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Stabilization of the Long Head of the Biceps Tendon in the Context of Early Repair of Traumatic Subscapularis Tendon Tears
Dirk Maier, MD1; Martin Jaeger, MD1; Norbert P. Suedkamp1; Wolfgang Koestler, MD1
1 Department of Orthopaedic and Trauma Surgery, University of Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedic and Trauma Surgery, University of Freiburg, Freiburg, Germany

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Aug 01;89(8):1763-1769. doi: 10.2106/JBJS.F.01012
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Abstract

Background: Tears of the subscapularis tendon commonly are associated with instability of the long head of the biceps tendon. Standard surgical treatment includes tenodesis or tenotomy of the biceps tendon. However, chronic discomfort from spasms and cosmetic disadvantages have been reported following both procedures, while the potential for functional impairments remains controversial. We investigated the outcome of stabilization of the long head of the biceps tendon in the context of early repair of traumatic tears of the subscapularis tendon.

Methods: We performed stabilization of an unstable, structurally intact long head of the biceps tendon in twenty-one patients in the acute phase after a traumatic tear of the subscapularis tendon. The average period from the injury to the surgery was 6.2 weeks. Open tendon stabilization and subscapularis reconstruction were performed with transosseous sutures. The follow-up consisted of clinical examination (with determination of the absolute, age and genderrelated, and individual relative Constant scores; clinical evaluation of the long head of the biceps; and subjective determination of shoulder function) and dynamic ultrasound examination.

Results: The average follow-up period was 28.4 months. The mean absolute Constant score increased from 26.3 points preoperatively to 79.3 points postoperatively (p < 0.01). The mean age and gender-related Constant score improved from 28.0% to 87.0% (p < 0.01). Seven patients showed clinical symptoms consistent with mild biceps tendinopathy. Using dynamic ultrasound examination, we found two cases of recurrent instability (medial subluxation) of the long head of the biceps tendon. Secondary rupture of the long head of the biceps tendon occurred in one patient, twenty-six months after the surgery.

Conclusions: The functional outcomes of stabilization of the long head of the biceps tendon in the context of early repair of a traumatic tear of the subscapularis tendon were comparable with the results of tenodesis or tenotomy reported in previous studies. The cosmetic results were superior, and chronic discomfort from spasms was not observed. Stabilization of the tendon of the long head of the biceps can be recommended as a treatment option for selected patients and should be discussed as an alternative to tenodesis or tenotomy, particularly in a young patient.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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