Arthroscopic percutaneous repair of anterosuperior rotator cuff tear including biceps long head: a 2-year follow-up

Abstract

Background: To report the results of an arthroscopic percutaneous repair technique for partial-thickness tears of the anterosuperior cuff combined with a biceps lesion.

Methods: The inclusion criteria were evidence of the upper subscapularis tendon tear and an articular side partial-thickness tear of the supraspinatus tendon, degeneration of the biceps long head or degenerative superior labrum anterior-posterior, above lesions treated by arthroscopic percutaneous repair, and follow-up duration > 24 months after the operation. American Shoulder and Elbow Surgeons (ASES) score, constant score, the pain level on a visual analogue scale, ranges of motion and strength were assessed.

Results: The mean (± standard deviation) age of the 20 enrolled patients was 56.0 ± 7.7 years. The forward flexion strength increased from 26.3 ± 6.7 Nm preoperatively to 38.9 ± 5.1 Nm at final follow-up. External and internal rotation strength was also significantly increased (14.2 ± 1.7 to 19.1 ± 3.03 Nm, 12.3 ± 3.2 to 18.1 ± 2.8 Nm, respectively). Significant improvement was observed in ASES and constant scores at 3 months, 1 year and the time of final follow-up when compared with preoperative scores (p < 0.001). The mean subjective shoulder value was 86% (range, 78% to 97%).

Conclusions: The implementation of complete rotator cuff repair with concomitant tenodesis of the biceps long head using arthroscopic percutaneous repair achieved full recovery of normal rotator cuff function, maximum therapeutic efficacy, and patient satisfaction.

Keywords: Arthroscopic repair; Biceps tenodesis; Partial tear; Subscapularis tendon.

Fig. 1

Conventional magnetic resonance imaging with T2-weighted images in the oblique coronal and axial planes show partial tear of supraspinatus tendon (A) and subscapularis tendon (B). The disrupted transverse ligament covering the bicipital groove was noted.

Fig. 2

The procedure for subscapularis tendon repair. (A) 3.7 mm punch for a suture anchor at the footprint of the subscapularis tendon. (B) Polydioxanone monofilament absorbable suture passed through the spinal needle and substance of the subscapularis tendon. (C) FiberWire suture limbs of the anchor passed through the subscapularis tendon. (D) The subscapularis tendon securely fixed to its insertion site and its tension restored.

Fig. 3

(A, B) Introduction of 18-G spinal needles through the biceps tendon through most of the superolateral rotator interval tissue followed by passing the polydioxanone suture through the 18-G needles to switch to FiberWire suture. (C) The root of the biceps long head cut by an electrocautery device through the anterior portal. (D) Intra-articular view after biceps tenodesis using the percutaneous intra-articular transtendon technique.

Fig. 4

(A) The polydioxanone suture passing through each of the 18-G spinal needles to exchange it into a loaded suture on the anchor following the insertion of 3.7 mm suture tak anchor at the far medial edge of the footprint at a dead man's angle of 45° or less. (B) Intra-articular view after complete repair of the partial articular side tear of suparaspinatus tendon lesion.

Fig. 5

(A) Follow-up magnetic resonance imaging taken at 2 years indicates incomplete healing defect (arrow) of supraspatus tendon. (B) Subscapularis tendon that was simultaneously repaired shows complete integrity. The 4 of 11 patients had an evident partial thickness defect under supraspinatus tendon that was initially fixed, but no correlation with clinical outcome.