Emma L Klosterman, Adam J Tagliero, Ian S MacLean, Anna Sumpter, Kaitlyn Shank, Jennifer Pierce, Stephen Brockmeier
{"title":"关节镜下胸骨上嵌体与胸骨下二头肌肌腱固定术:临床结果和超声评估结构完整性的前瞻性随机分析。","authors":"Emma L Klosterman, Adam J Tagliero, Ian S MacLean, Anna Sumpter, Kaitlyn Shank, Jennifer Pierce, Stephen Brockmeier","doi":"10.1016/j.jse.2024.11.014","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Surgical techniques for biceps tenodesis vary in approach, fixation strategy, and anatomic location without clear superior technique for this common procedure.</p><p><strong>Hypothesis/purpose: </strong>The purpose of this study was to prospectively evaluate a randomized cohort of patients undergoing arthroscopic suprapectoral (ASBT) with interference screw fixation using an inlay technique versus mini-open subpectoral (MOBT) with a unicortical button implant using an onlay technique with regards to 1) clinical outcome measures and 2) structural healing as evaluated by ultrasound.</p><p><strong>Methods: </strong>From May 2017 to April 2021, patients undergoing biceps tenodesis were preoperatively randomized to either ASBT or MOBT. American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Visual Analogue Scale (VAS) scores were recorded at baseline, three months, and two years postoperatively. The integrity of the biceps tendon at the tenodesis site was independently examined via ultrasound by a musculoskeletal trained radiologist at three months and two years postoperatively. T-tests were performed for continuous variables, while Chi squared tests were performed for categorical variables.</p><p><strong>Results: </strong>A total of 52 patients (24 ASBT, 28 MOBT) were randomized and completed follow-up. At baseline, three months, and two years postoperatively, the mean ASES, SANE and VAS scores were not statistically different between ASBT and MOBT. At the three-month postoperative ultrasound, 23/24 (96%) of the ASBT patients and 26/28 (93%) of the MOBT patients were noted to have a clearly intact biceps tenodesis. At two years, all biceps tenodesis regardless of group were noted to be intact and healed, including all three shoulders whose ultrasound noted a questionably intact repair without significant retraction of the tendon at prior three-month ultrasound evaluation.</p><p><strong>Conclusion: </strong>This study demonstrates similar clinical outcomes at two year follow-up between ASBT and MOBT. Both groups demonstrated improvement that exceeded the reported patient acceptable symptom state (PASS) and minimal clinically important difference (MCID). Ultrasound showed excellent structural healing rates for both inlay and onlay biceps tenodesis techniques.</p><p><strong>Level of evidence: </strong>Level II; Randomized Controlled Trial; Treatment Study.</p>","PeriodicalId":50051,"journal":{"name":"Journal of Shoulder and Elbow Surgery","volume":" ","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Arthroscopic Inlay Suprapectoral versus Mini-Open Onlay Subpectoral Biceps Tenodesis: A Prospective, Randomized Analysis of Clinical Outcomes and Ultrasound-Assessed Structural Integrity.\",\"authors\":\"Emma L Klosterman, Adam J Tagliero, Ian S MacLean, Anna Sumpter, Kaitlyn Shank, Jennifer Pierce, Stephen Brockmeier\",\"doi\":\"10.1016/j.jse.2024.11.014\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Surgical techniques for biceps tenodesis vary in approach, fixation strategy, and anatomic location without clear superior technique for this common procedure.</p><p><strong>Hypothesis/purpose: </strong>The purpose of this study was to prospectively evaluate a randomized cohort of patients undergoing arthroscopic suprapectoral (ASBT) with interference screw fixation using an inlay technique versus mini-open subpectoral (MOBT) with a unicortical button implant using an onlay technique with regards to 1) clinical outcome measures and 2) structural healing as evaluated by ultrasound.</p><p><strong>Methods: </strong>From May 2017 to April 2021, patients undergoing biceps tenodesis were preoperatively randomized to either ASBT or MOBT. American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Visual Analogue Scale (VAS) scores were recorded at baseline, three months, and two years postoperatively. The integrity of the biceps tendon at the tenodesis site was independently examined via ultrasound by a musculoskeletal trained radiologist at three months and two years postoperatively. T-tests were performed for continuous variables, while Chi squared tests were performed for categorical variables.</p><p><strong>Results: </strong>A total of 52 patients (24 ASBT, 28 MOBT) were randomized and completed follow-up. At baseline, three months, and two years postoperatively, the mean ASES, SANE and VAS scores were not statistically different between ASBT and MOBT. At the three-month postoperative ultrasound, 23/24 (96%) of the ASBT patients and 26/28 (93%) of the MOBT patients were noted to have a clearly intact biceps tenodesis. At two years, all biceps tenodesis regardless of group were noted to be intact and healed, including all three shoulders whose ultrasound noted a questionably intact repair without significant retraction of the tendon at prior three-month ultrasound evaluation.</p><p><strong>Conclusion: </strong>This study demonstrates similar clinical outcomes at two year follow-up between ASBT and MOBT. Both groups demonstrated improvement that exceeded the reported patient acceptable symptom state (PASS) and minimal clinically important difference (MCID). Ultrasound showed excellent structural healing rates for both inlay and onlay biceps tenodesis techniques.</p><p><strong>Level of evidence: </strong>Level II; Randomized Controlled Trial; Treatment Study.</p>\",\"PeriodicalId\":50051,\"journal\":{\"name\":\"Journal of Shoulder and Elbow Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.9000,\"publicationDate\":\"2025-01-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Shoulder and Elbow Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jse.2024.11.014\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Shoulder and Elbow Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jse.2024.11.014","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Arthroscopic Inlay Suprapectoral versus Mini-Open Onlay Subpectoral Biceps Tenodesis: A Prospective, Randomized Analysis of Clinical Outcomes and Ultrasound-Assessed Structural Integrity.
Background: Surgical techniques for biceps tenodesis vary in approach, fixation strategy, and anatomic location without clear superior technique for this common procedure.
Hypothesis/purpose: The purpose of this study was to prospectively evaluate a randomized cohort of patients undergoing arthroscopic suprapectoral (ASBT) with interference screw fixation using an inlay technique versus mini-open subpectoral (MOBT) with a unicortical button implant using an onlay technique with regards to 1) clinical outcome measures and 2) structural healing as evaluated by ultrasound.
Methods: From May 2017 to April 2021, patients undergoing biceps tenodesis were preoperatively randomized to either ASBT or MOBT. American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Visual Analogue Scale (VAS) scores were recorded at baseline, three months, and two years postoperatively. The integrity of the biceps tendon at the tenodesis site was independently examined via ultrasound by a musculoskeletal trained radiologist at three months and two years postoperatively. T-tests were performed for continuous variables, while Chi squared tests were performed for categorical variables.
Results: A total of 52 patients (24 ASBT, 28 MOBT) were randomized and completed follow-up. At baseline, three months, and two years postoperatively, the mean ASES, SANE and VAS scores were not statistically different between ASBT and MOBT. At the three-month postoperative ultrasound, 23/24 (96%) of the ASBT patients and 26/28 (93%) of the MOBT patients were noted to have a clearly intact biceps tenodesis. At two years, all biceps tenodesis regardless of group were noted to be intact and healed, including all three shoulders whose ultrasound noted a questionably intact repair without significant retraction of the tendon at prior three-month ultrasound evaluation.
Conclusion: This study demonstrates similar clinical outcomes at two year follow-up between ASBT and MOBT. Both groups demonstrated improvement that exceeded the reported patient acceptable symptom state (PASS) and minimal clinically important difference (MCID). Ultrasound showed excellent structural healing rates for both inlay and onlay biceps tenodesis techniques.
Level of evidence: Level II; Randomized Controlled Trial; Treatment Study.
期刊介绍:
The official publication for eight leading specialty organizations, this authoritative journal is the only publication to focus exclusively on medical, surgical, and physical techniques for treating injury/disease of the upper extremity, including the shoulder girdle, arm, and elbow. Clinically oriented and peer-reviewed, the Journal provides an international forum for the exchange of information on new techniques, instruments, and materials. Journal of Shoulder and Elbow Surgery features vivid photos, professional illustrations, and explicit diagrams that demonstrate surgical approaches and depict implant devices. Topics covered include fractures, dislocations, diseases and injuries of the rotator cuff, imaging techniques, arthritis, arthroscopy, arthroplasty, and rehabilitation.