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Joaquin T, Bellaire C, Perraut G, Argintar E. BicepBrace biceps tendon augmentation improves outcomes one year following surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2025; 35:159. [PMID: 40232575 DOI: 10.1007/s00590-025-04285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 03/30/2025] [Indexed: 04/16/2025]
Abstract
PURPOSE This study emphasizes the clinical utility of our newly published "BicepBrace" technique by comparing its preliminary outcomes with standard treatment within the short term follow-up of 12 months following massive rotator cuff repair surgery. METHODS A retrospective chart review of all the rotator cuff repairs by E.H.A. over a two year span was completed under institutional review board approval. Inclusion criteria included all adult patients who received primary massive rotator cuff repair within the time frame of June 15, 2021 and June 15, 2023. Exclusion criteria included non-massive rotator cuff repair, revision surgery, or rotator cuff repairs that were paired with total shoulder arthroplasty. These massive rotator cuff repairs were then evaluated for clinical failure necessitating revision surgery within 12 months of original repair. Statistical analyses were performed using t tests and chi square tests. RESULTS In total, 102 rotator cuff repairs were identified within the study timeframe. In total, 24 of these cases met criteria to be labeled as massive tears. In total, 13 of these massive tears were treated by standard technique and 11 of them were treated with our BicepBrace biceps tendon transfer technique. In total, 4 of the patients in the standard technique group were deemed clinical failures necessitating revision surgery (failure rate of 30.8%). Only one of the BicepBrace patients were deemed clinical failures (failure rate of 9.1%). CONCLUSION In the setting of a massive rotator cuff tear, the BicepBrace technique-utilizing the long head of the biceps tendon for superior cuff augmentation-may enhance the survivability of the repair within one year of surgery. This relatively new approach offers a promising alternative to standard techniques, particularly for certain patient populations.
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Thamrongskulsiri N, Limskul D, Tanpowpong T, Kuptniratsaikul S, Itthipanichpong T. Reduced retear rates yet similar clinical outcomes following arthroscopic partial repair of large and massive irreparable rotator cuff tears with biceps augmentation compared to repairs without biceps augmentation: A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2025; 33:1472-1487. [PMID: 39189109 DOI: 10.1002/ksa.12440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/18/2024] [Accepted: 08/02/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE To compare the clinical outcomes between arthroscopic partial rotator cuff repair with biceps augmentation (BA) and partial repair (PR) without BA. METHODS This systematic review included studies comparing outcomes of arthroscopic repair for large to massive irreparable rotator cuff tears with and without the BA. The focus was on postoperative clinical results and retear rates. Mean differences were used to express continuous outcomes, while odds ratios (ORs) were employed for dichotomous outcomes. RESULTS Ten studies (733 shoulders, all level 3 evidence) were included. The BA group showed a significant reduction in retear rates (OR = 0.40, 95% confidence interval [CI]: 0.20-0.77, P = 0.007) and comparable postoperative outcomes across various measures: American Shoulder and Elbow Surgeons (ASES) score, visual analogue scale for pain, University of California-Los Angeles shoulder score, active forward flexion motion and active external rotation at the arm-at-side position compared to the PR group. Subgroup analysis of two BA techniques-rerouting and supplementation following supraglenoid tenotomy-showed no significant differences in ASES score for either technique versus PR. However, rerouting significantly lowered retear rates (OR = 0.21, 95% CI: 0.12-0.36, p < 0.001), while supplementation showed similar retear rates to PR (OR = 0.87, 95% CI: 0.37-2.02, n.s.). CONCLUSION Arthroscopic partial rotator cuff repair with BA for large to massive irreparable rotator cuff tears is a reliable technique, resulting in improved postoperative outcomes. BA using supplementation following supraglenoid tenotomy showed similar clinical outcomes and range of motion but with lower retear rates compared to the PR group. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Napatpong Thamrongskulsiri
- Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Danaithep Limskul
- Department of Orthopaedics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Thanathep Tanpowpong
- Department of Orthopaedics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Somsak Kuptniratsaikul
- Department of Orthopaedics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Thun Itthipanichpong
- Department of Orthopaedics, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
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Paccot D, Fleet CT, Johnson JA, Athwal GS. Superior capsular reconstruction using the long head of biceps tendon: a biomechanical assessment of tenodesis location and angle of fixation. J Shoulder Elbow Surg 2025; 34:688-698. [PMID: 39153566 DOI: 10.1016/j.jse.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/07/2024] [Accepted: 07/04/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Massive irreparable rotator cuff tears (MIRCTs) treated with superior capsular reconstruction (SCR) using the long head of the biceps tendon have shown satisfactory early results. Different techniques and positions for biceps tenodesis have been described. This study aimed to evaluate the effect of tenodesis location and glenohumeral fixation angle for graft tensioning on the biomechanics of an SCR using a single-strand biceps technique. METHODS Eight cadaveric shoulders were mounted onto a custom biomechanical simulator that used static tone loads to the deltoid and rotator cuff muscles. All cadavers were first tested in the intact condition, and then in the simulated MIRCT condition by sectioning the tendinous insertions of the supraspinatus and upper border of the infraspinatus. SCR using the long head of the biceps tendon was then evaluated. Three biceps tenodesis locations relative to the greater tuberosity (anterior, middle, and posterior) and 2 glenohumeral fixation angles (0° and 30°) for graft tensioning were tested. An optical tracking system was used to quantify superior-inferior and anterior-posterior humeral head translation relative to the glenoid, whereas the functional abduction force was quantified using a load sensor. All tests were conducted at 0°, 30°, and 60° of glenohumeral abduction in a randomized fashion. RESULTS When assessing isolated superior humeral head migration, all biceps tenodesis locations were effective at decreasing superior migration, with no tenodesis location significantly better than the other (P = .213). However, biceps grafts tensioned at 30° of glenohumeral abduction were significantly better at reducing proximal humeral migration as compared to graft tensioning at 0° abduction (P = .008). Posterior humeral head translation observed in the MIRCT condition was significantly reduced when tensioning the biceps tendon at 30° of glenohumeral abduction compared with 0° for all tenodesis locations (P ≤ .043). The tenodesis location also significantly influenced posterior humeral head translation (P = .001), with the middle and posterior positions restoring near normal humeral head position when fixed at 30° glenohumeral abduction. All SCR techniques using the biceps tendon improved the functional abduction force relative to the MIRCT condition, although no statistically significant differences were observed relative to the intact condition (P ≥ .448). DISCUSSION SCR using the long head of the biceps tendon is biomechanically effective in reducing posterosuperior translation of the humeral head in the setting of an MIRCT. Graft tensioning and fixation at 30° of glenohumeral abduction combined with either a middle or posterior tenodesis location on the greater tuberosity most effectively restores near normal time-zero humeral head kinematics.
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Affiliation(s)
- Daniel Paccot
- Roth | McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada
| | - Cole T Fleet
- Roth | McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - James A Johnson
- Roth | McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - George S Athwal
- Roth | McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Surgery, Western University, London, ON, Canada.
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Kim Y, Karl E, Ishijima M, Guy S, Jacquet C, Ollivier M. The potential of tendon autograft as meniscus substitution: Current concepts. J ISAKOS 2024; 9:100353. [PMID: 39427818 DOI: 10.1016/j.jisako.2024.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 10/01/2024] [Accepted: 10/16/2024] [Indexed: 10/22/2024]
Abstract
Meniscectomy is known to alter the mechanics, stability, and kinematics of the tibiofemoral joint, leading to early knee osteoarthritis (KOA). While several meniscal substitutions exist, such as meniscus allograft transplantation, collagen meniscus implants, and artificial substitutes, they often come with technical challenges, high costs, and risks, including allograft failure, infections, and disease transmission. Tendon autografts emerge as a promising option, offering safety, availability, biocompatibility, and a reduced risk of pathophoresis. This review delves into basic, in vivo, in vitro, and biomechanical studies alongside clinical outcomes and future prospects of tendon autografts as meniscus substitutes. A thorough understanding of this option is vital for integrating these evolving techniques into clinical practice and mitigating early KOA progression.
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Affiliation(s)
- Youngji Kim
- Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan; Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
| | - Eriksson Karl
- Department of Orthopaedics, Stockholm South Hospital, Institution for Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Muneaki Ishijima
- Department of Orthopaedics, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Sylvain Guy
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
| | - Christophe Jacquet
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France
| | - Matthieu Ollivier
- Institut du Mouvement et de l'appareil locomoteur, Hôpital Sainte-Marguerite, Aix-Marseille Université, Marseille, France.
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Fares MY, Abboud JA. Editorial Commentary: Arthroscopic Subscapular Sling Procedure for Anterior Glenohumeral Instability Has Limitations: Dynamic Anterior Stabilization Using Long Head of the Biceps Tendon May Represent a More Favorable Alternative. Arthroscopy 2024; 40:2553-2555. [PMID: 38705545 DOI: 10.1016/j.arthro.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
Anterior shoulder instability is common. Cases of mild glenoid bone loss are typically addressed with conventional arthroscopic Bankart repair procedures, whereas more critical glenoid bone loss often necessitates more invasive, bone-blocking procedures. Recently, for cases that fall between the need for arthroscopic repair and open procedures, surgeons have developed methods for using soft tissue grafts to create a "sling" effect and augment glenoid labral repair. The subscapular sling procedure aims to restore stability by introducing a semitendinosus autograft into the glenohumeral joint to reconstruct the torn labrum; the graft is wrapped around the subscapularis to create a suspensory sling. Limitations include harvest site morbidity; increased surgical time; subscapularis split, which can compromise the tendon integrity, resulting in loss of internal rotation; and a persistently positive apprehension test. Finally, the technique is complex, and similar alternatives with fewer limitations may include a dynamic anterior stabilization technique using the long head of the biceps tendon, which creates a stabilizing sling effect without graft harvest from the leg and has positive reported outcomes.
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Milano G, Colosio A, Minotta Quebradas MJ, Pratobevera A, Daffara V, Saccomanno MF. Biologic augmentation of rotator cuff repair with microfragmented autologous subacromial bursal tissue enveloped in a patch of compressed autologous long head of biceps tendon tissue: the Bio-Ravioli technique. JSES Int 2024; 8:1010-1015. [PMID: 39280168 PMCID: PMC11401564 DOI: 10.1016/j.jseint.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Abstract
Background Rotator cuff repair is one of the most frequently performed procedures in orthopedic surgery. However, considering the limited healing potential of rotator cuff tendons, several augmentation strategies have evolved to enhance tendon healing. The purpose of this article was to present a new surgical technique called Bio-Ravioli. Methods Patients with repairable full-thickness posterosuperior rotator cuff tear and a moderate-to-high risk of healing failure were chosen as candidates for the Bio-Ravioli procedure. It is a biologic augmentation strategy to increase healing potential of arthroscopic rotator cuff repair by use of a biologic graft fixed at the bone-tendon interface. The Bio-Ravioli consists of microfragmented autologous subacromial bursal tissue enveloped in a patch of compressed autologous long head of biceps tendon tissue. The rotator cuff is then repaired to the bone and over the graft using a transosseus equivalent configuration. Conclusion The Bio-Ravioli technique represents an easy and reliable way to increase the healing potential at the bone-tendon interface by using autologous mesenchymal stem cells from different sources: subacromial bursa and long head of the biceps tendon.
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Affiliation(s)
- Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Alessandro Colosio
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Andrea Pratobevera
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Valerio Daffara
- Department of Orthopaedic Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Maristella F Saccomanno
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
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Bonfatti R, Smith AF, Ledoux A, Lefebvre Y, Neyton L. "Shoe Shop" Lacing Technique: A New Biceps-Augmented Knotless Suture for Arthroscopic Rotator Cuff Repair. Arthrosc Tech 2024; 13:102980. [PMID: 39036405 PMCID: PMC11258873 DOI: 10.1016/j.eats.2024.102980] [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: 11/08/2023] [Accepted: 02/08/2024] [Indexed: 07/23/2024] Open
Abstract
Advancements in rotator cuff tear repair have led to innovative techniques for complex cases. In this article, we introduce the "shoe shop" lacing technique, a knotless, side-to-side, and tendon-to-bone suture method augmented with the long head of the biceps tendon (LHBT) for anterior margin-deficient massive rotator cuff tears. This approach offers simplicity, durability, and potential advantages in biomechanics. The LHBT integration and knotless sutures make it a promising solution for challenging tear patterns. This technique provides an attractive option for arthroscopic repair, improving outcomes in cases where anterior cable reinforcement is essential.
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Affiliation(s)
- Rocco Bonfatti
- Orthopaedic Surgery and Traumatology Department, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Yves Lefebvre
- Clinique Rhena, Chirurgie orthopédique et traumatologique, Strasbourg, France
| | - Lionel Neyton
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
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Burns KA. Anterior Labral Reconstruction With Biceps Autograft for Anterior Shoulder Instability. Arthrosc Tech 2024; 13:102935. [PMID: 38690329 PMCID: PMC11056781 DOI: 10.1016/j.eats.2024.102935] [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: 09/28/2023] [Accepted: 12/22/2023] [Indexed: 05/02/2024] Open
Abstract
Shoulder instability is a common problem, with current research focused on understanding the implications of humeral and glenoid bone loss. Soft tissue injury, including damage to the anterior labrum, deformity of the capsule, and disruption of the inferior glenohumeral ligament, also contributes to the pathology of shoulder dislocation with implications for recurrent instability. Anatomic placement of the labral tissue and restoration of capsular tension are essential components of successful arthroscopic Bankart repair (ABR). Patients who meet criteria for ABR with a diminutive, ruptured, or absent anterior labrum at the time of arthroscopic stabilization present a significant challenge to repair. In this Technical Note, we demonstrate a technique using biceps autograft to reconstruct the anterior labrum.
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