Tenodese bicipital "a rocambole": técnica e resultados

Abstract

This article is available online in Portuguese and ABSTRACTObjective: To present a new technique for bicipital tenodesis and its results: accomplished partially via arthroscopy and grounded in concepts of the normal and pathological anatomy of the tendon of the biceps long head. It is based on the predisposition of this tendon towards becoming attached to the intertubercular sulcus after rupture or tenotomy (auto-tenodesis). Methods: Evaluations were conducted on 63 patients (63 shoulders), aged from 32 to 77 years (average 55), consisting of 32 females (51%) and 31 males (49%). Thirty-five of the patients (55.6%) were over 60 years of age and 28 patients (44.4%) were under 60 years of age. Eighteen were sports participants (28.6%). Fourteen had injuries associated with the subscapularis (22.2%). The average follow up was 43 months (ranging from 12 to 74 months). The right shoulder accounted for 48 cases (76.2%), of which one was a left-handed individual and 47 were right-handed. The left shoulder accounted for 15 (23%) of the patients, of whom two were left-handed and 13 were right-handed. There were no bilateral occurrences. The statistical analysis were done using SPSS version 18. Pearson's chi-square test and continuity corrections were used to investigate the statistical significance of associations between variables. Associations were taken to be statistically significant when p was less than 0.05. Results: Residual Popeye deformity was perceived by seven patients (11.1%); it was only observed by the examiner in 15 cases (23.8%); and neither the patient nor the examiner observed it in 41 cases (65%). There were no statistically valid influences from age, participation in contact or throwing sports, subscapularis tendon-associated injury or Popeye deformity. Fifty-eight patients (92.06%) were satisfied, two patients were dissatisfied (3.17%) and three patients were indifferent (4.76%). Conclusion: The technique presented high patient satisfaction rates (92.06%) and residual deformity was perceived by 11.1% of the patients. The appearance did not have any statistically valid correlation with ages over or under 60 years (p = 0.883), sports practice (p = 0.195) or subscapularis-associated injury (p = 0.958).

Interprofessional analysis of esthetical deformity from long head biceps tenotomy

“…It is likely that little agreement among experts has been, in this study, an incidental finding, with no statistically significant difference of the divergence found in other professionals. We agree with Godinho et al 28 who suggest a correlation between the sensitivity of the patient and the professional to detect the residual deformity after tenotomy of the LHB, however, even the specialized professionals have difficulty visualizing the deformity in obese patients. Our findings suggest that the aggregating tenodesis of LHB in obese patients could be unnecessary, since the tenodesis does not increase the clinical and functional results when compared to the isolated tenotomy of the LHB.…”

“…Godinho et al 28 demonstrated in a statistically significant way that the ability to verify the residual Popeye deformity is more concise in the professional physician. They used an independent examiner who had not participated in the surgical procedure to evaluate the presence of Popeye deformity after performing the LHB tenotomy technique associated with "jelly roll" tenodesis.…”

“…Most studies question patients about the perception or not of aesthetic deformity resulting from tenotomy of LHB, these rates vary between 5 and 65%. 8 , 13 , 21 - 28 Almeida et al 22 showed that the perception of aesthetic deformity by patient was higher in men with the operated dominant upper limb (UL), BMI < 30 kg/m 2 , abdominal skinfold < 23.2 mm and contralateral tricipital fold < 14.5 mm. Godinho et al 28 stated that the assessment of cosmetic deformity is more concise when performed by an professional orthopedist.…”

Evaluation of the results from arthroscopic tenodesis of the long head of the biceps brachii on the tendon of the subscapularis muscle

“…Sethi et al 8 reported that there was lower risk of Popeye's sign appearing when tenodesis was chosen as the procedure. In a study in which 63 patients who underwent arthroscopic tenodesis on the tendon of the LHBB were evaluated, Godinho et al 9 reported that seven patients (11.1%) complained about esthetic deformity. When examined by the evaluator, 41 (65%) did not present Popeye's sign.…”

“…In a series of 22 patients who underwent another technique for arthroscopic tenodesis of the LHBB, Mazzoca et al 14 did not report any complaints of pain after the operation. Godinho et al 9 only presented two cases of residual pain (3.2%) among 63 patients who were evaluated after tenodesis. The present study showed postoperative anterior pain only in one interviewee (3.1%), observed excellent results from the technique presented and was in agreement with most of the studies encountered in the literature.…”