The role of the long head of the biceps tendon in posterior shoulder stabilization during forward flexion

Long head of the biceps tendon versatility in reconstructive shoulder surgery: a narrative review of arthroscopic techniques and their biomechanical principles with video presentation

The management of the long head of the biceps tendon (LHBT) during shoulder arthroscopy has been a subject of controversy for many years, with evolving discussions and trends. Despite long-standing debate, the nature of the surgical indication regarding how to treat concomitent LHBT injuries has undergone changes in recent years. It now extends beyond the timing of tenotomy to encompass considerations of alternative methods for preserving the LHBT, along with an ongoing exploration of how it can be effectively utilized in reconstructive shoulder surgery. Recent techniques describe approaches to using LHBT in a wide range of procedures, from shoulder instability to rotator cuff tears. Additionally, LHBT-based reconstructive techniques have surfaced for addressing what were formerly denoted as irreparable rotator cuff tears. While current literature provides detailed anatomical descriptions of the LHBT and many reports of novel, advanced techniques, there is still much debate regarding the decision-making process in each case. Because of the growing number of emerging techniques and the escalating debate in the subsequent paper, a decision has been made to present the current literature review concerning the potential utilization of LHBT in shoulder arthroscopy. In a dedicated video, we demonstrate the main arthroscopic techniques employed by the authors in their daily practice.

Complete Restoration of Native Glenoid Width Improves Glenohumeral Biomechanics After Simulated Latarjet

BACKGROUND

The amount of glenoid width that must be restored with a Latarjet procedure in order to reestablish glenohumeral stability has not been determined.

PURPOSE/HYPOTHESIS

The purpose of this article was to determine the percentage of glenoid width restoration necessary for glenohumeral stability after Latarjet by measuring anterior humeral head translation and force distribution on the coracoid graft. The hypothesis was that at least 100% of glenoid width restoration with Latarjet would be required to maintain glenohumeral stability.

STUDY DESIGN

Controlled laboratory study.

METHODS

Nine cadaveric shoulders were prepared and mounted on an established shoulder simulator. A lesser tuberosity osteotomy (LTO) was performed to allow accurate removal of glenoid bone. Coracoid osteotomy was performed, and the coracoid graft was sized to a depth of 10 mm. Glenoid bone was sequentially removed, and Latarjet was performed using 2 screws to reestablish 110%, 100%, 90%, and 80% of native glenoid width. The graft was passed through a subscapularis muscle split, and the LTO was repaired. A motion tracking system recorded glenohumeral translations, and force distribution was recorded using a TekScan pressure sensor secured to the glenoid face and coracoid graft. Testing conditions included native; LTO; Bankart tear; and 110%, 100%, 90%, and 80% of glenoid width restoration with Latarjet. Glenohumeral translations were recorded while applying an anteroinferior load of 44 N at 90° of humerothoracic abduction and 0° or 45° of glenohumeral external rotation. Force distribution was recorded without an anteroinferior load.

RESULTS

Anterior humeral head translation progressively increased as the proportion of glenoid width restored decreased. A marked increase in anterior humeral head translation was found with 90% versus 100% glenoid width restoration (10.8 ± 3.0 vs 4.1 ± 2.6 mm, respectively; P < .001). Greater glenoid bone loss also led to increased force on the coracoid graft relative to the native glenoid bone after Latarjet. A pronounced increase in force on the coracoid graft was seen with 90% versus 100% glenoid width restoration (P < .001).

CONCLUSION

Anterior humeral head translation and force distribution on the coracoid graft dramatically increased when <100% of the native glenoid width was restored with a Latarjet procedure.

CLINICAL RELEVANCE

If a Latarjet is unable to fully restore the native glenoid width, surgeons should consider alternative graft sources to minimize the risk of recurrent instability or coracoid overload.

Massive and Irreparable Rotator Cuff Tears: A Review of Current Definitions and Concepts

Background

While massive and irreparable rotator cuff tears (MIRCTs) have been abundantly studied, inconsistent definitions in the literature and theories about pain and dysfunction related to them can be difficult to navigate when considering an individual patient.

Purpose

To review the current literature for definitions and critical concepts that drive decision-making for MIRCTs.

Study Design

Narrative review.

Methods

A search of the PubMed database was performed to conduct a comprehensive literature review on MIRCTs. A total of 97 studies were included.

Results

Recent literature reflects added attention to clarifying the definitions of "massive, "irreparable," and "pseudoparalysis." In addition, numerous recent studies have added to the understanding of what generates pain and dysfunction from this condition and have reported on new techniques for addressing them.

Conclusion

The current literature provides a nuanced set of definitions and conceptual foundations on MIRCTs. These can be used to better define these complex conditions in patients when comparing current surgical techniques to address MIRCTs, as well as when interpreting the results of new techniques. While the number of effective treatment options has increased, high-quality and comparative evidence on treatments for MIRCTs is lacking.