Walch, J Shoulder Elbow Surg 2005 - Arthroscopic Tenotomy of the Long Head of the Biceps in the Treatment of Rotator Cuff Tears: Clinical and Radiographic Results of 307 Cases
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Arthroscopic Tenotomy of the Long Head of the Biceps in the Treatment of Rotator Cuff Tears: Clinical and Radiographic Results of 307 Cases
Walch, Szabo, et al.·J Shoulder Elbow Surg·2005·675 citations·Retrospective cohort
Walch and colleagues assessed functional, subjective and radiographic outcomes after arthroscopic long‑head biceps tenotomy for selected full‑thickness cuff tears.
307 tenotomies in patients whose tears were judged irreparable, or who were older and unwilling to do post‑repair rehabilitation, followed a mean of 57 months (range 24 to 168).
Methods
Design
Consecutive single‑surgeon series, 1988 to 1999
Patients
307 shoulders in 291 patients
Full‑thickness rotator cuff tears
Tear judged irreparable, or older patient unwilling to do repair rehabilitation
Exposure
Arthroscopic biceps tenotomy in all 307 shoulders
Concomitant acromioplasty in 110 shoulders
Fatty infiltration of the cuff muscles
Follow-up
Mean 57 months (range 24 to 168)
Outcomes
Constant score
Patient satisfaction
Acromiohumeral interval
Glenohumeral arthritis
Reoperation
Key Findings
The mean Constant score rose from 48.4 points before surgery to 67.6 points at final follow‑up (p < 0.0001).
87% of patients rated themselves satisfied or very satisfied.
Radiographic changes progressed despite the clinical gains, as the mean acromiohumeral interval narrowed by 1.3 mm and humeral head osteonecrosis (Hamada stage 5), absent before surgery, appeared in 2.3% of shoulders.
An obvious biceps deformity was seen in 154 shoulders (50.2%), yet no patient rated the result fair or poor because of its appearance.
In multiple regression, fatty infiltration of the subscapularis and infraspinatus, with the preoperative Constant score, were the 3 factors most influencing the final adjusted Constant score.
Nine shoulders (2.9%) had another operation, 6 of them a reverse arthroplasty for increasing pain at a mean of 50 months.
Board pearl
Concomitant acromioplasty helped only when the preoperative acromiohumeral interval was over 6 mm, and with 6 mm or less it was associated with smaller gains in mobility and elevation.
Authors' conclusion
Arthroscopic biceps tenotomy in the treatment of rotator cuff tears in selected patients yields good objective improvement and a high degree of patient satisfaction. Despite these improvements, arthroscopic tenotomy does not appear to alter the progressive radiographic changes that occur with long-standing rotator cuff tears.
Walch and colleagues assessed functional, subjective and radiographic outcomes after arthroscopic long‑head biceps tenotomy for selected full‑thickness cuff tears.
307 tenotomies in patients whose tears were judged irreparable, or who were older and unwilling to do post‑repair rehabilitation, followed a mean of 57 months (range 24 to 168).
Methods
Design
Consecutive single‑surgeon series, 1988 to 1999
Patients
307 shoulders in 291 patients
Full‑thickness rotator cuff tears
Tear judged irreparable, or older patient unwilling to do repair rehabilitation
Exposure
Arthroscopic biceps tenotomy in all 307 shoulders
Concomitant acromioplasty in 110 shoulders
Fatty infiltration of the cuff muscles
Follow-up
Mean 57 months (range 24 to 168)
Outcomes
Constant score
Patient satisfaction
Acromiohumeral interval
Glenohumeral arthritis
Reoperation
Key Findings
The mean Constant score rose from 48.4 points before surgery to 67.6 points at final follow‑up (p < 0.0001).
87% of patients rated themselves satisfied or very satisfied.
Radiographic changes progressed despite the clinical gains, as the mean acromiohumeral interval narrowed by 1.3 mm and humeral head osteonecrosis (Hamada stage 5), absent before surgery, appeared in 2.3% of shoulders.
An obvious biceps deformity was seen in 154 shoulders (50.2%), yet no patient rated the result fair or poor because of its appearance.
In multiple regression, fatty infiltration of the subscapularis and infraspinatus, with the preoperative Constant score, were the 3 factors most influencing the final adjusted Constant score.
Nine shoulders (2.9%) had another operation, 6 of them a reverse arthroplasty for increasing pain at a mean of 50 months.
Board pearl
Concomitant acromioplasty helped only when the preoperative acromiohumeral interval was over 6 mm, and with 6 mm or less it was associated with smaller gains in mobility and elevation.
Authors' conclusion
Arthroscopic biceps tenotomy in the treatment of rotator cuff tears in selected patients yields good objective improvement and a high degree of patient satisfaction. Despite these improvements, arthroscopic tenotomy does not appear to alter the progressive radiographic changes that occur with long-standing rotator cuff tears.