Biceps tenodesis combined with rotator cuff repair increases functional status and elbow strength

Kılıç, Ali İhsan; Hapa, Onur; Özmanevra, Ramadan; Demirkıran, Nihat Demirhan; Gürsan, Onur

doi:10.1177/23094990211056978

Cited by 4 publications

(4 citation statements)

References 39 publications

(57 reference statements)

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“…In the last 10–15 years, all‐arthroscopic LHBT tenodesis has become the mainstream surgical approach for treating symptomatic LHBT lesions 9,22 . The Lasso‐Loop suture technique has a reliable clinical outcome and is currently the commonly used arthroscopic onlay tenodesis technique for LHBT tenodesis in the intertubercular groove 23–26 . Although the Lasso‐Loop suture technique is easy to operate under the arthroscope with a strong tissue grasping ability, according to recent biomechanical studies, the Lasso‐Loop suture technique shows biomechanical defects of uneven suture tendon load distribution 12,15 .…”

Section: Discussionmentioning

confidence: 99%

“…9,22 The Lasso-Loop suture technique has a reliable clinical outcome and is currently the commonly used arthroscopic onlay tenodesis technique for LHBT tenodesis in the intertubercular groove. [23][24][25][26] 26 Although the Lasso-Loop suture technique is easy to operate under the arthroscope with a strong tissue grasping ability, according to recent biomechanical studies, the Lasso-Loop suture technique shows biomechanical defects of uneven suture tendon load distribution. 12,15 At the same time, the suture can easily cut the tendon and causes fixation failure, resulting in inferior biomechanical results compared with other techniques.…”

Section: All-arthroscopic Suprapectoral Biceps Tenodesismentioning

confidence: 99%

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Biomechanical Analysis of Lark‐Loop, Lasso‐Loop and Krackow Suture Technique in Tenodesis

Zhou

Cui

et al. 2023

Orthopaedic Surgery

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Objective Strong tendon grasping is vital to the success of a tenodesis operation. The purpose of this study was to evaluate the initial tendon‐fixation strength of the Lark‐Loop technique in arthroscopic suprapectoral biceps tenodesis and compare it with others commonly used techniques. Methods Thirty‐three porcine superficial flexor digitorum tendons were harvested from a local slaughterhouse and randomly divided into three groups to perform three tendon fixation techniques (Lasso‐Loop stich group, Lark‐Loop stich group or Krackow stich group; 11 tendons each group) with a No. 2 suture, respectively. Each tendon was pre‐tensioned in 5°N for 2 min and then cyclically loaded 5 to 30°N for 500 cycles to assess displacement. After cyclic loading, the tendon was loaded to ultimate tendon‐suture configuration failure at the rate of 1 mm/s. Finally, the mode of failure and the construct stiffness of the tendon were recorded and calculated. Results After cyclical loading, the displacement of the Lark‐Loop group was equivalent to the Krakow group (P > 0.9999) but significantly smaller than the Lasso‐Loop group (P = 0.0009). The ultimate load to failure for the Lark‐Loop was equivalent to the Krakow technique group (P = 0.1463) but significantly greater than the Lasso‐Loop group (P < 0.0001). The stiffness for the Lark‐Loop was equivalent to the Krakow group (P = 0.4718) but significantly greater than the Lasso‐Loop technique group (P < 0.0001). In the Lark‐Loop and Krackow group, all the tendons failed by suture breakage, while all the tendons failed by suture cutting through the tendon in the Lasso‐Loop technique group. Conclusion Lark‐Loop suture technique has biomechanical properties comparable to Krackow and superior to the Lasso‐Loop in terms of suture displacement, ultimate load to failure, and stiffness. Therefore, the Lark‐Loop suture fixation technique may be beneficial for arthroscopic biceps tenodesis.

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Section: Discussionmentioning

confidence: 99%

Section: All-arthroscopic Suprapectoral Biceps Tenodesismentioning

confidence: 99%

Biomechanical Analysis of Lark‐Loop, Lasso‐Loop and Krackow Suture Technique in Tenodesis

Zhou

Cui

et al. 2023

Orthopaedic Surgery

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“…1,15 In a study using the Surgical Outcomes System database comparing tenodesis versus tenotomy, tenodesis was shown to provide improved pain and functional scores compared with tenotomy at 2 years; however, the benefit did not exceed the previously reported MCID for the outcome scores. 19 In a 2021 study, Kilic et al 9 evaluated VAS and Constant scores as well as forearm supination and elbow flexion muscle strength pre- and postoperatively in the setting of biceps tenodesis with RCR. The cohort of 19 patients revealed a statistically significant increase in elbow flexion and forearm supination strength at postoperative evaluation.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Biceps Tenodesis Variations With Concomitant Rotator Cuff Repair: A Multicenter Database Analysis

Hagan

Hao

King

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: Studies to date comparing biceps tenodesis methods in the setting of concomitant rotator cuff repair (RCR) have demonstrated relatively equivalent pain and functional outcomes. Purpose: To compare biceps tenodesis constructs, locations, and techniques in patients who underwent RCR using a large multicenter database. Study Design: Cohort study; Level of evidence, 3. Methods: A global outcome database was queried for patients with medium- and large-sized tears who underwent biceps tenodesis with RCR between 2015 and 2021. Patients ≥18 years of age with a minimum follow-up of 1 year were included. The American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, visual analog scale for pain, and Veterans RAND 12-Item Health Survey (VR-12) scores were compared at 1 and 2 years of follow-up based on construct (anchor, screw, or suture), location (subpectoral, suprapectoral, or top of groove), and technique (inlay or onlay). Nonparametric hypothesis testing was used to compare continuous outcomes at each time point. The proportion of patients achieving the minimal clinically important difference (MCID) at the 1- and 2-year follow-ups were compared between groups using chi-square tests. Results: A total of 1903 unique shoulder entries were analyzed. Improvement in VR-12 Mental score favored anchor and suture fixations at 1 year of follow-up ( P = .042) and the onlay tenodesis technique at 2 years of follow-up ( P = .029). No additional tenodesis comparisons demonstrated statistical significance. The proportion of patients with improvement exceeding the MCID did not differ based on tenodesis methods for any outcome score assessed at the 1- or 2-year follow-up. Conclusion: Biceps tenodesis with concomitant RCR led to improved outcomes regardless of tenodesis fixation construct, location, or technique. A clear optimal tenodesis method with RCR remains to be determined. Surgeon preference and experience with various tenodesis methods as well as patient clinical presentation should continue to guide surgical decision-making.

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“…Several factors, including Goutallier grade, 15 biceps tenodesis, and repair technique, have been identified to be related to postrepair strength recovery. 1 , 14 , 21 , 32 However, the impact of post-ARCR retear on strength recovery remains poorly understood. Moreover, return to previous work after ARCR is an active area of research, 17 , 18 , 20 with a systematic review by Haunschild et al 20 finding that 62.3% of patients returned to their previous level of work.…”

mentioning

confidence: 99%

Effect of Retear After Arthroscopic Rotator Cuff Repair on Return to Work and Sports in Nonathletes: A Retrospective Cohort Study

Kim,

Hur,

Jeon

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: The impact of retear after arthroscopic rotator cuff repair (ARCR) on clinical outcomes of patients remains controversial. Purpose/Hypothesis: The purpose of this study was to determine the effects of retear on strength recovery, return to previous levels of work, and return to sports participation. It was hypothesized that retears (1) would not have a significant effect on patient-reported outcome measures (PROMs) and (2) would significantly inhibit strength recovery and return to previous work and sports. Study Design: Cohort study; Level of evidence, 3. Methods: The authors collected data from patients who underwent ARCR between January 2015 and December 2019. All included patients had undergone magnetic resonance imaging (MRI) and strength measurements 1 year postoperatively. Minimum 2-year postoperative PROMs (Constant score, pain visual analog scale, American Shoulder and Elbow Surgeons score, and Single Assessment Numeric Evaluation) and status on work and sports participation were collected, and PROM scores, strength recovery (percentage compared with the contralateral shoulder), return to work, and return to sports were compared between patients with versus without retear on 1-year postoperative MRI. Additionally, factors related to return to work and sports were identified through multivariable regression analysis. Results: A total of 159 patients were included, of whom 19 (11.9%) had evidence of retear. Return-to-work and return-to-sports status was evaluated in 134 (84.3%) and 93 (58.5%) patients, respectively. There were no significant differences in PROM scores between patients with and without retears; however, patients with retears exhibited significantly worse supraspinatus strength recovery (73% vs 86%; P = .018) and external rotation strength recovery (78% vs 88%; P = .030) compared with patients with intact shoulders. There were no between-group differences in return to work or sports. Active workload was associated with unsuccessful return to work, whereas preoperative participation in shoulder sports was associated with successful return to work. Conclusion: Patients with postoperative retears had significantly worse postoperative strength recovery than patients with intact shoulders. Active workload and preoperative shoulder sports participation were factors associated with ability to return to work.

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Biceps tenodesis combined with rotator cuff repair increases functional status and elbow strength

Cited by 4 publications

References 39 publications

Biomechanical Analysis of Lark‐Loop, Lasso‐Loop and Krackow Suture Technique in Tenodesis

Biomechanical Analysis of Lark‐Loop, Lasso‐Loop and Krackow Suture Technique in Tenodesis

Outcomes of Biceps Tenodesis Variations With Concomitant Rotator Cuff Repair: A Multicenter Database Analysis

Effect of Retear After Arthroscopic Rotator Cuff Repair on Return to Work and Sports in Nonathletes: A Retrospective Cohort Study

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