The use of long head biceps tendon autograft for massive rotator cuff tears: a PRISMA compliant systematic review

Aicale, Rocco; Poeta, Nicola; Savarese, Eugenio; Bernardini, Giulio; Oliva, Francesco; Maffulli, Nicola

doi:10.1093/bmb/ldac021

Cited by 6 publications

(6 citation statements)

References 50 publications

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“…Also, only three articles described an arthroscopic technique for the use of LHBT as an augmentation, performing a tenotomy to the glenoid insertion and maintaining intact the tendon into the groove [11, 24, 25, 52]. Retears rate using LHBT as augmentation are reported between 1.7% and 20% [2].…”

Section: Discussionmentioning

confidence: 99%

“…Recent systematic review [2] investigated different modalities of use of LHBT. For example, as a free patch or simply as a graft attached to the cuff reconstruction, and contrasting results have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…When its use is compared with a control group of patients with MRCTs, no differences were found regarding retear rates or in their functional evaluations, at 1‐year follow‐up by MRI [49]. However, the small numbers of patients and short follow‐up prevent meaningful comparisons [2].…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, several authors routinely perform an LHBT tenotomy or tenodesis to improve clinical results [59]. More recently, different authors proposed to preserve the LHBT and use it as an autologous graft, providing tenocytes and promoting healing, to augment the RC repair and perform also a partial superior capsular reconstruction [2, 60].…”

Section: Discussionmentioning

confidence: 99%

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Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved

Savarese,

Aicale,

Torsiello

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeManagement of massive rotator cuff tears (MRCTs) remains debated, and various arthroscopic and open techniques have been described for their management. Nevertheless, the optimal strategy remains unclear. The present study evaluated the clinical results in patients managed arthroscopically for MRCTs augmented with the long head biceps tendon (LHBT) at a minimum 1‐year follow‐up, considering different type of tears, demographic data and number of torn tendons.MethodsPatients treated in a secondary referral centre from January 2021 to April 2022 were enroled prospectively. Inclusion criteria were pain, inability to fully elevate the affected shoulder, irreparable tears and active and motivated patients. All patients were managed within 2 months from diagnosis in a single centre by the same surgeons. Preoperative shoulder radiographs and magnetic resonance imaging (MRI) were collected, and clinical assessment was also performed using the Numerical analogue scale (NAS), Constant score (CS) American Shoulder and Elbow Surgeons Shoulder Score (ASES). Tissue retraction and tendon fatty infiltration were evaluated using Patte and Fuchs scale, respectively. Clinical assessment was performed using the same scales at 3–6 months and 1‐year follow‐up.ResultsA total of 55 patients (31 female and 24 male) with a mean age of 60 ± 7.1 years were enroled for a mean follow‐up of 18.2 ± 4.3 months. The mean preoperative NAS was 7.8 ± 0.6, CS was 20.5 ± 7.6 and ASES was 22.6 ± 9.2, increasing, respectively, to 0.3 ± 0.6, 91.5 ± 6.9 and 94.2 ± 6.7. No adverse side effects (infection, rejection, allergy) were reported during the study period. All patients were evaluated after surgery at 3 and 6 months and 1 year with statistically significant improvement for each score at the first and last follow‐up (p < 0.05).ConclusionsThe use of LHBT augmentation in patients with MRCTs in appropriately selected patients is safe and effective and can lead to pain relief and acceptable clinical outcomes. Furthermore, its use carries low donor site morbidity and is cost effective. Comparative studies, including randomised controlled trials, with other proposed techniques are needed to confirm these findings.Level of EvidenceLevel IV.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved

Savarese,

Aicale,

Torsiello

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…Tendinopathy of the long head of the biceps tendon (LHBT), which occurs in isolation or is accompanied by other shoulder pathologies, is a common cause of anterior shoulder pain [ 2 , 28 ]. Surgical interventions for LHBT tendinopathy include tenotomy and tenodesis [ 13 , 21 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

Modified arthroscopic intra-articular transtendinous looped biceps tenodesis leads to satisfactory functional outcomes and less frequent Popeye deformity compared to biceps tenotomy

Chiang

Lin

et al. 2023

J Orthop Surg Res

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Purpose The present study aimed to propose a modified intra-articular transtendinous looped biceps tenodesis (mTLBT) using a suture anchor and to compare the functional outcomes and incidence of Popeye deformities between biceps tenotomy and mTLBT. Methods Medical records of patients who underwent either tenotomy or mTLBT for the long head of the biceps tendon (LHBT) lesion between January 2016 and April 2021 were retrospectively reviewed. The inclusion criteria were patients aged 40–70 years with LHBT pathologies, such as superior labrum anterior to posterior (SLAP) lesions > type II, LHBT pulley system rupture with bicipital instability, and intra-articular LHBT tear. The exclusion criteria were full-thickness supraspinatus tears, frozen shoulder, shoulder fracture, and postoperative traumatic events that affected the operated shoulder. All patients were followed up for at least 1 year. Popeye deformity, bicipital cramping pain, visual analog scale (VAS) pain score, and functional outcome scores (University of California at Los Angeles [UCLA] and American Shoulder and Elbow Surgeons [ASES] scores) were recorded. Fisher’s exact test and Chi-square test were used for categorical variables, whereas the Mann–Whitney U test was used for nonparametric variables. Results The mTLBT and tenotomy groups included 15 and 40 patients, respectively. The incidence of Popeye deformity and biceps cramping pain in the tenotomy group (52.5% and 50%, respectively) was significantly higher than that in the mTLBT group (13.3% and 20%, respectively) (p = 0.009 and p = 0.045, respectively). The postoperative VAS, UCLA, and ASES scores were not significantly different between the two groups. One patient in the tenodesis group experienced metallic-anchor pullout. Conclusion mTLBT is an arthroscopic intra-articular top of the groove tenodesis that can be performed completely in the intra-articular space and is especially suitable for patients with an intact or partially torn rotator cuff. This technique is reliable for treating biceps pathologies as it results in similar functional outcome scores, lesser biceps cramping pain, and less frequent Popeye deformity compared to biceps tenotomy. Level of Evidence III.

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Shoulder balloon spacer for massive irreparable rotator cuff tears results in significant improvements

Savarese,

Aicale,

Romeo

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of the present study was to assess the effectiveness of balloon implantation in patients with irreparable supraspinatus tears alone or in combination with other rotator cuff (RC) tendon tears and the effect of several covariables, such as age, gender, status of the long head biceps, with or without tendon repair and regardless the number of tendon involved.MethodsPatients enrolled from ‘San Carlo’ Hospital of Potenza (Italy, IT), from January 2012 to September 2014, underwent arthroscopic implantation of shoulder balloon by a single surgeon, and followed for 3 years. The American Shoulder and Elbow Surgeons (ASES) and Constant score (CS) were administered pre‐, post‐operatively at 12 months, and then annually. Patients were classified on the basis of the number of tendons involved in the tears and treatment performed, considering the reparability of the tendons themselves. Gleno‐humeral joint osteoarthrosis (OA) was evaluated through shoulder radiographs and classified according to the Samilson–Prieto classification, at the first examination and at the final follow‐up. Statistical improvements were evaluated using a variance model (least‐squares means) and a T distribution test for the evaluation between different treatment groups.ResultsA total of 61 procedures were performed, and eight patients were lost during follow‐up. The mean baseline CS was 30.2 ± 15.4 with statistically significant improvement, respectively, at 1‐, 2‐ and 3‐year follow‐up to 69.3 ± 4.2, 74.6 ± 3.6 and 69.7 ± 5.1 respectively. ASES score at baseline was 22.5 ± 10.9, with a statistically significant improvement to 69.7 ± 9.2, 68 ± 17.8 and 71.2 ± 16.6 at 1‐, 2‐ and 3‐year follow‐up, respectively. Tenotomy or absence of long head biceps at presentation did not influence results (n.s.), with no difference according to gender and age. At final follow‐up, 24 patients (43.9%) showed progression of glenohumeral OA. One patient required secondary surgery for shoulder replacement after 18 months for persistent pain and one patient required implant removal following post‐operative laser treatment.ConclusionArthroscopic rotator cuff tears repair with subacromial spacer balloon implantation showed statistically significant clinical and functional improvement at 3‐year follow‐up. Patients treated with combined partial repair and subacromial spacer balloon implantation experienced good results independent of gender, age, type of tear and long‐head biceps tendon status. The risks related to this procedure appear to be minimal.Level of EvidenceLevel IV.

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The use of long head biceps tendon autograft for massive rotator cuff tears: a PRISMA compliant systematic review

Cited by 6 publications

References 50 publications

Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved

Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved

Modified arthroscopic intra-articular transtendinous looped biceps tenodesis leads to satisfactory functional outcomes and less frequent Popeye deformity compared to biceps tenotomy

Shoulder balloon spacer for massive irreparable rotator cuff tears results in significant improvements

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