Objective To evaluate the mid-to long-term efficacy of arth roscopic (long head of biceps tendon, LHBT) transposition bridging technique in the treatment of irreparable massive rotator cuff tears. Methods A retrospective analysis of 27 patients with irreparable massive rotator cuff tears admitted to our hospital from March 2020 to May 2022 was performed. The patients had an average age of (64.47±10.30) years and all underwent rotator cuff repair using the LHBT transfer bridging technique under shoulder arthroscopy. Preoperatively, at 1-year postoperatively, and at 3 years postoperatively, patients were assessed by using the visual analog scale (VAS), University of California, Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley shoulder function score, and shoulder range of motion. At 1 year and 3 years postoperatively, MRI of the shoulder was used to evaluate the integrity of the repair. According to the Sugaya classification at 1 year and 3 years postoperatively, 21 patients (6 of the 27 patients were lost to follow-up) were divided into an intact tendon group (n=17) and a tendon tear group (n=4), and the differences in the aforementioned indices were compared. Results Compared with preoperative values, the 21 patients showed significant improvements in visual analog scale scores, UCLA scores, ASES scores, Constant-Murley shoulder function scores, and shoulder joint range of motion at 1 year and 3 years postoperatively (P<0.05). There were differences in preoperative Goutallier grading between the intact tendon group and the tear tendon group (P<0.05), but there was no significant difference in visual analog scale scores, UCLA scores, ASES scores, Constant-Murley shoulder function scores, and shoulder joint range of motion at 1 year and 3 years postoperatively (P>0.05). At 3 years postoperatively, MRI of the affected shoulder showed that the repaired tendon had healed well in 17 patients, with a healing rate of 80.9%. Conclusions The LHBT transposition bridging technique under shoulder arthroscopy can provide reliable repair for irreparable massive rotator cuff tears, significantly relieve shoulder pain, and restore shoulder joint function. After up to three years of follow-up, the re-tear rate is low, effectively promoting tendon-bone healing of the rotator cuff.
Key words
Arthroscopy /
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Irreparable massive /
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Rotator cuff tear /
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Long head of biceps tendon transfer /
Application value
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References
[1] Doiron-cadrin P, Lafrance S, Saulnier M, et al. Shoulder rotator cuff disorders: A systematic review of clinical practice guidelines and semantic analyses of recommendations[J]. Arch Phys Med Rehabil, 2020, 101(7): 1233-1242. DOI:10.1016/j.apmr.2019.12.017.
[2] Deorio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair[J]. J Bone Joint Surg Am, 1984, 66(4): 563-567. DOI:10.2106/00004623-198466040-00011.
[3] Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff[J]. J Bone Joint Surg Am, 2000, 82(4): 505-515. DOI: 10.2106/00004623-200004000-00006.
[4] Yang Z, Zhang M, Liu T, et al. Does the fatty infiltration influence the retear rate and functional outcome after rotator cuff repair? a systematic review and Meta-analysis[J]. Indian J Orthop, 2023, 57(2):227-237. DOI:10.1007/s43465-022-00807-0.
[5] Virk MS, Cole BJ. Proximal biceps tendon and rotator cuff tears[J]. Clin Sports Med, 2016, 35(1):153‑161. DOI:10.1016/j.csm.2015.08. 010.
[6] 李敏, Shaikh Atik Badshah, 彭赓, 等. 合并肩袖损伤的肱二头肌长头腱病变固定与切断比较[J].中国矫形外科杂志, 2021, 29(24): 2272-2274, 2278. DOI:10.3977/j.issn.1005-8478.2021.24.15.
Li M, Shaikh AB, Peng G, et al. Comparison of fixation and tenotomy of long head of biceps tendon in combined rotator cuff injuries [J]. Chinese Journal of Orthopaedic Surgery, 2021, 29(24):2272-2274, 2278. DOI:10.3977/j.issn.1005-8478.2021.24.15.
[7] 尚西亮, 吕婧仪, 张树蓉, 等. LHBT转位上关节囊重建治疗巨大不可修复性肩袖撕裂的生物力学与临床研究[J].中华骨科杂志, 2021, 41(9): 559‑567. DOI:10.3760/cma.j.cn121113-20201201-00702.
Shang XL, Lv JY, Zhang SR, et al. Biomechanical and clinical study of LHBT transposition with joint capsule reconstruction for the treatment of massive irreparable rotator cuff tears [J]. Chinese Journal of Orthopaedics, 2021, 41(9): 559-567.DOI:10.3760/cma.j.cn121113-20201201-00702.
[8] 冯超, 刘启涛, 秦浩然, 等. 新型辅助套管在关节镜下大肩袖撕裂修复术中的应用 [J].中华创骨科杂志, 2025, 27(2):133-142. DOI:10.3760/cma.j.cn115530-20241125-00453.
Feng C, Liu QT, Qin HR, et al. Application of a novel auxiliary sleeve in arthroscopic repair of large rotator cuff tear[J]. Chinese Journal of Orthopaedic Trauma, 2025, 27(2):133-142. DOI:10.3760/cma.j.cn115530-20241125-00453.
[9] 尚西亮, 吕婧仪, 陈疾忤, 等.关节镜下LHBT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 [J]. 中国运动医学杂志, 2019, 38(8):652-657.DOI:10.16038/j.1000-6710.2019.08.004.
Shang XL, Lv JY, Chen JW, et al. Clinical efficacy of arthroscopic LHBT transposition fixation assisted alternative superior capsular reconstruction (Chinese Way) for repairing massive and irreparable rotator cuff tears [J]. Chinese Journal of Sports Medicine, 2019, 38(8):652-657. DOI:10.16038/j.1000-6710.2019.08.004.
[10] Degan TJ, Hartzler RU, Rahal A, et al. Prospective 1-Year Outcomes Are Maintained at Short-Term Final Follow-Up After Superior Capsular Reconstruction Augmentation of Complete Rotator Cuff Repair[J]. Arthroscopy, 2022, 38(5):1411-1419. DOI:10.1016/j.arthro. 2021. 11.008.
[11]Cvetanovich GL, Waterman BR, Verma NN, et al. Management of the irreparable rotator cuff tear[J]. J Am Acad Orthop Surg, 2019, 27(24):909-917. DOI:10.5435/jaaos-d-18-00199.
[12]Guevara JA, Entezari V, Ho JC, et al. An update on surgical management of the repairable large-to-nassive rotator cuff tear[J]. J Bone Joint Surg Am, 2020, 102(19):1742-1754. DOI:10.2106/jbjs. 20.00177.
[13]尚西亮, 华英汇, 陈世益. 肩袖修补术后再断裂原因分析[J]. 中华骨科杂志,2013, 9（33）: 965-970. DOI:10.3760/cma.j.issn.0253-2352. 2013. 09.015.
Shang XL, Hua YH, Chen SY. Analysis of the causes of re-tear after rotator cuff repair[J]. Chinese Journal of Orthopaedics, 2013, 9(33): 965-970. DOI: 10.3760/cma.j.issn.0253-2352.2013.09.015.
[14]Han F, Kong CH, Hasan MY, et al. Superior capsular reconstruction for irreparable supraspinatus tendon tears using the long head of biceps: A biomechanical study on cadavers[J]. Orthop Traumatol Surg Res, 2019, 105(2): 257-263. DOI: 10.1016/j.otsr.2018.10.023.
[15]孙晟轩, 谢晔, 沈光思, 等. 关节镜下“Chinese way”治疗老年肩关节脱位合并巨大肩袖撕裂的临床疗效[J].中国临床解剖学杂志, 2024, 42(3):316-321. DOI: 10.13418/j.issn.1001-165x.2024.3.12.
Sun SX, Xie Y, Shen GS, et al. Clinical efficacy of the "Chinese way" in arthroscopic treatment of elderly shoulder dislocation combined with massive rotator cuff tear [J]. Chinese Journal of Clinical Anatomy, 2024, 42(03):316-321. DOI: 10.13418/j.issn.1001-165x.2024.3.12.
[16]Cheppalli NS, Purudappa PP, Metikala S, et al. Superior capsular reconstruction using the biceps tendon in the treatment of irreparable massive rotator cuff tears improves patient-reported outcome scores: a systematic review[J]. Arthrosc Sports Med Rehabil, 2022, 4(3): e1235-e1243. DOI:10.1016/j.asmr.2022.04.003.
[17]Hermanowicz K, Goralczyk A, Malinowski K, et al. Long head biceps tendon-natural patch for massive irreparable rotator cuff tears[J]. Arthrosc Tech, 2018, 7(5): e473-e478. DOI: 10.1016/j.eats.2017.11.008.
[18]张清, 向明, 杨金松, 等. 肱二头肌长头腱转位上关节囊重建术治疗大及巨大肩袖损伤[J].中华骨科杂志, 2022, 42(4):195-203. DOI:10.3760/cma.j.cn121113-20211020-00608.
Zhang Q, Xiang M, Yang JS, et al. Long head of biceps tendon transfer with superior capsule reconstruction for the treatment of large and massive rotator cuff tears [J]. Chinese Journal of Orthopaedics, 2022, 42(4): 195-203. DOI:10.3760/cma.j.cn121113-20211020-00608.
[19]高秋明, 丁浩亮, 孙健. 肩关节镜下肱二头肌长头肌腱转位重建肩关节上关节囊修复巨大肩袖撕裂[J].中华创伤杂志, 2021, 37(3): 222-228. DOI:10.3760/cma.j.cn501098-20200814-00549.
Gao QM, Ding HL, Sun J. Arthroscopic long head of biceps tendon transfer reconstruction and shoulder joint capsule repair for massive rotator cuff tears [J]. Chinese Journal of Traumatology, 2021, 37(3):222-228. DOI:10.3760/cma.j.cn501098-20200814-00549.
[20]Ardebol J, Hwang S, Pak T, et al. Female sex and higher infraspinatus fatty infiltration are linked to dissatisfaction at a minimum follow-up of 4 years after arthroscopic repair of massive rotator cuff tears[J]. Arthrosc Sports Med Rehabil, 2023, 5(3): e731-e737. DOI:10.1016/j.asmr.2023.03.016.
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