Clinical and radiological effects of arthroscopic biceps reroutingin treating large to massive rotator cuff tears / 中华骨科杂志

ABSTRACT

Objective:To evaluate the short-term effects of arthroscopic biceps rerouting along with rotator cuff repair in treating large to massive rotator cuff tears.Methods:Retrospective evaluation of patients with large to massive rotator cuff tears who were treated with arthroscopic biceps rerouting along with rotator cuff repair was conducted from May 2017 to September 2020. There were 48 patients with average age 58.7±18.4 years (range from 45-72 years), of which 19 cases were males and 29 cases were females. The following outcomes, range of motion, functional outcomes, pain and radiological outcomes, were assessed perioperatively. Pain symptom was assessed according to visual analogue scale (VAS). The functional outcomes were assessed according to American Shoulder and Elbow Surgeons (ASES) score and Constant-Murley score. MRI was used to evaluate radiological outcomes preoperatively and at 3, 6, 12 months postoperatively.Results:All forty-eight patients were followed-up. The mean duration of follow-up was 24.2±33.5 months (range from 13-53 months) after surgery. The average VAS of the patients decreased from 6.4±1.8 before surgery to 4.6±2.2 at 6 months after surgery, to 1.9±2.1 at 12 month after surgery, and to 1.7±2.0 at the last follow-up with significant difference ( F=4.47, P<0.001) . ASES score decreased from 56.4±20.9 before surgery to 48.3±29.1 at 6 months after surgery, and increased to 77.2±18.2 at one year after surgery, and to 82.3±13.8 at the last follow-up with statistically significant difference ( F=36.34, P<0.001). The Constant-Murley decreased from 52.7±17.5 before surgery to 49.4±27.5 at 6 months after surgery, and increased to 80.1±20.1 at one year after surgery and to 87.4±11.9 at the last follow-up, respectively. The difference between the preoperative and the last follow-up was statistically significant ( F=52.68, P<0.001). The forward flexion increased from 102°±24° preoperatively to 121°±33° at 6 months, to 140°±17° at 12 months, and to 148°±15° at the last follow-up ( F=34.24, P<0.001). External rotation decreased from 57°±32° before surgery to 45°±37° at 6 months, and increased to 70°±31° at 12 months after surgery and to 75°±30° at the last follow-up with significant difference ( F=19.68, P=0.042). Internal rotation decreased from 8±3 before surgery to 7±4 at 6 months, and increased to 9±3 at 12 months after surgery and to 10±2 at the last follow-up with significant difference ( F=11.86, P=0.015). Six patients (12.5%) underwent retear of the repaired rotator cuff on the postoperative MRI, of which 4 cases were confirmed at 3 months after surgery and 2 cases at 6 months after surgery. Conclusion:Arthroscopic biceps rerouting along with rotator cuff repair for the treatment of large to massive rotator cuff injuries could significantly relieve pain symptoms and improve shoulder joint function without the help of scaffold. The present technique has lower retear rate.