Effects of Biceps Tenotomy on The Shoulder Joint in the Treatment of Slap Lesions

Yıl 2025, Cilt: 20 Sayı: 3, 179 - 185

Caner Poyraz , Vahit Yıldız

https://doi.org/10.17517/ksutfd.1570649

Öz

Objective: This study aimed to investigate the radiologic and clinical changes in the shoulder joint after biceps tenotomy for isolated SLAP (Superior Labrum Anterior to Posterior) lesions.
Material and Methods: A total of 380 patients who underwent shoulder arthroscopy for SLAP lesions between September 2015 and September 2019 in our center were retrospectively analyzed. The study included 44 patients who met the inclusion criteria (isolated SLAP lesion, biceps tenotomy, no shoulder instability, no advanced shoulder arthrosis, no additional shoulder pathology, follow-up period longer than 1 year). Post operative and pre-operative values of the patients were compared with clinical and radiologic measurements. In clinical evaluation; UCLA, Constant, VAS, DASH scoring system and muscle strength were compared. In radiologic evaluation; Superior Humeral Migration, Coracohumeral Distance, Acromiohumeral Distance, Critical Shoulder Angle, Acromial Index were compared.
Results: Among the 44 patients included in the study, 18 were female and 26 were male. The mean age of the patients was 51 years and the mean follow-up period was 32.2 months. In the preoperative measurements of the patients, Coracohumeral Distance: 11.5 ± 2.4 mm, Superior Migration of the Humeral Head: 3.4 ± 1.0 mm. In the postoperative group measurements, Coracohumeral Distance: 8.4 ± 1.4 mm, Superior Migration of the Humeral Head: 4.5 ± 1.3 mm. When these values were compared, the changes in the SHY and KH distance values were statistically significant (p=0.031, p=0.012). Significant improvements were observed in all functional measurements and scoring systems within the scope of clinical evaluations.
Conclusion: Biceps tenotomy in the treatment of isolated SLAP lesions resulted in anterior and superior translation of the humerus radiologically. According to clinical evaluations, tenotomy contributes to pain relief and improved function in these patients.

Anahtar Kelimeler

SLAP lesion , Biceps Pathology , Superior Humeral Orientation , Coracohumeral Distance , Biceps Tenotomy.

Slap Lezyonlarına Uygulanan Biceps Tenotomisinin Omuz Eklemine Etkileri

Öz

Amaç: Bu çalışmada izole SLAP (Superior Labrum Anterior To Posterior) lezyonlarında biseps tenotomisi sonrası omuz eklemindeki radyolojik ve klinik değişikliklerin araştırılması amaçlandı.
Gereç ve Yöntemler: Eylül 2015 ile Eylül 2019 tarihleri arasında merkezimizde SLAP lezyonları için omuz artroskopisi yapılan toplam 380 hasta retrospektif olarak analiz edildi. Çalışmaya dahil edilme kriterlerini karşılayan 44 hasta dahil edildi (izole SLAP lezyonu, biseps tenotomisi, omuz instabilitesi yok, ileri omuz artrozu yok, ek omuz patolojisi yok, takip süresi 1 yıldan uzun). Hastaların ameliyat öncesi ve sonrası değerleri klinik ve radyolojik ölçümlerle karşılaştırıldı. Klinik değerlendirmede; UCLA, Constant, VAS, DASH skorlama sistemi ve kas gücü karşılaştırıldı. Radyolojik değerlendirmede; Superior Humeral Migrasyon, Korakohumeral Mesafe, Akromiohumeral Mesafe, Kritik Omuz Açısı, Akromiyal İndeks karşılaştırıldı.
Bulgular: Çalışmaya dahil edilen 44 hastanın 18'i kadın, 26'sı erkekti. Hastaların ortalama yaşı 51 ve ortalama takip süresi 32,2 aydı. Hastaların ameliyat öncesi ölçümlerinde Korakohumeral Mesafe: 11,5 ± 2,4 mm, Humerus Başı Superior Migrasyonu: 3,4 ± 1,0 mm idi. Ameliyat sonrası grup ölçümlerinde Korakohumeral Mesafe: 8,4 ± 1,4 mm, Humerus Başı Superior Migrasyonu: 4,5 ± 1,3 mm. Bu değerler karşılaştırıldığında, SHY ve KH mesafesi değerlerindeki değişiklikler istatistiksel olarak anlamlıydı (p=0,031, p=0,012). Klinik değerlendirmeler kapsamındaki tüm fonksiyonel ölçümlerde ve skorlama sistemlerinde istatistiksel olarak anlamlı iyileşmeler gözlendi.
Sonuç: İzole SLAP lezyonlarının tedavisinde biseps tenotomisi, radyolojik olarak humerusun anterior ve superior translasyonu ile sonuçlandı. Klinik değerlendirmelere göre, tenotomi bu hastalarda ağrının giderilmesine ve fonksiyonun iyileşmesine katkıda bulunmaktadır.

Anahtar Kelimeler

SLAP lezyonu , Biceps Patolojisi , Superior Humeral Yönelim , Korakohumeral Mesafe , Biceps Tenotomisi.

Kaynakça

• Manske RC, Voight M, Wolfe C, Page P. Long Head of the Biceps Tendon (LHBT). Int J Sports Phys Ther. 2022 Dec 2;17(7):1205–7.
• Khazzam M, George MS, Churchill RS, Kuhn JE. Disorders of the long head of biceps tendon. J Shoulder Elbow Surg. 2012 Jan;21(1):136–45.
• Yu J, Yin Y, Chen W, Mi J. Long Head of the Biceps Tendon Plays a Role in Stress Absorption and Humeral Head Restriction during the Late Cocking and Deceleration Phases of Overhead Throwing: A Finite Element Study. J Shoulder Elbow Surg. 2024 Aug 13;S1058-2746(24)00573-1.
• Diplock B, Hing W, Marks D. The long head of biceps at the shoulder: a scoping review. BMC Musculoskelet Disord. 2023 Mar 28;24(1):232.
• Onyekwelu I, Khatib O, Zuckerman JD, Rokito AS, Kwon YW. The rising incidence of arthroscopic superior labrum anterior and posterior (SLAP) repairs. J Shoulder Elbow Surg. 2012 Jun;21(6):728–31.
• Bey MJ, Elders GJ, Huston LJ, Kuhn JE, Blasier RB, Soslowsky LJ. The mechanism of creation of superior labrum, anterior, and posterior lesions in a dynamic biomechanical model of the shoulder: the role of inferior subluxation. J Shoulder Elbow Surg. 1998;7(4):397–401.
• Huri G, Hyun YS, Garbis NG, McFarland EG. Treatment of superior labrum anterior posterior lesions: a literature review. Acta Orthop Traumatol Turc. 2014;48(3):290–7.
• GOLDING FC. The shoulder--the forgotten joint. Br J Radiol. 1962;35(411):149–58.
• Cetinkaya M, Ataoglu MB, Ozer M, Ayanoglu T, Oner AY, Kanatli U. Do subscapularis tears really result in superior humeral migration? Acta Orthop Traumatol Turc. 2018;52(2):109–14.
• Balke M, Banerjee M, Greshake O, Hoeher J, Bouillon B, Liem D. The Coracohumeral Distance in Shoulders with Traumatic and Degenerative Subscapularis Tendon Tears. Am J Sports Med. 2016;44(1):198–201.
• Dey R, Roche S, Rosch T, Mutsvangwa T, Charilaou J, Sivarasu S. Anatomic variations in glenohumeral joint: an interpopulation study. JSES Open Access. 2018;2(1):1–7.
• Nyffeler RW, Werner CML, Sukthankar A, Schmid MR, Gerber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Jt Surg - Ser A. 2006;88(4):800–5.
• Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint? A radiological study of the critical shoulder angle. Bone Jt J. 2013;95 B(7):935–41.
• Weiner DS, Macnab I. Superior migration of the humeral head. A radiological aid in the diagnosis of tears of the rotator cuff. J Bone Joint Surg Br. 1970 Aug;52(3):524–7.
• Hsu SH, Miller SL, Curtis AS. Long head of biceps tendon pathology: management alternatives. Clin Sports Med. 2008 Oct;27(4):747–62.
• Bicos J. Biomechanics and anatomy of the proximal biceps tendon. Sports Med Arthrosc Rev. 2008 Sep;16(3):111–7.
• Molnár S, Hunya Z, Pavlik A, Bozsik A, Shadgan B, Maffulli N. SLAP Lesion and Injury of the Proximal Portion of Long Head of Biceps Tendon in Elite Amateur Wrestlers. Indian J Orthop. 2020 May;54(3):310–6.
• Warner JJ, Bowen MK, Deng X, Torzilli PA, Warren RF. Effect of joint compression on inferior stability of the glenohumeral joint. J Shoulder Elbow Surg. 1999;8(1):31–6.
• Walch G, Edwards TB, Boulahia A, Nové-Josserand L, Neyton L, Szabo I. Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg. 2005;14(3):238–46.
• Szabó I, Boileau P, Walch G. The proximal biceps as a pain generator and results of tenotomy. Sports Med Arthrosc Rev. 2008 Sep;16(3):180–6.
• Pagnani MJ, Deng XH, Warren RF, Torzilli PA, Altchek DW. Effect of lesions of the superior portion of the glenoid labrum on glenohumeral translation. J Bone Joint Surg Am. 1995 Jul;77(7):1003–10.
• Pagnani MJ, Deng XH, Warren RF, Torzilli PA, O’Brien SJ. Role of the long head of the biceps brachii in glenohumeral stability: a biomechanical study in cadavera. J Shoulder Elbow Surg. 1996;5(4):255–62.
• Burkart A, Debski R, Musahl V, McMahon P, Woo SLY. [Biomechanical tests for type II SLAP lesions of the shoulder joint before and after arthroscopic repair]. Orthopade. 2003 Jul;32(7):600–7.
• Burkart A, Debski RE, Musahl V, McMahon PJ. Glenohumeral translations are only partially restored after repair of a simulated type II superior labral lesion. Am J Sports Med. 2003;31(1):56–63.
• Leite MJ, Sá MC, Lopes MJ, Matos RM, Sousa AN, Torres JM. Coracohumeral distance and coracoid overlap as predictors of subscapularis and long head of the biceps injuries. J Shoulder Elbow Surg. 2019 Sep;28(9):1723–7.
• Alexander S, Southgate DFL, Bull AMJ, Wallace AL. The role of negative intraarticular pressure and the long head of biceps tendon on passive stability of the glenohumeral joint. J Shoulder Elbow Surg. 2013 Jan;22(1):94–101.
• Gill TJ, McIrvin E, Mair SD, Hawkins RJ. Results of biceps tenotomy for treatment of pathology of the long head of the biceps brachii. J Shoulder Elbow Surg. 2001;10(3):247–9.
• Boileau P, Baqué F, Valerio L, Ahrens P, Chuinard C, Trojani C. Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am. 2007 Apr;89(4):747–57.
• Carpenter JE, Flanagan CL, Thomopoulos S, Yian EH, Soslowsky LJ. The effects of overuse combined with intrinsic or extrinsic alterations in an animal model of rotator cuff tendinosis. Am J Sports Med. 1998;26(6):801–7.
• Koh KH, Ahn JH, Kim SM, Yoo JC. Treatment of biceps tendon lesions in the setting of rotator cuff tears: prospective cohort study of tenotomy versus tenodesis. Am J Sports Med. 2010 Aug;38(8):1584–90.
• Kelly AM, Drakos MC, Fealy S, Taylor SA, O’Brien SJ. Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results. Am J Sports Med. 2005 Feb;33(2):208–13.