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Tendon patch grafting using the long head of the biceps for irreparable massive rotator cuff tears

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Surgical treatment of massive rotator cuff tears is challenging for shoulder surgeons. The purpose of this study was to investigate both clinical outcomes and cuff integrity after tendon patch grafting using the long head of the biceps (LHB) tendon for irreparable massive rotator cuff tears.

Methods

A short deltoid splitting approach was used to expose the torn cuff tendon stump. After tenodesis of the LHB tendon, its intraarticular portion was resected. If the size of the harvested tendon was smaller than that of the cuff defect, it was split into two layers. Then, the LHB tendon was sutured to the remnant cuff tendons and fixed to the footprint using the transosseous suture technique. A total of 14 patients (12 men, 2 women; average age 64 years) underwent this procedure. The average postoperative follow-up period was 28 months (range 12–51 months). Active elevation angle of the shoulder as well as the Japanese Orthopaedic Association (JOA) score were assessed before surgery and at the time of follow-up. Postoperative cuff integrity was assessed using T2-weighted magnetic resonance imaging (MRI).

Results

All cuff defects were successfully closed with this technique. Average active elevation angle improved from 69° to 149°. Total JOA score also improved from 54.7 points to 83.1 points. Thirteen shoulders showed no re-tearing on T2-weighted MRI; a minor discontinuity of the repaired cuff tendon was observed in the other shoulder.

Conclusions

The LHB tendon is available in case tenodesis or tenotomy is needed. The resected tendon may be used as a graft for rotator cuff repair without any additional skin incision, which could reduce both the surgical invasion and the risk of infection. The LHB tendon patch grafting may be one of the useful options for surgical treatment of irreparable massive rotator cuff tears.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan

    Hirotaka Sano & Eiji Itoi

  2. Department of Orthopaedic Surgery, Iwaki-Kyoritsu General Hospital, Sendai, Japan

    Mitsuyoshi Mineta

  3. Department of Orthopaedic Surgery, Sendai Red Cross Hospital, Sendai, Japan

    Atsushi Kita

Authors
  1. Hirotaka Sano
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  2. Mitsuyoshi Mineta
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  3. Atsushi Kita
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  4. Eiji Itoi
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Sano, H., Mineta, M., Kita, A. et al. Tendon patch grafting using the long head of the biceps for irreparable massive rotator cuff tears. J Orthop Sci 15, 310–316 (2010). https://doi.org/10.1007/s00776-010-1453-5

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  • DOI: https://doi.org/10.1007/s00776-010-1453-5

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