Long head of biceps tendon transposition for massive and irreparable rotator cuff tears:A systematic review and meta-analysis

BACKGROUND Superior capsular reconstruction(SCR)with long head of biceps tendon(LHBT)transposition was developed to massive and irreparable rotator cuff tears(MIRCTs);however,the outcomes of this technique remain unclear.AIM To perform a systematic review of biomechanical outcomes and a meta-analysis of clinical outcomes after LHBT transposition for MIRCTs.METHODS We performed a systematic electronic database search on PubMed,EMBASE,and Cochrane Library.Studies of SCR with LHBT transposition were included according to the inclusion and exclusion criteria.Biomechanical studies were assessed for main results and conclusions.Included clinical studies were evaluated for quality of methodology.Data including study characteristics,cohort demographics,and outcomes were extracted.A meta-analysis was conducted of the clinical outcomes.RESULTS According to our inclusion and exclusion criteria,a total of six biomechanical studies were identified and reported an overall improvement in subacromial contact pressures and prevention of superior humeral migration without limiting range of motion(ROM)after LHBT transposition for MIRCTs.A total of five clinical studies were included in the meta-analysis of LHBT transposition outcomes,consisting of 253 patients.The results indicated that compared to other surgical methods for MIRCTs,LHBT transposition had advantages of more significant improvement in ROM(forward flexion mean difference[MD]=6.54,95%confidence interval[CI]:3.07-10.01;external rotation[MD=5.15,95%CI:1.59-8.17];the acromiohumeral distance[AHD][MD=0.90,95%CI:0.21-1.59])and reducing retear rate(odds ratio=0.27,95%CI:0.15-0.48).No significant difference in American Shoulder and Elbow Surgeons score,visual analogue scale score,and University of California at Los Angles score was demonstrated between these two groups for MIRCTs.CONCLUSION In general,SCR with LHBT transposition was a reliable and economical technique for treating MIRCTs,both in terms of biomechanical and clinical outcomes,with comparable clinical outcomes,improved ROM,AHD,and reduced the retear rates compared to conventional SCR and other established techniques.More high-quality randomized controlled studies on the long-term outcomes of SCR with LHBT transposition are required to further assess.

Management of proximal biceps tendon pathology

The long head of the biceps tendon is widely recognized as an important pain generator,especially in anterior shoulder pain and dysfunction with athletes and working individuals.The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures,function,and relevant clinical information such as evaluation,treatment options,and complications in hopes of helping orthopaedic surgeons counsel their patients.An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally.The biceps-labral complex has been identified and broken down into different regions that can further enhance a physician’s knowledge of common anterior shoulder pain etiologies.Although various physical examination maneuvers exist meant to localize the anterior shoulder pain,the lack of specificity requires orthopaedic surgeons to rely on patient history,advanced imaging,and diagnostic injections in order to determine the patient’s next steps.Nonsurgical treatment options such as anti-inflammatory medications,physical therapy,and ultrasound-guided corticosteroid injections should be utilized before entertaining surgical treatment options.If surgery is needed,the three options include biceps tenotomy,biceps tenodesis,or superior labrum anterior to posterior repair.Specifically for biceps tenodesis,recent studies have analyzed open vs arthroscopic techniques,the ideal location of tenodesis with intra-articular,suprapectoral,subpectoral,extra-articular top of groove,and extra-articular bottom of groove approaches,and the best method of fixation using interference screws,suture anchors,or cortical buttons.Orthopaedic surgeons should be aware of the complications of each procedure and respond accordingly for each patient.Once treated,patients often have good to excellent clinical outcomes and low rates of complications.

The management of the long head of the biceps in rotator cuff repair:A comparative study of high vs.subpectoral tenodesis

Background:Tenodesis of the long head of the biceps(LHB)is commonly undertaken during arthroscopic rotator cuff repair.We assessed the clinical and structural outcomes after high arthroscopic tenodesis(HAT)or mini-open subpectoral tenodesis(ST).We hypothesized that the clinical and structural results after HAT and ST are similar.Methods:We included 40 patients with rotator cuff tear and LHB tendinopathy.Twenty patients(7 women and 13 men;mean age:57.9 years;range:56-63 years)were treated using HAT,and 20 patients(8 women and 12 men;mean age:58.5 years;range:55-64 years)were treated using ST.Functional evaluation was performed preoperatively and at 6 weeks,6 months,and 1 year after surgery,using the Constant Murley Score and Simple Shoulder Test scores;the LHB was evaluated using the LHB score.A Visual Analogue Scale was administered to all patients preoperatively and 2 days after surgery.Results:The postoperative total and pain subscale’s Constant scores were significantly higher in the ST group.Moreover,2 LHB score values were significantly different between the groups.The postoperative LHB total score in the ST and HAT groups averaged 86.9±4.1(mean±SD)points and 73.3±6.4 points,respectively.The Pain/Cramps subscale in the ST and HAT groups averaged 47.1±5.9 and 33.2±4.6 points,respectively.The 2 groups showed no difference in Visual Analogue Scale values(5.5 in the HAT group;5.8 in the ST group)postoperatively.One patient in the HAT group reported a secondary onset of Popeye deformity.Conclusion:Both high arthroscopic and mini-open ST of the LHB tendon produced reliably good functional results,but the ST group was associated with better postoperative clinical outcomes.

Bilateral dislocation of the long head of biceps tendon with intact rotator cuff tendon:A case report

BACKGROUND Dislocation of the long head of biceps tendon(LHBT)usually involves rotator cuff injury,and isolated dislocation with an intact rotator cuff is rare.Some cases of isolated dislocation have been reported.However,to the best of our knowledge,there has been no report of bilateral dislocation of the LHBT without rotator cuff pathology.CASE SUMMARY A 23-year-old male presented to our outpatient clinic with left side dominant pain in both shoulders.The patient had no history of trauma or overuse.The patient underwent intra-articular injection and physical therapy,but his symptoms aggravated.Based on preoperative imaging,the diagnosis was bilateral dislocation of the LHBT.Dysplasia of the bicipital groove was detected in both shoulders.Active dislocation of the biceps tendon over an intact subscapularis tendon was identified by diagnostic arthroscopy.Staged biceps tenodesis was performed and continuous passive motion therapy was administered immediately after surgery.The patient’s pain was resolved,and full functional recovery was achieved,and he was satisfied with the condition of his shoulders.CONCLUSION This study describes a rare case of bilateral dislocations of the LHBT without rotator cuff injury due to dysplasia of the bicipital groove.

Outcomes of tenodesis of the long head of the biceps tendon more than three months after rupture

AIM: To demonstrate that long head of the biceps tendon(LHBT) tenodesis is possible more than 3 mo after rupture. METHODS: From September 2009 to January 2012 we performed tenodesis of the LHBT in 11 individuals(average age 56.9 years, range 42 to 73) more than 3 mo after rupture. All patients were evaluated by Disabilites of the Arm Shoulder and Hand(DASH) and Mayo outcome scores at an average follow-up of 19.1 mo. We similarly evaluated 5 patients(average age 58.2 years, range 45 to 64) over the same time treated within 3 mo of rupture with an average follow-up of 22.5 mo.RESULTS: Tenodesis with an interference screw was possible in all patients more than 3 mo after rupture and 90% had good to excellent outcomes but two had recurrent rupture. All of those who had tenodesis less than 3 mo after rupture had good to excellent outcomes and none had recurrent rupture. No statistical difference was found for DASH and Mayo outcome scores between the two groups(P <0.05). CONCLUSION: Tenodesis of LHBT more than 3 mo following rupture had outcomes similar to tenodesis done within 3 mo of rupture but recurrent rupture occurred in 20%.

Stability of motor endplates is greater in the biceps than in the interossei in a rat model of obstetric brachial plexus palsy

The time window for repair of the lower trunk is shorter than that of the upper trunk in patients with obstetric brachial plexus palsy. The denervated intrinsic muscles of the hand become irreversibly atrophic much faster than the denervated biceps. However, it is unclear whether the motor endplates of the denervated interosseous muscles degenerate more rapidly than those of the denervated biceps. In this study, we used a rat model of obstetric brachial plexus palsy of the right upper limb. C5–6 was lacerated distal to the intervertebral foramina, with concurrent avulsion of C7–8 and T1, with the left upper limb used as the control. Bilateral interossei and biceps were collected at 5 and 7 weeks. Immunofluorescence was used to assess the morphology of the motor endplates. Real-time quantitative polymerase chain reaction and western blot assay were used to assess mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ), rapsyn and β-catenin. Immunofluorescence microscopy showed that motor endplates in the denervated interossei were fragmented, while those in the denervated biceps were morphologically intact with little fragmentation. The number and area of motor endplates, relative to the control side, were significantly lower in the denervated interossei compared with the denervated biceps. mRNA and protein expression levels of acetylcholine receptor subunits(α, β and δ) were significantly lower, whereas β-catenin protein expression was higher, in the denervated interossei compared with the denervated biceps. The protein expression of rapsyn was higher in the denervated biceps than in the denervated interossei at 7 weeks. Our findings demonstrate that motor endplates of interossei are destabilized, whereas those of the biceps remain stable, in the rat model of obstetric brachial plexus palsy. All procedures were approved by the Experimental Animal Ethics Committee of Fudan University, China(approval No. DF-187) in January 2016.

Distal biceps tendon rupture reconstruction using musclesplitting double-incision approach

AIM: To evaluate the clinical and functional results after repair of distal biceps tendon tears, following the Morrey's modified double-incision approach.METHODS: We retrospectively reviewed 47 patients with distal rupture of biceps brachii treated between2003 and 2012 in our Orthopedic Department with muscle-splitting double-incision technique. Outcome measures included the Mayo elbow performance, the DASH questionnaire, patient's satisfaction, elbow and forearm motion, grip strength and complications occurrence.RESULTS: At an average 18 mo follow-up(range, 7 mo-10 years) the average Mayo elbow performance and DASH score were respectively 97.2 and 4.8. The elbow flexion range was 94%, extension was-2°, supination was 93% and pronation 96% compared with the uninjured limb. The mean grip strength, expressed as percentage of respective contralateral limb, was 83%. The average patient satisfaction rating on a Likert scale(from 0 to 10) was 9.4. The following complications were observed: 3 cases of heterotopic ossification(6.4%), one(2.1%) re-rupture of the tendon at the site of reattachment and 2 cases(4.3%) of posterior interosseous nerve palsy. No complication required further surgical treatment.CONCLUSION: This technique allows an anatomic reattachment of distal biceps tendon at the radial tuberosity providing full functional recovery with low complication rate.

Inflammation and apoptosis accelerate progression to irreversible atrophy in denervated intrinsic muscles of the hand compared with biceps: proteomic analysis of a rat model of obstetric brachial plexus palsy

In treating patients with obstetric brachial plexus palsy,we noticed that denervated intrinsic muscles of the hand become irreversibly atrophic at a faster than denervated biceps.In a rat model of obstetric brachial plexus palsy,denervated intrinsic musculature of the forepaw entered the irreversible atrophy far earlier than denervated biceps.In this study,isobaric tags for relative and absolute quantitation were examined in the intrinsic musculature of forepaw and biceps on denervated and normal sides at 3 and 5 weeks to identify dysregulated proteins.Enrichment of pathways mapped by those proteins was analyzed by Kyoto Encyclopedia of Genes and Genomes analysis.At 3 weeks,119 dysregulated proteins in denervated intrinsic musculature of the forepaw were mapped to nine pathways for muscle regulation,while 67 dysregulated proteins were mapped to three such pathways at 5 weeks.At 3 weeks,27 upregulated proteins were mapped to five pathways involving inflammation and apoptosis,while two upregulated proteins were mapped to one such pathway at 5 weeks.At 3 and 5 weeks,53 proteins from pathways involving regrowth and differentiation were downregulated.At 3 weeks,64 dysregulated proteins in denervated biceps were mapped to five pathways involving muscle regulation,while,five dysregulated proteins were mapped to three such pathways at 5 weeks.One protein mapped to inflammation and apoptotic pathways was upregulated from one pathway at 3 weeks,while three proteins were downregulated from two other pathways at 5 weeks.Four proteins mapped to regrowth and differentiation pathways were upregulated from three pathways at 3 weeks,while two proteins were downregulated in another pathway at 5 weeks.These results implicated inflammation and apoptosis as critical factors aggravating atrophy of denervated intrinsic muscles of the hand during obstetric brachial plexus palsy.All experimental procedures and protocols were approved by the Experimental Animal Ethics Committee of Fudan University,China(approval No.DF-325)in January 2015.

Best approach for the repair of distal biceps tendon ruptures

The preferred treatment of distal biceps tendon ruptures is by operative repair. However, the best approach for repair(single vs double incision) is still subject of debate. Grewal and colleagues recently presented the results of a randomized clinical trial evaluating two different surgical approaches for the repair of distal biceps tendon ruptures. Despite the fact that this article currently presents the highest level of evidence for the surgical repair of distal biceps tendon ruptures, we have some comments on the study that might be interesting to discuss. We think that some of the results and conclusions presented in this study need to be interpreted in the light of these comments.

Comparison of the Effects of Kinesio Taping to Local Injection of Methyl Prednisolone in Treating Brachial Biceps Tendonitis

Objectives: This study compared the effect of Kinesio Taping (KT) with local Methyl Prednisolone injection in patients with biceps tendonitis based on visual analog scale (VAS) and range of motion (ROM). Methods: Thirty-eight patients (15 females and 23 males;mean age: 29.87 ± 6.31, years) with biceps tendonitis were participated in this study during 2014-2015. The patients were randomly assigned into two groups: 19 patients in KT group and 19 patients in injection group. In the first group, KT was used three times for 24 hours sequentially with four-day intervals;in the second group, one dose of Methyl Prednisolone (40 mg) plus 1% lidocaine was injected in the bicipital fissure around the long head of the biceps muscle. The injections and KT therapy were performed by the same physician. The patients were investigated for VAS and ROM in the first, second, seventh and twelfth days. Results: VAS and ROM indices were significantly improved in the second and seventh days (p 0.05). Conclusion: Regarding the more immediate effect of KT on ROM and VAS and the fast restoring of the patient to normal life, it could be used as a noninvasive alternative to injection and as the first line of treatment specially in patients who need the immediate effect of treatment.

Irreducible Traumatic Anterior Shoulder Dislocation Secondary to Both Subscapularis and Long Head of Biceps Tendon Interposition—A Case Report

An Irreducible dislocation of the shoulder is an uncommon event. When it does occur, blocks to reduction can include bone, labrum, rotator cuff musculature or tendon. Patients older than 40 at the time of initial dislocation are at increased risk of sustaining a concomitant rotator cuff tear. We present a case of an irreducible anterior shoulder dislocation due to interposition of both subscapularis tendon and a posteriorly dislocated long head of biceps. Both Computed Tomography (CT) and magnetic resonance imaging (MRI), along with intraoperative findings are discussed. Conclusion: We would advocate maintaining a low threshold for MR imaging post shoulder dislocation in the older population, when there is radiological or clinical concern regarding the integrity of the rotator cuff, and also to evaluate whether a concentric reduction of the shoulder joint has been achieved.

Chronic Partial Rupture of Distal Biceps Tendon in an Adolescent―A Case Report

Distal biceps tendon rupture accounts for only 3% - 10% of all biceps tendon injuries. The majority of distal biceps tendon injuries are from complete rupture. It is especially rare to diagnose partial rupture of the distal biceps tendon. Our case profiles a chronic partial tear of the distal biceps tendon in a pediatric patient.

Rupture of the long head of the biceps brachii tendon near the musculotendinous junction in a young patient: A case report

We report an unusual case of the long head of the biceps brachii tendon rupture near the musculotendinous junction in a young patient.The injury occurred in a young athlete during sports competition.The clinical presentation,surgical treatment,and technique with tenodesis using a unicortical button of the ruptured tendon were presented.The post-surgical recovery was uneventful,and the patient returned to sports in 6 mo.The treatment approach and surgical technique of the long head of biceps brachii rupture was reviewed and discussed.In conclusion,surgical treatment of the long head of the biceps brachii tendon rupture with unicortical button tenodesis resulted in a favorable outcome in a young athlete.

双头异极藻(Gomphonema biceps Meister)——中国淡水硅藻一个新记录种

2015年11月对武夷山北部山区溪流的附着藻类多样性进行调查研究时,发现了淡水硅藻的一个中国新记录种——双头异极藻(Gomphonema biceps Meister)。通过光镜和扫描电镜观察,对双头异极藻武夷山地理种群的形态特征进行了详细描述,并将其与国外种群以及其他相似物种的形态特征进行了比较,同时对该物种的生境特点和世界地理分布作了介绍。

Irreducible anteromedial radial head dislocation without fracture caused by transposed biceps tendon in an adult:A case report and literature review

Irreducible anteromedial radial head dislocation(IARHD)caused by transposed biceps tendon is rare.Delayed diagnosis and surgical failure often occur.A 46-year-old fisherman presented with 10 days history of painful swelling and restricted movement of his right elbow due to strangulation injury by a fishing boat cable.On examination,the images of the right elbow reveals in a"semi-extended and pronated"elastic fixation position.Radiography and 3-dimensional reconstruction CT reveals an isolated anteromedial radial head dislocation with extreme protonation of the radius and the bicipital tuberosity towards the posterior aspect of the elbow joint,and MRI shows biceps tendon wrapping around the radial neck,similar to umbilical cord wrapping seen in newborns.The Henry approach was applied for the first time to reduce the biceps tendon.The patient achieved a good functional recovery at 26 months,which represents the first reported case of IARHD without fracture caused by biceps tendon in an adult.In treatment of IARHD,attention should be paid to the phenomenon of biceps tendon transposition.Careful clinical examination,comprehensive imaging modalities,and appropriate surgical approach are the keys to successful management.

铍针结合三七散外敷治疗肱二头肌长头腱鞘炎疗效及对患者肌骨超声参数、血清炎症因子、肩关节功能的影响

目的:探讨铍针结合三七散外敷治疗肱二头肌长头腱鞘炎效果及对患者肌骨超声参数、血清炎症因子、肩关节功能的影响。方法:80例肱二头肌长头腱鞘炎患者随机分为对照组与观察组,各40例。对照组采用放射式冲击波治疗,观察组则实施铍针结合三七散外敷治疗,均连续治疗4周。比较两组临床疗效,治疗前后两组患者疼痛情况[视觉模拟疼痛评分(VAS)、压痛阈值(PPTs)]、肩关节功能[Constant-Murley肩关节功能活动评分量表(CMS)]、肌骨超声参数(肌腱厚度、腱鞘厚度、积液最大径)、血清炎症因子[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]的变化。结果:观察组患者临床疗效87.50%,明显高于对照组的67.50%(P<0.05);治疗后,观察组VAS评分低于对照组,观察组PPTs值高于对照组(P<0.05);观察组肌力、疼痛、肩关节活动度及功能评分均高于对照组(P<0.05);观察组肌腱厚度、腱鞘厚度、积液水平均低于对照组(P<0.05);观察组血清TNF-α、CRP、IL-6水平均低于对照组(P<0.05)。结论:铍针结合三七散外敷治疗肱二头肌长头腱鞘炎可提高临床效果,减轻患者疼痛,提高疼痛阈值,同时可降低患者血清炎症因子水平,改善肌骨超声参数和肩关节功能。

肩关节镜下肱二头肌长头腱转位强化缝合修复巨大肩袖撕裂损伤

背景:肱二头肌长头腱转位是治疗巨大肩袖撕裂的常用手术方式,目前对于肱二头肌长头腱转位的临床疗效报道较少且转位后肩袖再撕裂的相关因素尚无定论。目的:观察肩关节镜下肱二头肌长头腱转位加强缝合治疗巨大肩袖撕裂的临床疗效。方法:回顾性分析2019年3月至2022年5月江苏省中医院收治的28例巨大肩袖撕裂患者的临床资料,年龄(61.79±10.50)岁,均在关节镜下行肱二头肌长头腱转位加强缝合进行修复。术前及术后1年,评估患者目测类比评分、加州大学洛杉矶分校(UCLA)评分、美国肩肘外科协会(ASES)评分、Constant-Murley肩关节功能评分及肩关节活动度;术后1年,利用肩关节MRI检查修复结构的完整性。根据术后1年的Sugaya分型将23例(28例失访5例)患者分为肌腱完整组(n=18)、肌腱撕裂组(n=5),根据术中肱二头肌长头腱质量分为正常组(n=8)、退变组(n=9)、部分撕裂组(n=6),对比上述指标的差异。结果与结论:(1)与术前比较,23例患者术后1年的目测类比评分、UCLA评分、ASES评分、Constant-Murley肩关节功能评分及肩关节活动度均明显改善(P<0.05);肌腱完整组与肌腱撕裂组术前Goutallier分级存在差异(P<0.05),术后1年的目测类比评分、UCLA评分、ASES评分、Constant-Murley肩关节功能评分及肩关节活动度比较差异均无显著性意义(P>0.05);正常组、退变组、部分撕裂组术后1年的目测类比评分、UCLA评分、ASES评分、Constant-Murley肩关节功能评分及肩关节活动度比较差异均无显著性意义(P>0.05);(2)术后1年,患侧肩关节MRI见18例患者缝合肌腱愈合良好,愈合率78%;(3)肩关节镜下肱二头肌长头腱转位加强缝合可为难以完成完全修补的巨大肩袖撕裂提供可靠修补,能明显缓解肩关节疼痛、恢复肩关节功能。

肱二头肌长头腱脱位分型与其周围组织结构损伤的关系

目的 探讨肱二头肌长头腱(LHBT)脱位分型及其常规磁共振成像(MRI)表现。方法 回顾性收集31例LHBT脱位患者MRI资料,分析不同脱位类型间LHBT、喙肱韧带外侧部(LCHL)、喙肱韧带内侧部-盂肱上韧带复合体(MCHL-SGHL)、肱横韧带(THL)、肩胛下肌腱(SSC)及冈上肌腱(SSP)撕裂率差异性及其MRI表现。结果 31例患者中,半脱位14例,全脱位17例(Ⅰ型10例,Ⅱ型6例,Ⅲ型1例),2组以上结构撕裂数依次分别为9例与11例;4例与13例;11例与16例;5例与16例;8例与17例;10例与11例。其中LCHL、THL及SSC撕裂率低于全脱位组(P均<0.05),且所有结构撕裂率在全脱位亚型间差异均无统计学意义(P均>0.05)。结论 LHBT脱位常合并自身及其固定结构的撕裂,诊断时应仔细全面观察。

Cosmological parameter fittings with the BICEP2 data

Combining the latest Planck, Wilkinson Microwave Anisotropy Probe （WMAP）, and baryon acoustic oscillation （BAO） data, we exploit the recent cosmic microwave background （CMB） B-mode power spectra data released by the BICEP2 collaboration to constrain the cosmological parameters of the ACDM model, especially the primordial power spectra parameters of the scalar and the tensor modes, ns, as, r, nt. We obtain constraints on the parameters for a lensed ACDM model using the Markov Chain -- ＋0,0307 ＋0,0061 ＋0,0105 Monte Carlo （MCMC） technique, the marginalized 68% bounds are r -0.1043 -0.0914, ns -0.9617-0.0061, as =-0.0175-0.0097, nt = 0.5198＋-0.4579. We find that a blue tilt for nt is favored slightly, but it is still well consistent with flat or even red tilt. Our r value is slightly smaller than the one obtained by the BICEP group, in that we permit nt as a free parameter without imposing the single-field slow roll inflation consistency relation. When we impose this relation, then r= 0.2130-0.06096 ＋0.0446. For most other parameters, the best fit values and measurement errors are not altered significantly by the introduction of the BICEP2 data.

Modified arthroscopic transfer of the long head of the biceps tendon to the conjoint tendon

The long head of the biceps tendon （LHBT） pathology has been implicated as a common source of shoulder pain. The patients may be more resistant to conservative treatment than those with isolated subacromial impingement. Even though, the surgical options of this disease remain controversial. It has been reported that tenotomy and tenodesis of the biceps tendon were usually utilized. However, persistent pain, deformity, and muscle cramping were frequently observed. Transfer of the LHBT to the conjoint tendon was originally described by Post and Benca in 1982.4 Verma et all has performed the transfer under arthroscopy since 2004. Eighty percent of their patients reported good results with a minimum 2 years of follow-up. However, there was a steep learning curve to become proficient in their technique. We devised a more convenient transfer compared with O＇Brien＇s technique. Six patients received our modified arthroscopic transfers from May 2006 to May 2007. All of them obtained good results.