham D. Pallante ◽

Shawn W. O’Driscoll

Keyword(s):

Surgical Repair ◽

Biceps Tendon ◽

Distal Biceps Tendon ◽

Level Of Evidence ◽

Distal Biceps ◽

Effective Manner ◽

Distal Biceps Repair ◽

Tendon Ruptures ◽

Test Result

Background: The hook test is a sensitive and specific tool that has been previously described for diagnosing distal biceps tendon ruptures in an efficient, cost-effective manner. However, its application in postoperative evaluations after surgical repair of distal biceps tendon ruptures is not documented. Hypothesis/Purpose: We hypothesized that the hook test result returns to normal at some point postoperatively after distal biceps repair. This information could be used in decision making during follow-up examinations with both normal and abnormal findings. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: We retrospectively reviewed records of distal biceps repair. Between July 1, 2003, and July 1, 2016, a total of 56 patients underwent distal biceps repair and also had clear documentation of the results of the hook test during the postoperative period. Hook test results consisted of “intact,” “abnormal,” or “absent.” The timing of the return to a normal hook test result was recorded. Results: Overall, 51 of 57 (89%) repairs were documented to have the hook test result return to “intact.” The test result returned to intact by a mean of 10 weeks after surgery (range, 2 weeks to 15 months). The biceps tendon was intact according to the hook test at the 4-month follow-up in 45 of the 51 patients (88%) in whom it ultimately returned. The hook test result was abnormal in 5 repairs in 5 patients with only a short-term follow-up, ranging from 2 to 7 weeks postoperatively. One patient with an abnormal hook test result at 2 weeks postoperatively underwent revision and was confirmed to have a partial tear of the biceps insertion. His hook test result returned to intact 3 months after revision repair. Conclusion: The hook test result returns to normal in patients who undergo distal biceps repair in the primary and revision settings with adequate follow-up. The vast majority of patients have a normal hook test result by 4 months postoperatively. An abnormal hook test result at 4 months postoperatively may indicate a failed repair and should prompt further investigation.

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Morphometric assessment of hip dysplasia in a cat treated by juvenile pubic symphysiodesis

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-15-11-0179 ◽

2016 ◽

Vol 29 (05) ◽

pp. 433-438

Author(s):

John Culvenor ◽

Craig Bailey ◽

Alen Lai

Keyword(s):

Computed Tomography ◽

Case Report ◽

Hip Dysplasia ◽

Simple Procedure ◽

Promising Treatment ◽

Design Case ◽

Sector Angle ◽

Morphometric Assessment ◽

Acetabular Rim

SummaryObjective: To quantitatively evaluate the change of the coxofemoral joints using computed tomography and distraction index in a cat with hip dysplasia treated by juvenile pubic symphysiodesis.Study Design: Case report.Animal: Eighteen-week-old female entire Maine Coon cat.Results: Juvenile pubic symphysiodesis resulted in changes in the distraction index, acetabular angle, dorsal acetabular rim angle, dorsal acetabular sector angle, and clinical improvement at the six month follow-up. No intra-operative or postoperative complications were recorded.Conclusions: Juvenile pubic symphysiodesis performed at 18 weeks of age resulted in improvement in hip joint conformation and hip laxity in a dysplastic cat.Clinical relevance: Juvenile pubic symphysiodesis may be a promising treatment for feline hip dysplasia and is a safe and technically simple procedure to perform. Further investigations are warranted.

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Arthroscopic Biceps Tenodesis: Technique and Results in Six Dogs

Journal of the American Animal Hospital Association ◽

10.5326/0410121 ◽

2005 ◽

Vol 41 (2) ◽

pp. 121-127 ◽

Cited By ~ 10

Author(s):

James L. Cook ◽

Keith Kenter ◽

Derek B. Fox

Keyword(s):

Surgical Management ◽

Biceps Tendon ◽

Interference Screw ◽

Cannulated Screw ◽

Biceps Tenodesis ◽

Fixation Methods ◽

Feasible Option ◽

Successful Outcomes ◽

Tendon Pathology

Biceps tenodesis was performed using an arthroscopic-assisted technique on six dogs diagnosed with chronic bicipital tendon pathology. The technique was performed using two different fixation methods (i.e., cannulated interference screw, cannulated screw and tissue washer). All six dogs had successful outcomes in terms of return to full function at a mean follow-up time of 11.7 months after surgery. Arthroscopic biceps tenodesis is a feasible option for surgical management of biceps tendon pathology, and it may have advantages over open tenodesis and open or arthroscopic tenotomy. Further study is needed before definitive recommendations regarding indications, complications, and prognosis associated with arthroscopic biceps tenodesis can be made.

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