Effectiveness of arthroscopic double fixation and enhanced suture of long head of biceps tendon <i>in situ</i> for repairing rotator cuff tear_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

FU Pengfei , TIAN Jinxiang , GUO Biao ,  YANG Dongqiang

Department of Orthopedic Sports Medicine, Fuyang People’s Hospital, Fuyang Anhui, 236000, P. R. China;

Corresponding author：

YANG Dongqiang, Email: ydq667079@163.com

Keywords：

Rotator cuff tear; long head of bicepstendon; double fixation; arthroscopy; enhanced repair

DOI：

10.7507/1002-1892.202501053

Video：

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Objective To investigate the effectiveness of arthroscopic double fixation and enhanced suture of long head of biceps tendon (LHBT) in situ for repairing rotator cuff tear. Methods A retrospective analysis was conducted on 31 patients with rotator cuff tears and LHBT injuries admitted between June 2022 and November 2023. All patients underwent arthroscopic double fixation and enhanced suture of LHBT in situ. There were 12 males and 19 females, with an average age of 61.6 years (range, 53-76 years). There were 10 cases of acute injury and 21 cases of chronic injury. According to DeOrio and Cofield classification criteria, the degree of rotator cuff tear rated as medium-sized tears in 3 cases, large tears in 12 cases, and massive tears in 16 cases. Associated injuries included 5 cases of shoulder joint adhesions, 12 cases of subscapularis muscle tears, and 31 case of shoulder impingement syndromes. The shoulder range of motion (ROM) (forward flexion, abduction, lateral external rotation, lateral internal rotation) and pain/function scores [visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, Constant-Murley Score] were recorded before operation and at last follow-up. MRI at last follow-up were taken to evaluate the rotator cuff healing and structural integrity. Results All 31 surgeries were successfully completed with operation time ranging from 90 to 210 minutes (mean, 144 minutes). The 3-5 anchors (mean 3.8) were used during operation. All Incisions healed by first intention. All patients were followed up 12-29 months (mean, 18.5 months). At 3 months after operation, 2 cases developed joint adhesions, 3 had internal rotation limitations, and 2 experienced residual pain at the intertubercular groove, all resolved with conservative management. No Popeye deformity occurred during follow-up. At last follow-up, Shoulder ROM (forward flexion, abduction, lateral external rotation, lateral internal rotation) and pain/function scores (VAS, UCLA, and Constant-Murley scores) showed significant improvement compared to preoperative values (P<0.05). At last follow-up, MRI evaluation that the rotator cuff healing rate reached 90.3% according to the Sugaya classification criteria. LHBT exhibited normal morphology, course, and continuity without dislocation. Surrounding synovial sheath showed no thickening or effusion. Conclusion Arthroscopic double fixation and enhanced suture of LHBT in situ for repairing rotator cuff tear can significantly reduce shoulder joint pain, improve ROM, and achieve a high rotator cuff healing rate.

1.	Ko SH, Na SC, Kim MS. Risk factors of tear progression in symptomatic small to medium-sized full-thickness rotator cuff tear: relationship between occupation ratio of supraspinatus and work level. J Shoulder Elbow Surg, 2023, 32(3): 565-572.
2.	李雨鹏, 黎富民, 杨晓. 肩袖合并肱二头肌长头腱损伤的相关因素概述. 四川医学, 2023, 44(5): 540-543.
3.	Alraddadi A, Aldebasi B, Alnufaie B, et al. The association between a rotator cuff tendon tear and a tear of the long head of the biceps tendon: Chart review study. PLoS One, 2024, 19(3): e0300265. doi: 10.1371/journal.pone.0300265.
4.	Lee DH, Lee GM, Park HB. Factors associated with long head of the biceps tendon tear severity and predictive insights for grade Ⅱ tears in rotator cuff surgery. Clin Shoulder Elb, 2024, 27(2): 149-159.
5.	Chiang CH, Shaw L, Chih WH, et al. Modified superior capsule reconstruction using the long head of the biceps tendon as reinforcement to rotator cuff repair lowers retear rate in large to massive reparable rotator cuff tears. Arthroscopy, 2021, 37(8): 2420-2431.
6.	Lu Y, Li Y, Zhang H, et al. The correlation between variation of labral attachment and lesions of the long head of the biceps tendon in patients with rotator cuff tears. Orthop Surg, 2023, 15(8): 1967-1974.
7.	Lalehzarian SP, Agarwalla A, Liu JN. Management of proximal biceps tendon pathology. World J Orthop, 2022, 13(1): 36-57.
8.	Cutbush K, Stalin KA, Ingoe H, et al. Arthroscopic suprapectoral biceps tenodesis using an onlay technique. Arthroscopy Techniques, 2024, 13(12): 103123. doi: 10.1016/j.eats.2024.103123.
9.	尚西亮, 吕婧仪, 陈疾忤, 等. 关节镜下肱二头肌长头腱转位固定辅助替代上关节囊重建 (Chinese Way)修补巨大及不可修复肩袖撕裂的临床疗效. 中国运动医学杂志, 2019, 38(8): 652-657.
10.	Sethi P, Fares MY, Murthi A, et al. The long head of the biceps tendon: a valuable tool in shoulder surgery. J Shoulder Elbow Surg, 2023, 32(9): 1801-1811.
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): 563-567.
12.	Sugaya H, Maeda K, Matsuki K, et al. Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy, 2005, 21(11): 1307-1316.
13.	丁凯, 姚雨婧, 李志鹏, 等. 肩关节镜下肱二头肌长头腱转位强化缝合修复巨大肩袖撕裂损伤. 中国组织工程研究, 2024, 28(35): 5675-5680.
14.	Cyrus Rezvanifar S, Lamb JJ, Wing MF, et al. The long head of the biceps tendon undergoes multiaxial deformation during shoulder motion. Journal of Biomechanics, 2024, 162: 111900. doi: 10.1016/j.jbiomech.2023.111900.
15.	Nicholson AD, Estrada JA, Mathew JI, et al. Minimum 15-year follow-up for clinical outcomes of arthroscopic rotator cuff repair. J Shoulder Elbow Surg, 2022, 31(8): 1696-1703.
16.	Tang X, Zhang J, Zhang J, et al. Correlation between the morphological features of the biceps groove and injuries to the biceps pulley and the long head tendon of the biceps. BMC Musculoskelet Disord, 2023, 24(1): 377. doi: 10.1186/s12891-023-06497-5.
17.	Vigié R, Bonnevialle N, Hao KA, et al. Tenotomy or tenodesis versus conservation of the long head of the biceps tendon in the repair of isolated supraspinatus tears: A systematic review of the literature. Orthop Traumatol Surg Res, 2023, 109(8S): 103673. doi: 10.1016/j.otsr.2023.103673.
18.	Laprus H, Brzóska R, Błasiak A, et al. Massive and irreparable rotator cuff tear treatment by arthroscopic partial repair with long head of the biceps tendon augmentation provides better healing and functional results than partial repair only. J Shoulder Elbow Surg, 2024, 33(2): 263-272.
19.	康运康, 郭标, 许健, 等. 关节镜下肱二头肌长头腱转位术联合Swivelock锚钉双固定治疗巨大及不可修复肩袖撕裂. 中国修复重建外科杂志, 2022, 36(12): 1459-1464.
20.	Savarese E, Aicale R, Torsiello E, et al. Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved. Knee Surg Sports Traumatol Arthrosc, 2024, 32(7): 1843-1853.
21.	Milano G, Colosio A, Minotta Quebradas MJ, et al. Biologic augmentation of rotator cuff repair with microfragmented autologous subacromial bursal tissue enveloped in a patch of compressed autologous long head of biceps tendon tissue: the Bio-Ravioli technique. JSES Int, 2024, 8(5): 1010-1015.

1. Ko SH, Na SC, Kim MS. Risk factors of tear progression in symptomatic small to medium-sized full-thickness rotator cuff tear: relationship between occupation ratio of supraspinatus and work level. J Shoulder Elbow Surg, 2023, 32(3): 565-572.
2. 李雨鹏, 黎富民, 杨晓. 肩袖合并肱二头肌长头腱损伤的相关因素概述. 四川医学, 2023, 44(5): 540-543.
3. Alraddadi A, Aldebasi B, Alnufaie B, et al. The association between a rotator cuff tendon tear and a tear of the long head of the biceps tendon: Chart review study. PLoS One, 2024, 19(3): e0300265. doi: 10.1371/journal.pone.0300265.
4. Lee DH, Lee GM, Park HB. Factors associated with long head of the biceps tendon tear severity and predictive insights for grade Ⅱ tears in rotator cuff surgery. Clin Shoulder Elb, 2024, 27(2): 149-159.
5. Chiang CH, Shaw L, Chih WH, et al. Modified superior capsule reconstruction using the long head of the biceps tendon as reinforcement to rotator cuff repair lowers retear rate in large to massive reparable rotator cuff tears. Arthroscopy, 2021, 37(8): 2420-2431.
6. Lu Y, Li Y, Zhang H, et al. The correlation between variation of labral attachment and lesions of the long head of the biceps tendon in patients with rotator cuff tears. Orthop Surg, 2023, 15(8): 1967-1974.
7. Lalehzarian SP, Agarwalla A, Liu JN. Management of proximal biceps tendon pathology. World J Orthop, 2022, 13(1): 36-57.
8. Cutbush K, Stalin KA, Ingoe H, et al. Arthroscopic suprapectoral biceps tenodesis using an onlay technique. Arthroscopy Techniques, 2024, 13(12): 103123. doi: 10.1016/j.eats.2024.103123.
9. 尚西亮, 吕婧仪, 陈疾忤, 等. 关节镜下肱二头肌长头腱转位固定辅助替代上关节囊重建 (Chinese Way)修补巨大及不可修复肩袖撕裂的临床疗效. 中国运动医学杂志, 2019, 38(8): 652-657.
10. Sethi P, Fares MY, Murthi A, et al. The long head of the biceps tendon: a valuable tool in shoulder surgery. J Shoulder Elbow Surg, 2023, 32(9): 1801-1811.
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): 563-567.
12. Sugaya H, Maeda K, Matsuki K, et al. Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy, 2005, 21(11): 1307-1316.
13. 丁凯, 姚雨婧, 李志鹏, 等. 肩关节镜下肱二头肌长头腱转位强化缝合修复巨大肩袖撕裂损伤. 中国组织工程研究, 2024, 28(35): 5675-5680.
14. Cyrus Rezvanifar S, Lamb JJ, Wing MF, et al. The long head of the biceps tendon undergoes multiaxial deformation during shoulder motion. Journal of Biomechanics, 2024, 162: 111900. doi: 10.1016/j.jbiomech.2023.111900.
15. Nicholson AD, Estrada JA, Mathew JI, et al. Minimum 15-year follow-up for clinical outcomes of arthroscopic rotator cuff repair. J Shoulder Elbow Surg, 2022, 31(8): 1696-1703.
16. Tang X, Zhang J, Zhang J, et al. Correlation between the morphological features of the biceps groove and injuries to the biceps pulley and the long head tendon of the biceps. BMC Musculoskelet Disord, 2023, 24(1): 377. doi: 10.1186/s12891-023-06497-5.
17. Vigié R, Bonnevialle N, Hao KA, et al. Tenotomy or tenodesis versus conservation of the long head of the biceps tendon in the repair of isolated supraspinatus tears: A systematic review of the literature. Orthop Traumatol Surg Res, 2023, 109(8S): 103673. doi: 10.1016/j.otsr.2023.103673.
18. Laprus H, Brzóska R, Błasiak A, et al. Massive and irreparable rotator cuff tear treatment by arthroscopic partial repair with long head of the biceps tendon augmentation provides better healing and functional results than partial repair only. J Shoulder Elbow Surg, 2024, 33(2): 263-272.
19. 康运康, 郭标, 许健, 等. 关节镜下肱二头肌长头腱转位术联合Swivelock锚钉双固定治疗巨大及不可修复肩袖撕裂. 中国修复重建外科杂志, 2022, 36(12): 1459-1464.
20. Savarese E, Aicale R, Torsiello E, et al. Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved. Knee Surg Sports Traumatol Arthrosc, 2024, 32(7): 1843-1853.
21. Milano G, Colosio A, Minotta Quebradas MJ, et al. Biologic augmentation of rotator cuff repair with microfragmented autologous subacromial bursal tissue enveloped in a patch of compressed autologous long head of biceps tendon tissue: the Bio-Ravioli technique. JSES Int, 2024, 8(5): 1010-1015.

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