Tenotomia artroscópica do bíceps nas lesões irreparáveis do manguito rotador (original) (raw)
Related papers
Revista Brasileira de Ortopedia, 2008
Objective: In this study we aim at statistically evaluating the results of the surgical treatment of the osteoarthrosis of the shoulder (OAS) with partial shoulder arthroplasty (PSA) and at correlating them with the several variables involved. Methods: In this study we evaluated 36 shoulders of 31 patients with OAS who underwent treatment with PSA in the Grupo . Patients who underwent PSA and who had a post-operative follow-up of at least 12 months were included in the study. Results: After the surgery the range of elevation, external rotation, internal rotation and the UCLA scale improved (with average differences of 35 o , 27 o , 4 o and 17 points, respectively), with a significant level of 5% (p < 0.05). For the same level of significance, the relation between a satisfactory UCLA and two variables was found: patients with maximum age of 60 years old at the moment of the surgery and patients that underwent tenotomy of the long head of biceps. Conclusion: Patients under 60 who underwent surgery and patients who underwent tenotomy of the long head of biceps achieved better results.
Clinical and isokinetic comparison between tenotomy and tenodesis in biceps pathologies
Acta Orthopaedica et Traumatologica Turcica, 2011
The purpose of this study to compare clinical and isokinetic results of patients who underwent biceps tenotomy or tenodesis for chronic tenosynovitis. Methods: Arthroscopic biceps tenotomy, arthroscopy assisted or arthroscopic biceps tenodesis were done in 20 patients who had diagnosis of chronic tenosynovitis and in whom conservative treatment was not helpful. Rotator cuff repair and acromioplasty was performed in 18 patients and acromioplasty alone in two patients in addition to biceps surgery. Arthroscopic biceps tenotomy was done in 10 patients (5 female, 5 male; mean age 63, range 53-75), 10 patients underwent tenodesis out of which arthroscopy assisted biceps tenodesis was done in 8 patients and all arthroscopic biceps tenodesis was done in 2 patients (4 female, 6 male; mean age 57, range 49-66). All patients were evaluated with Constant and UCLA scores preoperatively and postoperatively. The average follow-up of the patients 3,1 years (between 1-8 years). Isokinetically elbow flexion and forearm supination were compared using the Cybex (Biodex 3, Cybex Biomedical System, NY, USA) machine. Pre-operative results of each group were compared with the postoperative results, using Mann-Whitney U test. Results: Preoperative average constant scores of tenotomy group were 64.40, whereas postoperative scores were 89.50 (p=0.002), and preoperative average constant scores of tenodesis group were 62.80, whereas postoperative scores were 86.70 (p=0.003). Preoperative average UCLA scores of tenotomy group were 23.20 whereas postoperative UCLA scores 22.60 (p=0.003), preoperative average UCLA scores of tenodesis group were 30.00 whereas postoperative UCLA scores was 29.20 (p=0.004). In both groups statistically significant improvement of UCLA and Constant scores was detected. Comparison between Constant, UCLA scores and isokinetic measurements of both groups showed no statistically significant difference (p>0.05). No complication was noted. Conclusion: In the treatment of chronic tenosynovitis, biceps tenodesis and tenotomy of long head of biceps showed similar clinical, functional, isokinetic and cosmetic results. No Popeye deformity was seen in the tenotomy group.
Biceps Tenodesis: An Evolution of Treatment
American journal of orthopedics (Belle Mead, N.J.)
The long head of the biceps (LHB) tendon is a potential generator of pain within the shoulder. Tenodesis of the LHB is a treatment option for several pathologic shoulder conditions. We conducted a study to determine trends in LHB tenodesis at a subspecialty-focused shoulder orthopedic practice. We hypothesized that the rate of LHB tenodesis would increase significantly over time and that there would be no significant change in the age of patients who underwent LHB tenodesis. Records of 4 fellowship-trained sports or shoulder/elbow orthopedic surgeons were used to identify total number of common arthroscopic shoulder surgeries performed between 2004 and 2014. Number of LHB tenodesis cases, combined or isolated, was recorded. Linear regression was used for analysis with significance set at P < .05. Of the 7640 patients who underwent arthroscopic shoulder procedures between 2004 and 2014, 2125 had LHB tenodesis. Mean (SD) age of the subgroup was 49.33 (13.2) years, and mean (SD) num...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2004
Surgical treatment of symptomatic pathology of the long head of the biceps tendon generally consists of either biceps tenotomy or tenodesis. Biceps tenodesis is generally recommended for younger patients and has been well described using open techniques. With advancements in arthroscopic ability and equipment, new arthroscopic techniques have recently been reported. These techniques can be especially useful when used in conjunction with other arthroscopic procedures such as distal clavicle resection, rotator cuff repair, and subacromial decompression. We present a modification of the techniques suggested by other researchers. In this technique, a bone anchor is used as a pulley at the bottom of the tunnel to pull the tendon into position. This is followed by interference screw fixation. To our knowledge, this technique has not been previously described.
MUSCULOSKELETAL SURGERY, 2012
The tendon of the long head of the biceps (LHB) is a common source of pain in the shoulder, and the surgical treatments proposed are tenotomy or tenodesis performed in different ways. The purpose of this study is to compare the clinical results (objective and subjective) of tenotomy versus soft tissue tenodesis. One-hundred and four patients with an isolated LHB pathology, arthroscopically treated between 2004 and 2007, were observed retrospectively. Forty-eight of these patients were treated with tenotomy and 56 with a soft tissue tenodesis technique. All the patients were evaluated by an independent observer with a minimum follow-up of 2 years which included VAS, DASH questionnaire, Constant score and ROM evaluation with a goniometer. All these evaluations were performed pre- and post-operatively. An independent expert radiologist then performed an ultrasound examination only in the post-operative evaluation of the tenodesis group looking to confirm the effectiveness of the procedure. In both groups, the scores were significantly improved. In the tenotomy group, 16.6 % of the patients had bicipital cramps for a mean post-operative time of 1 month. Constant score improved in both groups: 46.6 to 86.1 in tenotomy group and 48.9-84.9 in tenodesis group; VAS improved from 8.4 to 1.5 in tenotomy group and from 8.8 to 1.4 in tenodesis group; DASH scores changed from 42.5 to 13.6 in tenotomy group and from 55.8 to 11.4 in tenodesis group. Popeye sign was present in 37.5 % in the tenotomy group and in 5.3 % in tenodesis group. In 3 patients of the tenodesis group, ultrasound revealed complete failure of the tenodesis. In conclusion, both procedures are effective in terms of treatment of LHB pathologies. Tenotomy does not require specific post-operative treatment and is easy to perform, but cramp and Popeye sign may occur after surgery. The soft tissue tenodesis technique is an easy and cost-effective way to perform tenodesis with good results, especially in preventing the Popeye sign, but requires a longer rehabilitation time. Level of evidence IV.
2013
patients with massive rotator cuff tear which include the rotator interval were treated with arthroscopic margin convergence of the posterior cuff to biceps tendon. Sixteen patients were female and four were male. The mean age was 58.95 years old. The dominant side was affected in 16 cases (80%). The outcomes were analysed according to the UCLA Score with a minimum follow-up period of two years. Results: The UCLA score improved, on average, 14 points (p < 0.001). Six patients had excellent results; nine good; three fair and two poor results. The mean improvement of forward flexion was 33 o (p < 0.001), 3 o of external rotation (p < 0.396) and two vertebral levels for internal rotation (p < 0.025). Conclusion: The arthroscopic margin convergence of the posterior cuff to the biceps tendon leads to satisfactory results.
BMC musculoskeletal disorders, 2017
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. 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), Ame...
Biceps tenodesis associated with arthroscopic repair of rotator cuff tears
Journal of Shoulder and Elbow Surgery, 2005
Associated lesions of the biceps tendon are commonly found during arthroscopic repair of rotator cuff tears. These lesions are treated with tenodesis, classically performed through an open approach. However, it seems reasonable to seek a single approach to correct both lesions; therefore, we have proposed a new arthroscopic technique that allows an exclusive arthroscopic tenodesis by including the biceps tendon in the rotator cuff suture, a surgical technique with a single suture of the rotator cuff that includes the biceps tendon. We treated 97 shoulders in 96 patients arthroscopically for complete rotator cuff tears. Of these shoulders, 15 required tenodesis for treatment of biceps tendon lesions. Through an arthroscopic approach, a subacromial decompression followed by a rotator cuff repair was carried out in association with a biceps tenodesis. In this technique, one limb of the suture was passed through the biceps tendon, and the other was passed through the rotator cuff tear, bringing both tissues together in the final suture. Of the patients, 9 were men and 5 were women. Their mean age was 71 years (range, 41–80 years). The dominant arm was affected in all patients. Postoperative evaluation, by use of the UCLA score, after a mean follow-up period of 32.4 months showed satisfactory results in 93.4% of patients: 11 had excellent results, 3 had good results, and only 1 had an unsatisfactory result. In this case a postoperative magnetic resonance imaging scan showed an intact rotator cuff and biceps tenodesis. The suture involving the rotator cuff and the biceps tendon proved effective to correct both lesions, with the main advantage being that an additional approach was not required.
Arthroscopic biceps tendon tenodesis: the anchorage technical note
Knee Surgery, Sports Traumatology, Arthroscopy, 2005
Treatment of pathology of long head biceps (LHB) tendon is an area of great debate among orthopaedic surgeons. Various opinions exist, in fact, about the role of LHB tendon in the shoulder biomechanics. Some authors ascribe it a role in stabilizing the glenohumeral joint [14, 17, 18], particularly during throwing motion [4] while other authors consider it a residual structure without any functional activity [9, 12]. Numerous authors have recommended tenotomy in cases of symptomatic tendonitis, partial or complete tears and subluxation or dislocation of LHB tendon [2, 8, 9]. Nevertheless, isolated tenotomy is criticized by authors who point out the role of LHB tendon as a secondary static depressor of the humeral head [3, 17]. This role seems to become most important in presence of rotator cuff pathology [19], confirmed by the flattening and hypertrophy of LHB tendon found in this setting. Interestingly, the rotator cuff lesions represent the most common cause of secondary LHB tendon abnormalities. Recently, developments in the field of research have better re-evaluated the role that the LHB tendon plays in rotator cuff diseases, with therapeutic consequences [21]. On the basis of its position, the LHB tendon operates like a superior belt of the humeral head and functions as a depressor of the same. Providing the tendon is positioned normally within its groove, the humeral head is able to glide on the tendon and the glenoid surface. However, when the rotator cuff is injured and the biceps