Long Head of Biceps Brachii Lesions, Rotator Cuff Tears
Conditions
Keywords
long head biceps, rotator cuff tears, tenotomy, no tenotomy
Brief summary
The function of the long head of the biceps tendon (LHBT) in the glenohumeral joint generates controversy among researchers. For some, the tendon does not have a significant function in the shoulder, while others consider it acts as a depressor of the humeral head and a stabilizer of the joint. These functions may be enhanced in cases of rotator cuff injuries, where compensatory hypertrophy and/or instability of the LHBT can occur, which can also be a source of pain. One of the imaging techniques used for diagnosing these injuries is ultrasound. Initially, G. Walch proposed tenotomy of the LHBT in massive rotator cuff tears to improve pain and, in some cases, shoulder function. Currently, many authors advocate tenotomy of the LHBT as an adjunct to rotator cuff repair to avoid postoperative pain. However, there is no evidence that this procedure improves the clinical outcomes of isolated rotator cuff repair. Based on the pathophysiology of the LHBT associated with rotator cuff injuries and the current trend to perform tenotomies in conjunction with cuff repair, the objectives of this doctoral thesis project were: To compare the clinical and imaging outcomes of arthroscopic rotator cuff repairs with and without LHBT tenotomy. To analyze the position and cross-sectional area of the LHBT in the bicipital groove using ultrasound in cases with and without tenotomy.
Interventions
PROCEDUREROTATOR CUFF REPAIR
ROTATOR CUFF REPAIR
Sponsors
Consorci Sanitari de Terrassa
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Intervention model description
Patients were randomly assigned to two groups, TENOTOMY (n=25) and NO TENOTOMY (n=29), using a centralized random number program.
Eligibility
Sex/Gender
ALL
Age
40 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age between 40 and 65 years * Partial supraspinatus tears (≥ 50% thickness) * Complete supraspinatus tears ≤ 3 cm in the coronal plane * Muscle atrophy less than stage 2 according to Thomazeau * Presence of the LHBT in the bicipital groove
Exclusion criteria
* Patients younger than 40 or older than 65 years * LHBT rupture * Partial supraspinatus tears \< 50% thickness * Supraspinatus tears \> 3 cm * Tears of other rotator cuff tendons, with or without supraspinatus involvement * Traumatic tears with surgery performed less than 3 months after injury * Muscle atrophy ≥ stage 2 Thomazeau * Associated degenerative glenohumeral pathology (\> Samilson 1) * Previous shoulder surgeries * Previous shoulder infections * Associated peripheral neurological injuries * Degenerative neurological conditions * Patients who refused to sign informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Constant Murley | 24 month | 100-point standardized tool for assessing shoulder function, comprising four domains Pain (0-15 points) daily life activity (0-20 points) range of motion (0-40 points) strenght (0-25 points) 0 (the worst) - 100 (the best) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| ASES | 24 MONTHS | The ASES score (American Shoulder and Elbow Surgeons score) is a 100-point questionnaire used to assess shoulder function and pain, with a higher score indicating better outcomes. From 0 (worst) to 100 (best). |
| cross sectional area of the LHBT | 24 months | Ultrasound Imaging: Integrity of the supraspinatus tendon (SST) repair, presence of the long head of the biceps tendon (LHBT) in the bicipital groove (BG), and cross-sectional area of the LHBT at three levels of the BG (proximal, middle, and distal). mesured in mm2 |
Outcome results
None listed