Rotator Manşet Tedavisi Sırasında Biseps Uzun Başı Patolojilerinin Tedavisinde Artroskopik Tenodez Ve Tenotominin Sonuçlarının Karşılaştırılması

Year 2021, Volume: 5 Issue: 2, 195 - 201, 30.08.2021

Mustafa Özçamdallı Gökay Eken Mahmut Günay Mehmet Yetiş Turan Bilge Kızkapan

https://doi.org/10.30565/medalanya.783683

Abstract

Amaç: Tam kat rotator manşet yırtıkları sıklıkla biseps uzun başı tenonu patolojileri ile birlikte görülmektedir. Bu çalışmanın amacı artroskopik rotator manşet tamiri yapılan ve ek olarak biseps uzun başı tendon patolojisi nedeniyle tenodez ve tenotomi tedavisi yapılan hastaların klinik skor, komplikasyon oranı ve işe dönüş oran ve zamanlarını karşılaştırmaktır.

Yöntemler: 129 artroskopik rotator manşet onarımı yapılan hasta 2 gruba ayrıldı. 1. Grupta biseps tenodezi uygulanan 62 hasta, 2. Grupta biseps tenotomisi uygulanan 67 hasta bulunmakta idi. Demografik ve klinik bulgular, komplikasyonlar, American Shoulder and Elbow Surgeons (ASES), Constant Murley (CM), Visual analogue scale (VAS) ve 36-item Short Form (SF-36) alt skorları değerlendirildi.

Bulgular: Ortalama takip süresi 13.68±4.22 ay idi. Ortalama ASES, CM, VAS ve SF-36 skorlarına bakıldığında gruplar arasında postoperatif ve preoperatif-postoperatif fark değerlerinde anlamlı fark bulunamadı. Popeye bulgusu 2. Grupta 13 (%19,4) hastada pozitif iken 1. Grupta hiçbir hastada görülmedi (p<0.001). Diğer kompikasyon oranlarında gruplar arasında anlamlı fark saptanmadı.

Sonuç: Artroskopik rotator manşet tamiri yapılan hastalarda, biseps tenodezi ve tenotomisi bisep uzun baş patolojilerinde klinik olarak iyi sonuç veren tedavi metodlarıdır. Teknik olarak daha zor ve maliyetli tenodez yerine tenotominin güvenle tercih edilebileceğini düşünmekteyiz.

Keywords

Biseps tendonu, tenotomi, tenodez, omuz artroskopisi

Comparing the outcomes of arthroscopic tenodesis versus tenotomy for the treatment of the long head of biceps tendon pathologies during supraspinatus tendon repair

Abstract

Aim: Long head of the biceps tendon pathologies are frequently accompany full-thickness rotator cuff tear. The purpose of this study was to compare functional scores, complication rates, and time to return to work after tenotomy and tenodesis who underwent arthroscopic supraspinatus repair (ASR).

Methods: Overall, 129 patients who underwent ASR surgery were divided into 2 groups. Group 1 consists of 62 patients underwent biceps tenodesis and group 2 consists of 67 patients underwent biceps tenotomy. We evaluated demographic data, clinical findings, complications and American Shoulder and Elbow Surgeons, Constant Murley, Visual analogue scale and 36-item Short Form subscale scores.

Results: Mean follow-up time was 13.68±4.22 months. Mean postoperative and preoperative-postoperative differences of ASES, CM, VAS and SF-36 subscale scores were not significantly different between two groups. Popeye sign was positive for 13 (19.4%) patients in group 2, however, none of patients in group 1 was positive (p<0.001). Other complications were not significantly different between two groups.

Conclusion: The results show that arthroscopic biceps tenotomy and tenodesis are both viable treatments for proximal biceps tendon pathology, yielding similar clinical outcomes in the context of concomitant rotator cuff repair. Tenotomy can be chosen instead of tenodesis which is technically more difficult and expensive.

Keywords

tenodesis,, shoulder arthroscopy,, tenotomy,, biceps tendon,

References

• 1. Chalmers PN, Granger E, Nelson R, Yoo M, Tashjian RZ. Factors Affecting Cost, Outcomes, and Tendon Healing After Arthroscopic Rotator Cuff Repair. Arthroscopy 2018;34(5):1393-400. DOI: 10.1016/j.arthro.2017.11.015.
• 2. Mardani-Kivi M, Keyhani S, Ebrahim-Zadeh MH, Hashemi-Motlagh K, Saheb-Ekhtiari K. Rotator cuff tear with concomitant long head of biceps tendon (LHBT) degeneration: what is the preferred choice? Open subpectoral versus arthroscopic intraarticular tenodesis. J Orthop Traumatol 2019;20(1):26. DOI: 10.1186/s10195-019-0531-5.
• 3. Shang X, Chen J, Chen S. A meta-analysis comparing tenotomy and tenodesis for treating rotator cuff tears combined with long head of the bicep’s tendon lesions. PLoS One 2017;12(10):e0185788. DOI: 10.1371/journal.pone.0185788.
• 4. Ahrens PM, Boileau P. The long head of biceps and associated tendinopathy. J Bone Joint Surg Br 2007;89(8):1001-9. DOI: 10.1302/0301-620x.89b8.19278.
• 5. Dwyer C, Kia C, Apostolakos JM, DiVenere J, Dyrna F, Cote M, et al. Clinical Outcomes After Biceps Tenodesis or Tenotomy Using Subpectoral Pain to Guide Management in Patients With Rotator Cuff Tears. Arthroscopy 2019;35(7):1992-2000. DOI: 10.1016/j.arthro.2019.02.017.
• 6. Belay ES, Wittstein JR, Garrigues GE, Lassiter TE, Scribani M, Goldner RD, et al. Biceps tenotomy has earlier pain relief compared to biceps tenodesis: a randomized prospective study. Knee Surg Sports Traumatol Arthrosc 2019;27(12):4032-7. DOI: 10.1007/s00167-019-05682-1.
• 7. MacDonald P, Verhulst F, McRae S, Old J, Stranges G, Dubberley J, et al. Biceps Tenodesis Versus Tenotomy in the Treatment of Lesions of the Long Head of the Biceps Tendon in Patients Undergoing Arthroscopic Shoulder Surgery: A Prospective Double-Blinded Randomized Controlled Trial. Am J Sports Med 2020;48(6):1439-49. DOI: 10.1177/0363546520912212.
• 8. Castricini R, Familiari F, De Gori M, Riccelli DA, De Benedetto M, Orlando N, et al. Tenodesis is not superior to tenotomy in the treatment of the long head of biceps tendon lesions. Knee Surg Sports Traumatol Arthrosc 2018;26(1):169-75. DOI: 10.1007/s00167-017-4609-4.
• 9. De Carli A, Vadala A, Zanzotto E, Zampar G, Vetrano M, Iorio R, et al. Reparable rotator cuff tears with concomitant long-head biceps lesions: tenotomy or tenotomy/tenodesis? Knee Surg Sports Traumatol Arthrosc 2012;20(12):2553-8. DOI: 10.1007/s00167-012-1918-5.
• 10. Meraner D, Sternberg C, Vega J, Hahne J, Kleine M, Leuzinger J. Arthroscopic tenodesis versus tenotomy of the long head of biceps tendon in simultaneous rotator cuff repair. Arch Orthop Trauma Surg 2016;136(1):101-6. DOI: 10.1007/s00402-015-2343-2.
• 11. DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am 1984;66(4):563-7. PMID: 6707035.
• 12. Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, et al. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 1994;3(6):347-52. DOI: 10.1016/S1058-2746(09)80019-0.
• 13. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987(214):160-4. PMID: 3791738.
• 14. Boonstra AM, Schiphorst Preuper HR, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res 2008;31(2):165-9. DOI: 10.1097/MRR.0b013e3282fc0f93.
• 15. Laucis NC, Hays RD, Bhattacharyya T. Scoring the SF-36 in Orthopaedics: A Brief Guide. J Bone Joint Surg Am 2015;97(19):1628-34. DOI: 10.2106/JBJS.O.00030.
• 16. Hufeland M, Wicke S, Verde PE, Krauspe R, Patzer T. Biceps tenodesis versus tenotomy in isolated LHB lesions: a prospective randomized clinical trial. Arch Orthop Trauma Surg 2019;139(7):961-70. DOI: 10.1007/s00402-019-03136-4.
• 17. Oh JH, Lee YH, Kim SH, Park JS, Seo HJ, Kim W, et al. Comparison of Treatments for Superior Labrum-Biceps Complex Lesions With Concomitant Rotator Cuff Repair: A Prospective, Randomized, Comparative Analysis of Debridement, Biceps Tenotomy, and Biceps Tenodesis. Arthroscopy 2016;32(6):958-67. DOI: 10.1016/j.arthro.2015.11.036.
• 18. Lee HJ, Jeong JY, Kim CK, Kim YS. Surgical treatment of lesions of the long head of the biceps brachii tendon with rotator cuff tear: a prospective randomized clinical trial comparing the clinical results of tenotomy and tenodesis. J Shoulder Elbow Surg 2016;25(7):1107-14. DOI: 10.1016/j.jse.2016.02.006.
• 19. Leroux T, Chahal J, Wasserstein D, Verma NN, Romeo AA. A Systematic Review and Meta-analysis Comparing Clinical Outcomes After Concurrent Rotator Cuff Repair and Long Head Biceps Tenodesis or Tenotomy. Sports Health 2015;7(4):303-7. DOI: 10.1177/1941738114539627.
• 20. Delle Rose G, Borroni M, Silvestro A, Garofalo R, Conti M, De Nittis P, et al. The long head of biceps as a source of pain in active population: tenotomy or tenodesis? A comparison of 2 case series with isolated lesions. Musculoskelet Surg 2012;96 Suppl 1:S47-52. DOI: 10.1007/s12306-012-0189-0.
• 21. Godeneche A, Kempf JF, Nove-Josserand L, Michelet A, Saffarini M, Hannink G, et al. Tenodesis renders better results than tenotomy in repairs of isolated supraspinatus tears with pathologic biceps. J Shoulder Elbow Surg 2018;27(11):1939-45. DOI: 10.1016/j.jse.2018.03.030.
• 22. Aflatooni JO, Meeks BD, Froehle AW, Bonner KF. Biceps tenotomy versus tenodesis: patient-reported outcomes and satisfaction. J Orthop Surg Res 2020;15(1):56. DOI: 10.1186/s13018-020-1581-3.
• 23. Hassan S, Patel V. Biceps tenodesis versus biceps tenotomy for biceps tendinitis without rotator cuff tears. J Clin Orthop Trauma 2019;10(2):248-56. DOI: 10.1016/j.jcot.2018.12.013.
• 24. Park JS, Kim SH, Jung HJ, Lee YH, Oh JH. A Prospective Randomized Study Comparing the Interference Screw and Suture Anchor Techniques for Biceps Tenodesis. Am J Sports Med 2017;45(2):440-8. DOI: 10.1177/0363546516667577.