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Biceps Management in Rotator Cuff Disease. OPER TECHN SPORT MED 2023. [DOI: 10.1016/j.otsm.2023.150985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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2
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Przybycień W, Bonczar M, Ostrowski P, Koziej M, Mizia E, Wysiadecki G, Loukas M, Walocha J. The deep brachial artery - a meta-analysis of its origin and diameter with a review of the literature. Clin Anat 2022; 35:838-846. [PMID: 35313051 DOI: 10.1002/ca.23853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/07/2022]
Abstract
The deep brachial artery (DBA) is the first and largest branch of the brachial artery. Multiple variations of the DBA's origin, termination, and diameter have been reported in the literature. Major online medical databases such as PubMed, Scopus, Embase, Web Of Science, and Google Scholar were searched in order to find all studies considering origin variations and the diameter of the DBA. The prevalence of the DBA originating directly from the axillary or brachial artery was shown to be 92.87%. DBA originating indirectly from the axillary or brachial artery, as a common trunk with other arteries, was found to be 7.13%. The mean diameter of the DBA was shown to be 2.05 mm. The authors of the present study believe that this is the most accurate and up-to-date meta-analysis considering origin patterns and the diameter of the DBA. Additionally, this study contains a comprehensive literature review in which current detailed anatomical knowledge concerning the DBA was gathered. The results of this study could provide a helpful tool for physicians, especially surgeons, dealing with an upper limb in their daily practice. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Wojciech Przybycień
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Ewa Mizia
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Łódź, Łódź, Poland
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, True Blue, Grenada
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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Otto A, Siebenlist S, Baldino JB, Murphy M, Muench LN, Mehl J, Obopilwe E, Cote MP, Imhoff AB, Mazzocca AD. All-suture anchor and unicortical button show comparable biomechanical properties for onlay subpectoral biceps tenodesis. JSES Int 2020; 4:833-837. [PMID: 33345223 PMCID: PMC7738569 DOI: 10.1016/j.jseint.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Hypothesis The purpose of this study was to biomechanically evaluate onlay subpectoral long head of the biceps (LHB) tenodesis with all-suture anchors and unicortical buttons in cadaveric specimens. Methods After evaluation of bone mineral density, 18 fresh-frozen, unpaired human cadaveric shoulders were randomly assigned to 2 groups: One group received an onlay subpectoral LHB tenodesis with 1 all-suture anchor, whereas the other group received a tenodesis with 1 unicortical button. The specimens were mounted in a servo-hydraulic material testing system. Tendons were initially loaded from 5 N to 100 N for 5000 cycles at 1 Hz. Displacement of the repair constructs was observed with optical tracking. After cyclic loading, each specimen was loaded to failure at a rate of 1 mm/s. Results The mean displacement after cyclic loading was 6.77 ± 3.15 mm in the all-suture anchor group and 8.41 ± 3.17 mm in the unicortical button group (P = not significant). The mean load to failure was 278.05 ± 38.77 N for all-suture anchor repairs and 291.36 ± 49.69 N for unicortical button repairs (P = not significant). The most common mode of failure in both groups was LHB tendon tearing. There were no significant differences between the 2 groups regarding specimen age (58.33 ± 4.37 years vs. 58.78 ± 5.33 years) and bone mineral density (0.50 ± 0.17 g/cm2 vs. 0.44 ± 0.19 g/cm2). Conclusion All-suture anchors and unicortical buttons are biomechanically equivalent in displacement and load-to-failure testing for LHB tenodesis. All-suture anchors can be considered a validated alternative for onlay subpectoral LHB tenodesis.
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Affiliation(s)
- Alexander Otto
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA.,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Joshua B Baldino
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Matthew Murphy
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julian Mehl
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
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Arthroscopic Onlay Articular Margin Biceps Tenodesis for Long Head of the Biceps Tendon Pathology. Arthrosc Tech 2020; 9:e959-e963. [PMID: 32714805 PMCID: PMC7372504 DOI: 10.1016/j.eats.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/15/2020] [Indexed: 02/03/2023] Open
Abstract
The long head of the biceps (LHB) tendon is a common source of shoulder pain. LHB tendon pathology typically occurs with concomitant rotator cuff or labrum injuries but can occasionally occur in isolation as biceps tendinopathy or rupture. Tenodesis has been increasingly used to treat LHB tendon pathology, and numerous techniques have been developed that vary in approach, fixation construct, and fixation location. In this Technical Note, we describe an arthroscopic onlay articular margin biceps tenodesis with suture anchors. This technique has several advantages, namely intra-articular visualization of the tenodesis, strong fixation to high density bone of the articular margin, and most importantly, preservation of the anatomic length-tension relationship.
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Diaz M, Shi BY, Baker MC, Binkley MT, Belkoff SM, Srikumaran U. Open Biceps Tenodesis: A Biomechanical Comparison of 6 Fixation Techniques. Orthopedics 2020; 43:e102-e108. [PMID: 31930414 DOI: 10.3928/01477447-20200107-03] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/04/2019] [Indexed: 02/03/2023]
Abstract
Tenodesis is used to treat pathology of the long head of the biceps tendon. The authors evaluated the biomechanical properties of 6 techniques for biceps tenodesis fixation. The authors dissected 42 fresh-frozen cadaveric shoulders (mean age, 71±9.8 years; 69% male specimens), leaving the proximal humerus, proximal biceps tendon, and pectoralis major insertion. Specimens were randomized to undergo biceps tenodesis with one of the following: (1) an interference screw; (2) a cortical button; (3) a double-loaded 2.9-mm polyetheretherketone anchor (DL-2.9); (4) a double-loaded 1.9-mm all-suture anchor (DL-1.9); (5) a single-loaded 1.7-mm all-suture anchor (SL-1.7); or (6) soft tissue tenodesis. Specimens then underwent load-to-failure axial traction testing. A generalized linear and latent mixed model with a random-effects term was used to account for specimen pairing. Mean failure loads ranged from 136 N (95% confidence interval, 103-169 N) in the cortical button group to 79 N (95% confidence interval, 58-99 N) in the interference screw group. Failure occurred most often when fixation sutures pulled out of the tendon; however, 7 specimens failed elsewhere. No significant differences in ultimate failure load were found by treatment group. The interference screw group showed significantly more weakness than the cortical button and DL-2.9 groups. Tendon quality and suture parameters are likely more important than the fixation technique in determining failure load. [Orthopedics. 2020;43(2):e102-e108.].
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Christian DR, Redondo ML, Cvetanovich GL, Beer AJ, Cole BJ. Mini-Open Subpectoral Biceps Tenodesis With an All-Suture Anchor. OPER TECHN SPORT MED 2018. [DOI: 10.1053/j.otsm.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Voss A, Imhoff AB, Dyrna F. Intra-Articular Tenodesis of the Long Head of the Biceps Tendon. OPER TECHN SPORT MED 2018. [DOI: 10.1053/j.otsm.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Altintas B, Pitta R, Fritz EM, Higgins B, Millett PJ. Technique for Type IV SLAP Lesion Repair. Arthrosc Tech 2018; 7:e337-e342. [PMID: 29868401 PMCID: PMC5981853 DOI: 10.1016/j.eats.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/07/2017] [Indexed: 02/03/2023] Open
Abstract
Type IV SLAP tears involve bucket-handle tears of the superior labrum with the tears extending into the biceps tendon. Surgical treatment options involve either primary repair or biceps tenodesis. Recent literature has shown good clinical outcomes after subpectoral biceps tenodesis for the treatment of type II and IV SLAP lesions. The purpose of this article is to present our technique for arthroscopic superior labrum repair with suture anchors and open subpectoral biceps tenodesis with an interference screw.
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Affiliation(s)
- Burak Altintas
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Rafael Pitta
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Erik M. Fritz
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Brendan Higgins
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,The Steadman Clinic, Vail, Colorado, U.S.A
| | - Peter J. Millett
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,The Steadman Clinic, Vail, Colorado, U.S.A.,Address correspondence to Peter J. Millett, M.D., M.Sc., The Steadman Clinic, 181 W Meadow Dr, Ste 400, Vail, CO 81657, U.S.A.
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Corpus KT, Garcia GH, Liu JN, Dines DM, O’Brien SJ, Dines JS, Taylor SA. Long Head of Biceps Tendon Management: a Survey of the American Shoulder and Elbow Surgeons. HSS J 2018; 14:34-40. [PMID: 29398992 PMCID: PMC5786587 DOI: 10.1007/s11420-017-9575-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Management of symptomatic long head of biceps tendon (LHBT) pathology remains a source of debate. QUESTIONS/PURPOSES The purpose of this study was to identify consensus trends for the treatment of LHBT pathology among specialists. METHODS A survey was distributed to members of the American Shoulder and Elbow Society (ASES), consisting of three sections-demographics, case scenarios, and general LHBT pathology management. Cases presented common clinical scenarios, and surgeons reported their management preferences. Consensus responses were defined as > 50% of participants giving a single response. RESULTS One hundred and forty-two of 417 (34%) surgeons completed surveys. Forty-seven percent of questions reached a consensus answer. Biceps tenodesis was the overwhelmingly preferred technique in cases demonstrating LHBT pathology, as compared to tenotomy. No consensus, however, was reached regarding a specific surgical technique for biceps tenodesis. The two most popular techniques were arthroscopic tenodesis to bone and open subpectoral biceps tenodesis. Fellowship-trained arthroscopic surgeons and surgeons with a largely arthroscopic practice were more likely to perform tenodesis arthroscopically. CONCLUSION ASES members favored biceps tenodesis over tenotomy for surgical management of LHBT pathology, without consensus regarding a specific surgical technique.
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Affiliation(s)
- Keith T. Corpus
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Grant H. Garcia
- Rush University Sports and Shoulder Department, Chicago, IL USA
| | - Joseph N. Liu
- Rush University Sports and Shoulder Department, Chicago, IL USA
| | - David M. Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Stephen J. O’Brien
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Joshua S. Dines
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Samuel A. Taylor
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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10
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Voss A, Cerciello S, DiVenere J, Solovyova O, Dyrna F, Apostolakos J, Lam D, Cote MP, Beitzel K, Mazzocca AD. Open subpectoral biceps tenodesis in patients over 65 does not result in an increased rate of complications. BMC Musculoskelet Disord 2017; 18:430. [PMID: 29110652 PMCID: PMC5674689 DOI: 10.1186/s12891-017-1780-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/11/2017] [Indexed: 12/03/2022] Open
Abstract
Background Long head biceps tendon pathology is a common cause of anterior shoulder pain and is often associated with other shoulder conditions, such as rotator cuff tears and osteoarthritis. It is well accepted that older patients are at increased risk for major and minor peri- and postoperative complications. The purpose of this study is to investigate patients over 65 years old who underwent subpectoral biceps tenodesis and compare the complication rates of this group to those of patients younger than 65 years old. The hypothesis is, that there would be no difference in complication rates and that clinical outcome scores for patients over 65 were satisfying and showed improvements over time. Methods There were 337 patients who underwent open subpectoral biceps tenodesis, between January 2005 and June 2015, 23 were identified as being over the age of 65 with a minimum follow up of 12 months. All patients over the age of 65 were evaluated pre- and postoperatively using Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), Constant-Murley (CM) and Single Assessment Numeric Evaluation (SANE). Intraoperative and postoperative adverse events (fracture, infection, wound opening, rupture/failure and neurovascular injuries) related to the tenodesis procedure and to the surgery itself were collected from all 337 patients in a routine postoperative follow-up. Results The under 65 group (range 27–64 years) at an average follow up (FU) of 30 months (range 12–91 months) showed a 5.4% (17 out of 314) post-operative complication rate related to the subpectoral tenodesis, whereas the group over 65 (range 65–77 years) at an average follow up of 33 months (range 12–79 months) showed an 8.7% (2 out of 23) complication rate. Conclusion This study demonstrates that in patients over the age of 65, biceps tenodesis is a successful procedure when performed for biceps tendinopathy and concomitantly with other surgical procedures of the shoulder, and does not result in an increased rate of complications when compared to a group of patients under the age of 65.
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Affiliation(s)
- Andreas Voss
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA. .,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
| | - Simone Cerciello
- Department of Orthopaedic Surgery, Casa di Cura Villa Betania, Rome, Italy.,Department of Orthopaedic Surgery, Marrelli Hospital, Crotone, Italy
| | - Jessica DiVenere
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA
| | - Olga Solovyova
- Department of Orthopaedic Surgery, NYU Hospital for Joint Disesases, New York, NY, USA
| | - Felix Dyrna
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA
| | - John Apostolakos
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA
| | - David Lam
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT, USA
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Cook JB, Sedory DM, Freidl MC, Adams DR. Low incidence of failure after proximal biceps tenodesis with unicortical suture button. J Orthop 2017; 14:384-389. [PMID: 28701853 DOI: 10.1016/j.jor.2017.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 06/22/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Recent interest in suture button fixation has developed with regard to proximal biceps tenodesis fixation. Biomechanical studies have demonstrated viability of a unicortical suture button technique in vitro. Despite this, no clinical data has been reported to validate the biomechanical data. The purpose of this study is to report on complication and failure rates in the early postoperative period after bicep tenodesis with a unicortical suture button. METHODS A retrospective review was performed of all biceps tenodesis performed at our institution over a 36-month period using a unicortical suture button for fixation. All included patients had a minimum 12 weeks follow up. Failures were defined as complete loss of fixation, change in biceps contour during the early postoperative period, acute pain at the tenodesis site, or acute loss of supination strength. RESULTS 145 of 166 biceps tenodesis procedures performed by the 4 surgeons at our institution met inclusion criteria. 80.1% of the patients were active duty military at the time of surgery. The average age was 38.2 years. There were 7 total complications (4.8%), including one failure (0.7%) requiring revision. CONCLUSION Failure and complication rates in the early postoperative period using a unicortical suture button for biceps tenodesis fixation are consistent with other reported techniques. This study adds clinical data to the existing biomechanical reports that this technique is strong enough to provide stable fixation of the biceps tendon to allow healing of the tendon to the humerus.
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Affiliation(s)
- Jay B Cook
- Orthopaedic Surgery Department, Winn Army Community Hospital, 1061 Harmon Ave., Fort Stewart, GA 31324, United States
| | - David M Sedory
- Orthopaedic Surgery Department, Winn Army Community Hospital, 1061 Harmon Ave., Fort Stewart, GA 31324, United States
| | - Michael C Freidl
- Orthopaedic Surgery Department, Winn Army Community Hospital, 1061 Harmon Ave., Fort Stewart, GA 31324, United States
| | - Douglas R Adams
- Orthopaedic Surgery Department, Winn Army Community Hospital, 1061 Harmon Ave., Fort Stewart, GA 31324, United States
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12
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Gervasi E, Sebastiani E, Cautero E. No-holes transpectoral tenodesis technique vs tenotomy of the long head of the biceps brachii. Muscles Ligaments Tendons J 2017; 6:427-432. [PMID: 28217562 DOI: 10.11138/mltj/2016.6.4.427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is no univocal consensus regarding Long Head of the Biceps (LHB) best treatment between tenotomy and tenodesis. There is no consensus regarding the best location to perform the tenodesis. The LHB tenodesis performed by the proximal tendon excision as first step can miss the proper tension to the muscle belly. Fixations proximal to the pectoralis major can lead to groove pain. This study aims to test the efficacy of a new LHB tenodesis technique by comparing its results with the tenotomy. METHODS We retrospectively evaluated patients who underwent surgery between May 2014 and May 2015. The mean follow up was 14.7 months. Sixteen patients underwent mini-open tenodesis to the Pectoralis Major tendon by the use of a resorbable suture (TD group); sixteen underwent tenotomy (TT group). The mean age of the TD group was 54 years; the mean age of the TT group was 56 years. We evaluated pain, subjective perception of the patient of possible aesthetic and strength differences between the two biceps, "Popeye sign", and tests to stimulate the LHB. We administered three evaluation questionnaires: the ASES score, the SPADI score, and the SST. RESULTS 32 consecutive patients were evaluated. The clinical scores did not record statistically significant differences: the mean ASES score was 92.9 (TD) and 90.8 (TT); the mean SPADI score was 92.5 (TD), and 89.7 (TT); the mean SST was 8.9 (TD), and 8.4 (TT). Compared to the TD group, in the TT group we registered with greater frequency the "Popeye sign" with a P value < 0.05 (9 cases vs 1), and spasms in the biceps muscle belly (5 cases vs 1). All other signs or symptoms evaluated were more frequent in the TT group, except the strength difference perceived by the patient (3 patients in the TT group, and 2 in the TD group). No complications were recorded. CONCLUSIONS This new Long Head of the Biceps (LHB) tenodesis technique is valuable and reliable, and provided better results than tenotomy. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Enrico Gervasi
- Department of Orthopaedics and Traumatology, Ospedale Civile di Latisana (UD), Italy
| | - Enrico Sebastiani
- Department of Orthopaedics and Traumatology, Ospedale Civile di Latisana (UD), Italy
| | - Enrico Cautero
- Department of Orthopaedics and Traumatology, Ospedale Civile di Latisana (UD), Italy
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Pogorzelski J, Beitzel K, Imhoff AB, Millett P, Braun S. [Surgical treatment of anterosuperior impingement of the shoulder]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2016; 28:418-429. [PMID: 27484678 DOI: 10.1007/s00064-016-0463-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/14/2016] [Accepted: 03/19/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Therapy of intraarticular lesions and elimination of structural risk factors for those suffering from clinical manifest anterosuperiorer impingement (ASI) of the shoulder. This includes as a maximum version the arthroscopic repair of supraspinatus (SST) and subscapularis tendon (SCT) tears with subsequent subpectoral tenodesis of the long head of the biceps tendon (LBT) and arthroscopic coracoplasty. INDICATIONS Clinical manifest anterosuperiorer impingement of the shoulder with anterior shoulder pain, failed conservative treatment and clear intraarticular damage in radiological imaging. This involves in detail lesions of the SST, SCT and damage to the LBT. CONTRAINDICATIONS Lack of structural intraarticular lesions or massive osteoarthritis. Persistent dysfunction of active and passive glenohumeral and scapulathoracal motion, due to neurologic deficits or stiff shoulder. A hypertrophic or deformed healed coracoid process is seen as a structural risk factor for suffering from ASI and should be addressed surgically when causing impingement. SURGICAL TECHNIQUE Arthroscopic tenotomy of the LBT with subsequent repair of the SST and SCT. Arthroscopic coracoplasty if indicated and subpectoral tenodesis of the long head of the biceps. POSTOPERATIVE MANAGEMENT No biceps activity and intermittent immobilization in sling for 6 weeks. Limitation of abduction, flexion and external rotation for 6 weeks depending on rotator cuff tendon repair. Start of sport-specific training after 3 months, over-head sports 6 months postoperatively. RESULTS The arthroscopic repair of anterosuperior rotator cuff tears provides reliable results for improvement in function, decreases in pain and improvement in shoulder scores. The overall rate of adverse events is low.
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Affiliation(s)
- J Pogorzelski
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - K Beitzel
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - A B Imhoff
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | | | - S Braun
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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