Arthroscopic suprapectoral biceps tenodesis provided earlier shoulder function restoration compared with open subpectoral biceps tenodesis during the recovery phase

Objectives: Rotator Cuff Repair (RCR) is frequently associated with treatment of the long head of the biceps brachii tendon. This is because the biceps tendon is a common pain generator of the shoulder, and it is commonly diseased concurrently with the rotator cuff. Biceps tendinopathy is commonly treated with tenodesis (open or arthroscopic) or tenotomy. Previous studies have shown no differences in complication rates and patient-reported outcomes (PROs) at 2-year follow-up between arthroscopic tenodesis or open tenodesis. Other literature has shown open biceps tenodesis (OBT) to have similar costs and operative time compared to arthroscopic biceps tenodesis (ABT); however, time-driven activity-based costing was not used. The purpose of this study was to evaluate for differences in day of surgery (DOS) costs at one-year for OBT, ABT, and biceps tenotomy in the context of RCR. We hypothesized that cost would be similar between OBT and ABT and would be less for tenotomy. The primary outcome was DOS cost as measured by time-driven activity-based costing. Secondary aims included assessing PROs with the Single Assessment Numeric Evaluation (SANE) score, and the American Shoulder and Elbow Surgeons (ASES) score, as well as operative time, symptomatic retear rate, and reoperation rate at one year. Methods: A prospectively collected PRO database was retrospectively reviewed for patients who underwent surgical treatment of their biceps tendon in the setting of primary RCR between 2018 and 2022. Inclusion criteria consisted of patients who underwent supraspinatus or supraspinatus and infraspinatus tendon repair, as well as biceps tenodesis (arthroscopic or open) or tenotomy and had full PRO data at preoperative baseline and at one-year follow up. Patients were excluded if they were missing PRO data, missing cost and implant data, had a prior history of shoulder surgery, underwent revision rotator cuff repair, or had their subscapularis, teres minor, or isolated infraspinatus tendon repaired. A total of 266 patients met criteria. PROs collected included SANE and ASES scores at baseline and one-year follow-up. Patient demographics, injury and surgical characteristics, operative time, retear and reoperation rates, and day of surgery cost were evaluated. Time-driven activity-based costing was used to determine DOS costs. Statistical analyses conducted included descriptive statistics, Fisher exact tests, and analysis of variance. Results: Of the 266 patients that met criteria, approximately half were female (n = 131, 49.3%). Mean patient age at time of surgery was 60.4 years old and mean body mass index was 30.15. Chronic tears were present in 55.6% of patients. 113 patients underwent OBT, 75 underwent ABT, and 78 underwent biceps tenotomy. The average values for ASES and SANE scores at baseline versus 1-year follow-up were 46.9 versus 84.3 and 40.2 versus 84.0, respectively. The age of patients who underwent tenotomy (64.2 years old) was significantly older than the ABT (58.7 years old) and OBT (58.8 years old) groups (p < 0.001). Additionally, more women underwent biceps tenotomy versus tenodesis compared to men (37.4% of women vs. 21.5% of men). Mean operative time was significantly different between the groups with tenotomy being the fastest (ABT 128.0 minutes, OBT 139.9 minutes, tenotomy 121.6 minutes, p < 0.001). DOS costs as well as biceps tendon fixation costs were highest for OBT compared to ABT and biceps tenotomy (DOS $3,963.64 vs. $3,426.67 vs. $3,095.34, p < 0.001, respectively; Biceps fixation $505.25 vs. $237.94 vs. $5.15, p < 0.001, respectively). Additionally, overall implant costs (including RCR) were highest for OBT, despite the number of anchors used not differing between the groups (p = 0.132). There was no difference in the number of tendons repaired by bicep treatment type (p = 0.203). Changes in 1-year ASES and SANE scores were not different between the group (p = 0.221 and p = 0.159, respectively). There were also no differences between groups in rotator cuff symptomatic retears or reoperations (p = 0.731 and p = 0.391, respectively). Conclusions: This study found DOS costs were lowest for biceps tenotomy and highest for OBT with a difference of more than $850. Operative time from shortest for biceps tenotomy, while OBT was associated with an 18 minute longer operative time. Despite the differences in cost and operative time, there were no differences in PROs, symptomatic rotator cuff retear rates, or reoperation rates at one-year follow-up. These results may indicate that all three treatment types can provide patients with similar outcomes; however, lower operative times and costs can be provided by tenotomy or ABT compared to OBT. Surgeons can use these results to help guide technique selection when treating patients with biceps pathology. [Figure: see text]

Objectives:Our group has previously reported the 1-year outcomes arthroscopic suprapectoral biceps tenodesis (ASPBT) versus open subpectoral biceps for the management of long head of the biceps tendon (LHBT) pathology. While patients had similar 1-year biceps strength and pain, any ongoing changes in functional outcomes is yet unknown. We aimed to directly compare clinical outcomes of ASPBT versus OSPBT with interference screw fixation, distal to the bony bicipital groove, at 2 years follow-up.Methods:Eighty-seven patients undergoing biceps tenodesis for LHBT disease were randomized into the ASPBT group or OSPBT group. Both techniques utilized polyether ether ketone (PEEK) inference screws for tenodesis fixation. Patients completed American Shoulder and Elbow Surgeon (ASES), Constant subjective, and Single Assessment Numeric Evaluation (SANE) questionnaires preoperatively, and again at 6 months, 12 months and final follow-up at minimum 24 months.Results:Seven-five patients (37/46 randomized to ASPBT [80%], 38/41 randomized to OSPBT [93%]) with a mean age of 50.3 ± 10.4 years and a mean body mass index of 28.9 ± 6.3 were included in clinical outcome analyses. Mean final follow-up was 35.1 months (ASPBT: 35.4 months, OSPBT: 34.9 months, range 24-63 months). Comparison of demographic characteristics and intraoperative findings showed no significant difference in age, gender, concomitant procedures, and rotator cuff disease. No statistically significant differences in ASES (P =.26), Constant subjective scores (P = .60), and SANE scores (P = .74) were found at final follow-up. Clinical outcomes scores showed no significant improvement from 12.6 months to final follow-up at 35.1 months (ASPBT: ASES, P=0.42; Constant, P=0.23; SANE, P=0.43 v. OSPBT: ASES, P=0.76; Constant, P=0.57; SANE, P=0.64). The mean SANE score in the ASPBT group had a statistically nonsignificant, 6.1-point increase from 1 to 3 years post-operatively (p = .23), which was greater than the minimal clinically importance difference (MCID). No patients required revision of biceps tenodesis in either group.Conclusions:No significant differences in patient-reported outcomes and complication rates were found at any time point between subjects undergoing ASPBT or OSPBT, utilizing the same interference screw technique, for the management of LHBT pathology.Table 1Patient Demographic and Other CharacteristicsTable 2Intraoperative FindingsTable 3Patient Reported Outcome measuresTable 4Patient Reported Outcome Measures Difference from 12 Months to Final Follow-Up

Objectives:Pathology of the long of head of the biceps tendon (LHB) is a well-known cause of shoulder pain that is commonly managed with arthroscopic suprapectoral biceps tenodesis when conservative treatment fails. The purpose of this study is to present an arthroscopic, knotless, suprapectoral biceps tenodesis technique known as the Loop ‘N’ Tack and report the clinical outcomes in patients with a minimum of 2 years follow-up.Methods:The technique grasps the LHB proximally at the superior labrum and fixes it to the most distally visualized portion of the intra-articular bicipital groove. A retrospective review of all patients who had undergone the Loop ‘N’ Tack biceps tenodesis by the senior author between January 2009 and May 2014 was completed. Patients were excluded if any portion of the surgery was performed open, or if they had less than 2 years of follow-up. Charts were reviewed and patients were contacted for demographic data, time from surgery, concomitant procedures, worker’s compensation (WC) status, visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and University of California, Los Angeles (UCLA) scores. Statistical analysis was performed using Mann-Whitney U test for comparing non-parametric data sets.Results:follow-up evaluations were performed in 59 of 68 patients (87%). Average follow-up was 43 months. 88% of patients had at least 1 additional procedure performed at the time of biceps tenodesis. The mean ASES scores improved from 42.5 preoperatively to 90.1 postoperatively (p < 0.001). Fifty-four of fifty-nine patients (91.5%) had a good/excellent outcome with UCLA score > 27 and ASES > 70. Three patients (5%) reported biceps cramping pain with overuse. Two patients (3.3%) reported intermittent anterior shoulder pain similar to preoperative symptoms. No patients had developed a “Popeye” deformity at final clinical examination. 97% of patients reported that they were satisfied overall with the procedure. Comparing patients who had a rotator cuff repair or labrum repair at the time of biceps tenodesis with patients who did not have either, there were no significant differences in preoperative VAS or ASES, or postoperative outcomes scores. There were 10 WC patients who had worse postoperative VAS (p = 0.02), ASES (p = 0.03), SANE (p = 0.03), and UCLA scores (p = 0.02) compared to non-WC patients.Conclusion:The Loop ‘N’ Tack biceps tenodesis technique provides a high rate of patient satisfaction and high outcomes scores with a low rate of postoperative pain and no reported incidence of ‘Popeye’ deformity. We believe these good clinical results are due to the secure fixation of the LHB while relieving tension and minimizing motion of the tendon within the bicipital groove.Figure 1.Right shoulder, beach chair position, posterior viewing portal. (A) Suture loop around BT and tissue penetrator through BT to secure loop. (B) BT cut at insertion. BT = Biceps Tendon, G = Glenoid, HH = Humeral Head

Objectives:Biceps pathology typically includes pain in the anterior shoulder that is reproduced with provocative maneuvers. However, optimal treatment of patient with this diagnosis is not clear and can include tenotomy or various forms of tenodesis. As tenotomy can lead to cosmetic deformity and anterior humeral discomfort from spasms, many surgeons perform tenodesis. Technique for tenodesis includes intra-articular soft tissue fixation or osseous fixation, suprapectoral osseous fixation, and subpectoral osseous fixation. Focusing on the later two, it is unclear if there is a clinical or surgical benefit of performing an open subpectoral biceps tenodesis (OBT) versus arthroscopic suprapectoral biceps tenodesis (ABT). We therefore designed this randomized clinical trial to assess these two techniques.Methods:Patients diagnosed with biceps tendinopathy meeting the inclusion and exclusion criteria were randomized into the arthroscopic and mini-open biceps tenodesis groups. Prior to surgery, patients were asked a series of questions regarding their anterior shoulder pain and underwent a subsequent shoulder exam. Follow-up was d at 3 months, 6 months, and 1 year time points, during which the shoulder exam and patient questionnaires were also d.Results:A total of 38 patients were enrolled with a mean age of 43.5 ± 10.5 years and a mean BMI of 28.3 ± 5.4. All patients had arthroscopic evidence of biceps pathology and underwent either an ABT (18) or an OBT (20). All patients underwent a concomitant arthroscopic subacromial decompression. The surgical time for the ABT group, 17.2 ± 3.7 minutes, was significantly greater than the OBT group, 11.7 ± 6.1 (p<0.01). One patient was converted from the ABT group to the OBT group due to sheering of a severely attenuated tendon preventing an ABT. One patient in the OBT group required a revision tenodesis. No significant difference (p > 0.05) was found in strength or anterior shoulder pain at 3 months, 6 months, and 1 year. Additionally, no significant difference (p > 0.05) was found in clinical outcome scores (ASES, Constant subjective, WORC, KJOC) between the two groups.Conclusion:This randomized clinical trial suggests there is no clinical difference between the two techniques. Additionally, while the arthroscopic procedure requires more surgical time, the revision rates are not different. Besides the cosmetic concern for an additional scar, we recommend decisions to be made based on surgeon preference and experience.

The optimal position of the elbow and forearm during biceps tenodesis is a debated topic. The aim of our study was to compare two different forearm positions, pronation-extension (PE) or neutral, for fixation of the long head of the biceps tendon (LHB) in biceps tenodesis. Fifty patients who underwent shoulder arthroscopy between February 2016 and January 2019 were included in our study. After diagnostic arthroscopy, the LHB was cut from its origin with a thermal ablator. The LHB was then tenodesed beneath the inferior border of the pectoralis major tendon for 25 patients in the PE position and for 25 patients in the neutral position. Patients were evaluated preoperatively and 3rd, 6th and 12th months postoperatively according to the visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) shoulder and Constant scores. Flexion and supination force measurements were made with a digital dynamometer device, compared to the healthy side for both groups. ASES and VAS scores were statistically better in the PE group compared with the neutral group (p < 0.05), but there was no statistically significant difference between Constant scores at 3 and 6months (p > 0.05). No significant difference was found in both groups for 3 scores at 12months. Comparison of the PE group with the contralateral extremity and comparing the neutral group with the contralateral extremity in terms of flexion strength showed no statistically significant difference. No statistically significant difference was found between the supination powers of both comparative groups. Functional scoring in the PE position is better at 3 and 6months because patients experience less pain at 3 and 6months. The simple change of the fixation position causes patients to feel less pain in the early period.

Arthroscopic superior capsule reconstruction (ASCR) using fascia lata autograft is a new surgical technique developed to overcome irreparable rotator cuff tears. There is little information about graft tear after ASCR and its impact on clinical outcome. This study is to investigate the graft tear rate, pattern of failure, and its correlation with clinical outcomes after arthroscopic superior capsule reconstruction (ASCR). From June 2013 to June 2016, 31 shoulders in 31 consecutive patients (mean 65.3years) underwent ASCR using fascia lata autograft for irreparable large-to-massive tears. Magnetic resonance imaging (MRI) was performed before surgery and at mean 12.8months (12-24months) after surgery to assess fatty infiltration progression and graft integrity. Graft tear was defined as the loss of graft continuity and was categorized as medial and lateral rows according to the failure location. Acromiohumeral distance (AHD) was pre- and postoperatively measured with the standard radiograph. Pain visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, constant score, and physical examination were used to assess clinical outcomes. Average follow-up was 15months (range 12-24months) after surgery. Mean active forward elevation increased from 133° to 146° (P = 0.011). Mean VAS score, ASES score, and constant score significantly improved: from 6 to 2.5, 54.4 to 73.7, and 51.7 to 63.7, respectively (P < 0.001). There was no remarkable progression of fatty infiltration after surgery. AHD increased from 5.3mm preoperatively to 6.4mm postoperatively (P < 0.016). Nine patients (29%) showed graft tear on follow-up MRI: 7 and 2at the medial and lateral rows, respectively. Although the intact graft group showed better outcomes than the graft tear group (pain VAS score 2.3 vs. 3.0; ASES score 74.1 vs. 69.8; constant score 63.4 vs. 57.9), the results were not statistically significant. Graft tear rate after ASCR assessed by MRI was 29%, and failures mostly occurred at the medial row. The graft tear group showed clinical improvement despite the recurred superior capsule defect. IV, case series, treatment study.

Background: Biceps tendon pathology is common in patients with rotator cuff tears. Leaving biceps pathology untreated in rotator cuff repairs (RCRs) may lead to suboptimal outcomes. Purpose/Hypothesis: The purpose was to compare clinical outcomes between patients who underwent isolated RCR versus patients who underwent RCR with concomitant biceps treatment. It was hypothesized that there would be no difference in clinical outcomes between groups. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 244 patients who underwent RCR in 2016 were included. Patient characteristics, presence of concomitant biceps pathology, pre- and postoperative American Shoulder and Elbow Surgeons (ASES) scores, rotator cuff failure, revision surgery, and complications were recorded. Results: There were no significant differences between patients who underwent isolated RCR (n = 143) and those who underwent RCR with biceps treatment (n = 101) at 2 years postoperatively in ASES scores (RCR, 81.5; RCR+biceps treatment, 79.5; P = .532), cuff failure rate (5.6% vs 4.0%; P = .760), revision RCR rate (3.5% vs 2.0%; P = .703), or complication rate (11.9% vs 5.0%; P = .102). Furthermore, when comparing concomitant biceps tenotomy (n = 30) versus concomitant biceps tenodesis (n = 71), there were no differences in ASES scores (P = .149), cuff failure rate (P > .999), revision RCR rate (P > .999), or complication rate (P > .999) postoperatively. Finally, when comparing arthroscopic biceps tenodesis (n = 50) versus subpectoral biceps tenodesis (n = 21), there were no differences in ASES scores (P > .592), cuff failure rate (P > .999), revision RCR rate (P = .507), or complication rate (P > .999) 2 years postoperatively. Conclusion: Addressing biceps pathology when performing RCR resulted in similar rates of cuff failure, revision RCR, and complications, as well as a similar improvement in patient-reported outcomes when compared with isolated RCR at 2 years postoperatively. Furthermore, when comparing tenotomy versus tenodesis and arthroscopic versus subpectoral tenodesis, comparable outcomes with regard to rate of rotator cuff repair failure, revision RCR, complications, and patient-reported outcomes were found.

Management of long head of the biceps tendon (LHBT) pathology is accomplished through a biceps tenotomy or tenodesis. While both modalities provide beneficial outcomes, a biceps tenodesis may confer improved cosmesis, functional outcomes, and decreased muscle cramping postoperatively. Many procedural considerations are undertaken prior to a tenodesis, such as the surgical approach and fixation device. While similar clinical outcomes are achieved between an open subpectoral and arthroscopic suprapectoral biceps tenodesis (ASPBT) with interference screw (IS) fixation, the latter technique offers a minimally invasive modality. The primary indications for an ASPBT include superior labrum anterior posterior (SLAP) tears, LHBT tears, biceps instability, bicipital tunnel disease, biceps pulley lesions, and biceps tenosynovitis. Contraindications to the arthroscopic approach include a distal lesion of the biceps tendon below the pectoralis major tendon (PMT). The IS may be used to create a biomechanically stiffer construct. With the arthroscope in the lateral portal, the distal aspect of the bicipital groove proximal to the superior border of the PMT is identified and opened. The LHBT is subsequently mobilized and released. An anterosuperolateral portal is localized with a spinal needle positioned perpendicular to the bicipital tunnel, 1.5 cm proximal to the superior border of the PMT. The biceps is then removed ex vivo and whip-stitches are sewn beginning 1 cm proximal to the myotendinous junction of the LHBT. After firmly associating the LHBT with the tip of the IS, a guidewire is placed 1.5 cm superior to the superior border of the PMT, perpendicular to the humerus, and a reamer is used to prepare a 6-, 7-, or 8-mm diameter socket. The tendon is inserted through the accessory portal into the tunnel, followed by screw fixation. Suture tails are tied with 5 alternating half hitches, each secured via an arthroscopic knot pusher. ASPBT with IS fixation provides significant pain relief, improves range of motion (ROM), and enhances quality of life. ASPBT with IS fixation provides significant improvements in patient-reported and functional outcomes and thus can be an acceptable treatment for LHBT pathology. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Background: A few studies have compared high-grade partial-thickness articular- and bursal-side rotator cuff tears postoperatively. Purpose: To compare the clinical and radiological outcomes of high-grade partial-thickness rotator cuff tears treated with arthroscopic conversion to full-thickness tears, followed by repair. Study Design: Cohort study; Level of evidence, 3. Methods: Forty-three consecutive shoulders with high-grade partial-thickness rotator cuff tears (20 articular- and 23 bursal-side lesions) treated with arthroscopic conversion to full-thickness tears, followed by repair using the suture-bridge technique, were evaluated. The final functional evaluation was conducted at a mean of 35.53 months (range, 24-54 months). Radiological outcomes were evaluated at a minimum of 1 year postoperatively. The following outcome measures were used in this study: the American Shoulder and Elbow Surgeons (ASES) score, the University of California, Los Angeles (UCLA) Shoulder Rating Scale, the Constant score, and range of motion. Results: At the final follow-up, the mean ASES, UCLA, and Constant scores improved significantly to 91.80, 32.70, and 75.85, respectively, in the articular-side group (all P < .001). The mean ASES, UCLA, and Constant scores improved significantly to 90.80, 32.52, and 83.00, respectively, in the bursal-side group (all P < .001). The UCLA and ASES scores did not differ significantly between the 2 groups (P = .821 and .869, respectively), while the Constant scores did (P = .048). The retear rate was 0% in the articular-side group and 9.5% in the bursal-side group; this difference was not significant (P = .204). Conclusion: The arthroscopic repair of partial-thickness bursal-side tears resulted in comparable or superior postoperative functional outcomes compared with that of articular-side tears. However, the postoperative retear rate did not differ significantly between the 2 groups.

The shoulder terrible triad (STT) is a traumatic anterior shoulder dislocation, associated with rotator cuff (RC) tear and nerve injury from the brachial plexus. This study aimed to describe the functional results and prognostic factors of surgery in patients with STT. Thirty consecutive patients with acute STT were included at the same institution. All patients were examined with x-rays, MRI, and electromyography. Surgical treatment in the acute setting was indicated to address an RC injury or a displaced greater tuberosity fracture. Variables registered on the day of surgery were preoperative Constant and Western Ontario Rotator Cuff (WORC) scores and injury pattern. At final discharge, Constant, American Shoulder and Elbow Surgeons (ASES), WORC, and subjective shoulder value scores were recorded by an independent evaluator. Twenty-seven patients underwent a complete follow-up. The dominant arm was affected in 50% of cases. The mean follow-up was 27 (12 to 43) months. The mean WORC and Constant scores improved from 1,543 to 1,093 (P = 0.015) and 31 to 54 (P = 0.003), respectively. The ASES and subjective shoulder value scores at the end of the follow-up were 60 and 56 points, respectively. RC tears and nerve injuries that did not involve the axillary or suprascapular nerves were associated to better results than greater tuberosity fractures and injuries to the axillary or suprascapular nerves, respectively, in WORC (P = 0.028), Constant (P = 0.024), and ASES scores (P = 0.035). Preoperative WORC and Constant scores were independent prognostic factors. The most frequent patterns include complete RC tears, anterior capsular injuries, and an axillary nerve injury. Patients had improved functional scores at the end of follow-up after surgery. Better functional results were correlated to RC tears, injuries to nerves with innervation distal to the shoulder, and higher preoperative Constant and WORC scores.

BackgroundShoulder surgery results in several months of rehabilitation, which is often underestimated by patients preoperatively. Currently, there is little written about this process of recovery. Information on this would help patients to anticipate the trajectory of their recovery. This would also provide a reference point allowing surgeons to compare a patient's progress in their recovery. The purpose of our study was to analyze and document the expected rate of recovery for the most common shoulder operations.MethodsA retrospective analysis of all patients who underwent total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA), arthroscopic rotator cuff repair (ARCR), and arthroscopic biceps tenodesis (BT) using prospectively collected data from the Surgical Outcomes System registry was performed. All patients included had a complete 2-year follow-up data set. The pain score (visual analog scale) was measured preoperatively at 2, 6, and 12 weeks and 6, 12, and 24 months. The American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) score were recorded preoperatively and after 6, 12, and 24 months. The speed of recovery, defined as the percentage of total improvement, for each procedure was assessed as the primary outcome parameter at all time points.ResultsAll shoulder interventions resulted in significant improvement of the pain, SANE, and ASES scores 2 years after shoulder surgery. The speed of recovery of all 3 scores was highest after TSA at all measured time points and slowest after ARCR and BT. Measured by the pain score, 90% and 82% of the total improvement after TSA and RTSA was completed after 6 weeks compared to 58% and 59% after ARCR and BT, respectively. Six months postoperatively the ASES recovery rate was significantly higher after arthroplasty (TSA 96% and RTSA 85%) compared to ARCR and BT (76% and 77%, respectively). The SANE score recovery rate was between 82% and 92% (TSA 92%, RTSA 89%, ARCR 87%, BT 82%) 6 months after surgery. After 1 year all patient groups reached 89% or more of the total improvement in all scores, except for the pain after ARCR (89%).ConclusionThe improvement in pain is fastest after TSA and slowest after ARCR and BT. After TSA and RTSA, >80% of the total pain reduction is achieved 6 weeks postoperatively, whereas after ARCR and BT, >80% of the pain reduction is achieved only 6 months postoperatively. At 12 months postoperatively, the differences in recovery curves were not significant.

Background: The repair of anterior L-shaped tears is usually difficult because of the lack of anterior rotator cuff tendon to cover the footprint. The biceps tendon is usually exposed from the retracted anterolateral corner of the torn tendon and can be easily used to augment rotator cuff repair. Hypothesis/Purpose: This study compared the clinical outcomes of the biceps augmentation technique with those of partial tendon repair for the arthroscopic treatment of large anterior L-shaped rotator cuff tears to evaluate the role of additional biceps augmentation in tendon healing. We hypothesized that the biceps augmentation technique would lead to a lower rotator cuff tendon retear rate and provide satisfactory functional outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 64 patients with anterior L-shaped rotator cuff tears who underwent arthroscopic repair. Patients were divided into 2 groups: group A (31 patients) underwent repair of an anterior L-shaped tear combined with biceps augmentation, and group B (33 patients) had a partially repaired tendon whose footprint was exposed after repair without undue tension on the retracted tendon. Clinical evaluations were performed using the American Shoulder and Elbow Surgeons (ASES) score, Constant score, muscle strength, visual analog scale for pain, and patient satisfaction. Magnetic resonance imaging (MRI) was performed for tendon integrity at 6 months postoperatively. Results: The mean period of follow-up was 29.1 ± 3.5 months (range, 24-40 months). The mean ASES and Constant scores significantly improved from 52.8 ± 10.6 and 43.2 ± 9.9 preoperatively to 88.2 ± 6.9 and 86.8 ± 6.2 at final follow-up in group A (P < .001) and from 53.0 ± 11.8 and 44.3 ± 11.3 preoperatively to 87.4 ± 7.2 and 87.9 ± 7.3 at final follow-up in group B (P < .001). Overall muscle strength (given as % of the other side’s strength) significantly increased from preoperatively to final follow-up in group A (forward flexion [FF]: 62.0 ± 8.2 to 89.0 ± 8.6; external rotation [ER]: 57.5 ± 9.9 to 86.8 ± 9.3; internal rotation [IR]: 68.1 ± 10.8 to 88.1 ± 8.4; P < .001) and group B (FF: 59.9 ± 9.6 to 87.7 ± 9.0; ER: 58.6 ± 9.3 to 86.2 ± 7.5; IR: 70.0 ± 9.3 to 87.0 ± 8.4; P < .001). Twenty-one patients (67.7%) in group A and 20 patients (60.6%) in group B showed a healed rotator cuff tendon on postoperative MRI. The retear rate between the 2 groups showed no significant difference (P = .552). Regarding clinical outcomes, both groups had no significant difference in the ASES score (P = .901), Constant score (P = .742), and muscle strength. Conclusion: There was no significant difference in the clinical outcomes and retear rate of anterior L-shaped tears between biceps augmentation and partial tendon repair. Additional biceps augmentation proved to have no enhancement in tendon healing. A precise method such as only partial tendon repair for reducing the footprint exposure without undue tension may be considered as one of the treatment options for large anterior L-shaped rotator cuff tears.

PurposeTo evaluate the clinical outcomes of lower trapezius tendon (LTT) transfer using an Achilles tendon allograft in patients with failed superior capsular reconstruction (SCR).MethodsA retrospective therapeutic review was conducted on patients who underwent LTT transfer using an Achilles tendon allograft after SCR failure between January 2018 and May 2020. The inclusion criteria encompassed both structural and functional failures of SCR in patients with minimal glenohumeral arthritis and a minimum follow-up of 2 years. Exclusion criteria were insufficient clinical data or loss to follow-up. Clinical outcomes were assessed preoperatively and at final follow-up using the visual analog scale (VAS), subjective shoulder value (SSV), Constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM).ResultsEighteen patients were included, with a mean follow-up of 42.5 months (range: 24-62 months). All outcome measures demonstrated statistically significant improvement: VAS scores improved from 5.9 ± 1.3 to 1.8 ± 1.4; SSV scores improved from 18.0 ± 9.1 to 61.4 ± 18.5; Constant score improved from 33.3 ± 5.3 to 65.5 ± 17.4; and ASES score improved from 38.5 ± 5.2 to 67.1 ± 17.7 (all P < .001). On the basis of the minimal clinically important difference (MCID) using a 0.5 SD distribution-based method, clinically meaningful improvements were observed in 88.9% of patients for VAS and ASES scores, and 94.4% for Constant and SSV scores. ROM gains included forward elevation (73° to 120°), abduction (57° to 93°), and external rotation (−22° to 40°). At final follow-up, 77.8% of patients had resumed occupational activities, and 61.1% returned to sports. Four patients (22.2%) required conversion to reverse shoulder arthroplasty.ConclusionsLTT transfer using an Achilles tendon allograft following failed SCR yields significant improvements in pain relief, functional outcomes, and ROM. LTT transfer using an Achilles tendon allograft following failed SCR may offer a potential treatment option, particularly in younger, active patients who seek to preserve native shoulder anatomy and function.Level of EvidenceLevel IV retrospective case series.

ABSTRACTPurposeThe treatment of partial-thickness rotator cuff tears (PTRCT) remains controversial. Few studies have focused on the conservative and new measurements of small to medium PTRCT. The use of sodium hyaluronate (SH) or platelet-rich plasma (PRP) as a method for rotator cuff repair requires further investigation. The aim of this study was to evaluate the combined use of SH and PRP in the treatment of small to medium PTRCT.Study DesignA double-blinded randomized trial was used in this study.MethodsIndividuals with PTRCT detected by clinical examination and magnetic resonance imaging (MRI) were included in this study. The patients were randomly assigned to receive subacromial injections of normal saline, SH, PRP, or SH + PRP once a week for 4 wk. The primary outcome measure was the Constant score, and the secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) and the visual analog scale scores. All of the clinical outcomes were assessed at pretreatment and 1, 3, 6, and 12 months posttreatment. MRI was used to evaluate the evolution of the cuff defect after 1 yr.ResultsThe PRP group and the SH + PRP group showed a significantly higher Constant score and ASES score after the treatments. There were significant differences between the SH + PRP group and the SH or PRP group at 12 months in the Constant, visual analog scale, and ASES scores. MRI results showed that the tear size significantly decreased in both the PRP and the SH + PRP groups, especially in the SH + PRP group.ConclusionOur study provided evidence of the efficacy of PRP injection in the healing of small to medium PTRCT. Moreover, the combined injection of SH and PRP yielded a better clinical outcome than SH or PRP alone.

Smokers Achieved Minimal Clinically Important Difference for Visual Analog Scale and American Shoulder and Elbow Surgeons Scores at a Lower Rate Than Nonsmokers Even When Repaired Supraspinatus Tendons Were Intact on Postoperative Magnetic Resonance Imaging