PDF(Pubmed)
Abstract：
UNASSIGNED: Patients with partial thickness rotator cuff tears (PTRCTs) often present with concurrent pathology of the long head of the biceps tendon (LHBT). To address both conditions simultaneously, long head of the biceps (LHB) tenotomy or tenodesis can be performed at the time of arthroscopic rotator cuff repair (RCR). This study aims to compare postoperative shoulder active range of motion (AROM) and complications following transtendinous RCR with concurrent LHB tenodesis or tenotomy.
UNASSIGNED: A total of 90 patients with PTRCTs met inclusion criteria for this study. Patients who underwent tear-completion-and-repair, revision surgery, or open repair of the LHB tendon were excluded. Patients were stratified into tenotomy, arthroscopic suprapectoral tenodesis, or no biceps operation cohorts and were propensity matched 1:1:1 on age, sex, body mass index, and smoking status. Primary outcome measures included AROM in forward flexion, abduction, external rotation, and internal rotation at 6 weeks, 3 months, and 6 months postoperatively. The development of severe stiffness and rates of rotator cuff retear at final follow-up were recorded as secondary outcomes.
UNASSIGNED: When comparing the tenotomy and tenodesis cohorts, tenotomy patients were found to have increased AROM at 3 months in forward flexion (153.2° vs. 130.1°, P = .004), abduction (138.6° vs. 114.2°, P = .019), and external rotation (60.4° vs. 43.8°, P = .014), with differences in forward flexion remaining significant at 6 months (162.4° vs. 149.4°, P = .009). There were no significant differences in interval rates of recovery in any plane between cohorts. Additionally, there were no significant differences in rates of symptomatic retears between groups (P = .458). Rates of severe postoperative stiffness approached but did not achieve statistical significance between tenotomy (4.2%) and tenodesis (29.2%) cohorts (P = .066). Smoking status was a significant predictor of severe stiffness (odds ratio, 13.69; P = .010).
UNASSIGNED: Despite significant differences in absolute AROM between cohorts, the decision to perform tenotomy or tenodesis was not found to differentially affect rates of AROM recovery for patients undergoing arthroscopic transtendinous RCR for PTRCT. Notably, however, transient stiffness complications were more commonly observed in smokers, and data trends suggested an increased risk of stiffness for patients undergoing LHB tenodesis. Overall, postoperative stiffness is likely multifactorial and attributable to both patient- and procedure-specific factors, and LHB tenotomy may be more appropriate for patients with risk factors for developing stiffness postoperatively.
UNASSIGNED: A total of 90 patients with PTRCTs met inclusion criteria for this study. Patients who underwent tear-completion-and-repair, revision surgery, or open repair of the LHB tendon were excluded. Patients were stratified into tenotomy, arthroscopic suprapectoral tenodesis, or no biceps operation cohorts and were propensity matched 1:1:1 on age, sex, body mass index, and smoking status. Primary outcome measures included AROM in forward flexion, abduction, external rotation, and internal rotation at 6 weeks, 3 months, and 6 months postoperatively. The development of severe stiffness and rates of rotator cuff retear at final follow-up were recorded as secondary outcomes.
UNASSIGNED: When comparing the tenotomy and tenodesis cohorts, tenotomy patients were found to have increased AROM at 3 months in forward flexion (153.2° vs. 130.1°, P = .004), abduction (138.6° vs. 114.2°, P = .019), and external rotation (60.4° vs. 43.8°, P = .014), with differences in forward flexion remaining significant at 6 months (162.4° vs. 149.4°, P = .009). There were no significant differences in interval rates of recovery in any plane between cohorts. Additionally, there were no significant differences in rates of symptomatic retears between groups (P = .458). Rates of severe postoperative stiffness approached but did not achieve statistical significance between tenotomy (4.2%) and tenodesis (29.2%) cohorts (P = .066). Smoking status was a significant predictor of severe stiffness (odds ratio, 13.69; P = .010).
UNASSIGNED: Despite significant differences in absolute AROM between cohorts, the decision to perform tenotomy or tenodesis was not found to differentially affect rates of AROM recovery for patients undergoing arthroscopic transtendinous RCR for PTRCT. Notably, however, transient stiffness complications were more commonly observed in smokers, and data trends suggested an increased risk of stiffness for patients undergoing LHB tenodesis. Overall, postoperative stiffness is likely multifactorial and attributable to both patient- and procedure-specific factors, and LHB tenotomy may be more appropriate for patients with risk factors for developing stiffness postoperatively.
摘要：
■肩袖部分厚度撕裂（PTRCT）的患者通常伴有二头肌肌腱长头（LHBT）的病理。为了同时解决这两个条件，在关节镜肩袖修复术(RCR)时,可进行肱二头肌长头肌(LHB)腱切开术或肌腱固定术.这项研究旨在比较经肌腱RCR并发LHB肌腱固定术或肌腱切开术后的术后肩关节活动范围（AROM）和并发症。
■共有90例PTRCT患者符合本研究的纳入标准。接受撕裂完成和修复的患者，翻修手术,或LHB肌腱的开放性修复被排除。患者被分层为肌腱切开术，关节镜胸上肌腱固定术，或没有二头肌手术队列，并且在年龄上倾向匹配1：1：1，性别,身体质量指数,和吸烟状况。主要结果测量包括AROM前屈，绑架,外部旋转,6周时内旋,3个月,术后6个月。最终随访时严重僵硬的发展和肩袖再撕裂的发生率被记录为次要结果。
■当比较肌腱切开术和肌腱固定术时，发现肌腱切开术患者在3个月前屈曲时AROM增加（153.2°vs.130.1°,P=.004)，外展（138.6°vs.114.2°,P=.019)，和外部旋转(60.4°vs.43.8°,P=.014)，向前屈曲的差异在6个月时仍然显着（162.4°与149.4°,P=.009）。队列之间任何平面的恢复间隔率都没有显着差异。此外,组间症状性再撕裂率无显著差异(P=0.458).严重术后僵硬率接近，但在肌腱切开术（4.2%）和肌腱固定术（29.2%）队列之间没有达到统计学意义（P=0.066）。吸烟状况是严重僵硬的显著预测指标(比值比，13.69；P=.010）。
■尽管队列之间的绝对AROM存在显着差异，对于接受PTRCT关节镜下经肌腱RCR的患者,没有发现进行肌腱切开术或肌腱固定术的决定对AROM恢复率有差异.值得注意的是,然而,短暂性僵硬并发症更常见于吸烟者，数据趋势表明,接受LHB肌腱固定术的患者发生僵硬的风险增加.总的来说,术后僵硬可能是多因素的，可归因于患者和手术特定因素，LHB肌腱切开术可能更适合有术后僵硬危险因素的患者。
■共有90例PTRCT患者符合本研究的纳入标准。接受撕裂完成和修复的患者，翻修手术,或LHB肌腱的开放性修复被排除。患者被分层为肌腱切开术，关节镜胸上肌腱固定术，或没有二头肌手术队列，并且在年龄上倾向匹配1：1：1，性别,身体质量指数,和吸烟状况。主要结果测量包括AROM前屈，绑架,外部旋转,6周时内旋,3个月,术后6个月。最终随访时严重僵硬的发展和肩袖再撕裂的发生率被记录为次要结果。
■当比较肌腱切开术和肌腱固定术时，发现肌腱切开术患者在3个月前屈曲时AROM增加（153.2°vs.130.1°,P=.004)，外展（138.6°vs.114.2°,P=.019)，和外部旋转(60.4°vs.43.8°,P=.014)，向前屈曲的差异在6个月时仍然显着（162.4°与149.4°,P=.009）。队列之间任何平面的恢复间隔率都没有显着差异。此外,组间症状性再撕裂率无显著差异(P=0.458).严重术后僵硬率接近，但在肌腱切开术（4.2%）和肌腱固定术（29.2%）队列之间没有达到统计学意义（P=0.066）。吸烟状况是严重僵硬的显著预测指标(比值比，13.69；P=.010）。
■尽管队列之间的绝对AROM存在显着差异，对于接受PTRCT关节镜下经肌腱RCR的患者,没有发现进行肌腱切开术或肌腱固定术的决定对AROM恢复率有差异.值得注意的是,然而,短暂性僵硬并发症更常见于吸烟者，数据趋势表明,接受LHB肌腱固定术的患者发生僵硬的风险增加.总的来说,术后僵硬可能是多因素的，可归因于患者和手术特定因素，LHB肌腱切开术可能更适合有术后僵硬危险因素的患者。
