Jinyoung Jeong

Surgical treatment of lesions of the long head of the biceps brachii tendon with rotator cuff tear: a prospective randomized clinical trial comparing the clinical results of tenotomy and tenodesis

BACKGROUND Tenotomy and tenodesis are common treatments for lesions in the long head of biceps tendon (LHBT); however, which treatment is superior is still controversial. This study compared the outcomes of tenotomy with outcomes of tenodesis for treatment of LHBT lesions with rotator cuff tears. METHODS The study enrolled 128 patients with LHBT lesions and small- to medium-sized rotator cuff tear. Arthroscopic LHBT tenotomy was done in 56 patients (group I), and LHBT tenodesis was done for 72 patients (group II) with rotator cuff repair. American Shoulder and Elbow Surgeons Score, simple shoulder test, pain visual analog scale, range of motion, and cosmetic changes were assessed initially, at 3, 6, and 12 months postoperatively, and the last visit. The elbow motor power and magnetic resonance imaging were evaluated at 12 months. RESULTS Both groups showed improvement in functional scores after treatments, but no significant difference was found between the 2 groups at each assessment. The rate of Popeye deformity was 3 times higher in group I (P = .04). Group II showed greater forearm supination power than group I (P = .02). On magnetic resonance imaging, 45 patients (80.4%) in group I showed maintenance of the LHBT cut end within the bicipital groove, whereas 65 patients (90.3%) in group II showed maintenance of fixated LHBT. CONCLUSION For the treatment of LHBT lesions with rotator cuff tear, patients with tenotomy and tenodesis both showed significant improvements in functional scores. The incidence of Popeye deformity was about 3-times higher in tenotomy group. No significant differences in elbow motor power were observed except greater forearm supination power in the tenodesis group.

Prevalence of asymptomatic rotator cuff tear and their related factors in the Korean population

BACKGROUND No information is available about asymptomatic rotator cuff tears (RCTs) in the Korean population. This study evaluated the prevalence of rotator cuff tears without symptoms and their related risk factors. MATERIALS AND METHODS The study included 486 volunteers (70.4% female; mean age, 53.1; range, 20-82 years) without any shoulder symptom complaints. Background data, medical history, clinical self-assessment, and physical examination were recorded. An ultrasonographic examination was conducted to identify rotator cuff pathology, but only full-thickness RCTs (FTRCTs) were included for the statistical analysis. RESULTS FTRCTs were found in 23 subjects (4.7%) but only in those aged ≥49 years. Subjects aged 50-59, 60-69, and ≥70 years of age had FTRCT prevalence rates of 3.5%, 13.3%, and 11.1%, respectively. The prevalence of FTRCTs was higher in subjects with diabetes (P = .042) and a smoking history (P= .002), but no differences were noted for the presence of thyroid disease (P = .051). Almost half of those who had FTRCTs had some pain and limited daily activity that was not bothersome. After excluding these subjects from the analysis, the prevalence of asymptomatic FTRCTs decreased to 2.3%. CONCLUSIONS The prevalence of asymptomatic FTRCTs was lower than expected. Half of asymptomatic FTRCTs were not actually symptom free after the clinical and physical assessments. The risk factors for a FTRCT were age, diabetes, and smoking.

Treatment of comminuted proximal humeral fractures using locking plate with strut allograft

BACKGROUND This study compared the radiologic outcome of fixation using locking plate only with fixation using locking plate with an endosteal strut allograft in the treatment of comminuted proximal humeral fracture. METHODS Among 52 patients with comminuted proximal humeral fracture, 32 patients underwent fixation with locking plate only, and 20 patients underwent fixation using locking plate with an endosteal strut allograft. The strut allograft was inserted into the intramedullary cavity of the humerus to support the humeral head and fixed with the locking plate. Immediate postoperative radiologic findings were compared with those of 6 months or more after the surgery, and loss of anatomic fixation was defined if the varus malalignment of neck-shaft angle (NSA) was more than 5° or if the change of humeral head height (HHH) was more than 3 mm. RESULTS In the locking plate-only group, 22 of 32 patients (69%) showed the change in NSA of more than 5°, with an average of 10.2°. The HHH change in 20 patients (62.5%) was more than 3 mm, with an average of 4 mm. Among 20 patients who underwent locking plate with the endosteal strut allograft, the average NSA and HHH change was 3° and 1 mm, respectively. Varus malalignment was evident in 2 patients (10%). The HHH change was more than 3 mm in 1 patient (5%). CONCLUSION Fixation using a locking plate with an endosteal strut allograft can be considered a reasonable option to maintain the anatomic reduction in elderly patients with comminuted proximal humeral fracture.

Arthroscopic Tenodesis of the Long Head of the Biceps Tendon

Lesions of the long head of the biceps brachii tendon (LHBT) are a common source of shoulder pain and dysfunction. Although the exact role of the LHBT in shoulder biomechanics is not clearly understood, pathological involvement of this tendon is a well-known pain generator and frequently the clinical presentation consists of both anterior pain and flexion loss. The initial treatment for lesions of the LHBT should be nonoperative, but if that fails or if the LHBT lesion is combined with rotator cuff lesions or other lesions that need to be repaired surgically, surgical intervention is indicated. Tenotomy and tenodesis of the LHBT are 2 classic representative treatments with confirmed results. Tenodesis may be especially beneficial for patients younger than 50 years old or those who perform strenuous labor. The procedure is performed arthroscopically with the following steps. Step 1: A standard posterior viewing portal and an anterior working portal are made. Step 2: After confirmation of the LHBT lesion inside the glenohumeral joint, number-1 polydioxanone (PDS) suture is passed through the tendon before tenotomy is performed just above the superior labrum. Step 3: The tenotomized tendon is pulled out through the anterior portal by gentle traction on the attached PDS suture. A Krackow whip-stitch with nonabsorbable suture is made in the tendon. Step 4: A 7 to 8-mm drill-hole is made in the intertubercular groove of the humeral head just proximal to the insertion of the subscapularis tendon. Step 5: The suture is tightly tied to the distal hole of a 7.0-mm BioComposite SwiveLock Interference Screw (Arthrex). Step 8: The interference screw with the tenotomized end is inserted into the drill-hole. LHBT tenodesis lessens the cosmetic problem of Popeye deformity that is seen after tenotomy. Also, elbow motor power including flexion and supination is preserved.