2023 ISAKOS Biennial Congress ePoster
Arthroscopic In-Situ Biceps Tenodesis for the Treatment of Massive Irreparable Rotator Cuff Tears
Matthew Veale, BS, MS, Waltham UNITED STATES
Irene Ghobrial, PA, MS, Waltham UNITED STATES
David Swanson, MD, MS UNITED STATES
Andrew R. Ames, DO, Bloomfield Hills, Michigan UNITED STATES
Kuhan Mahendraraj, BA, MS, Waltham UNITED STATES
William Martell, BA, Waltham UNITED STATES
Daniel Patrick Swanson, BS, Waltham, MA UNITED STATES
Jacob M. Kirsch, MD, Boston, MA UNITED STATES
Alan Curtis, MD, Waltham, MA UNITED STATES
New England Baptist Hospital, Boston, MA, UNITED STATES
FDA Status Not Applicable
Summary
A retrospective cohort study to evaluate an alternative treatment for MCTs, a partial repair with an in-situ biceps tenodesis, effectively acting as a biologic SCR.
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Abstract
Introduction
Massive irreparable rotator cuff tears (MCTs) are a common problem with various treatment strategies. In patients without osteoarthritis, joint preserving options include debridement, partial repair, superior capsular reconstruction (SCR), or a subacromial balloon. Limited evidence exists demonstrating superiority of any of these techniques. The purpose of this study is to evaluate an alternative technique to treat MCTs, a partial repair with an in-situ biceps tenodesis, which effectively acts like a biologic SCR.
Methods
A retrospective cohort study was performed on patients that underwent partial rotator cuff repair with an in-situ biceps tenodesis by a single surgeon between March 2017 and January 2020 with minimum two-year clinical follow-up. Preoperative MRIs were reviewed to analyze rotator cuff tear size, fatty infiltration (FI), and presence of a tangent sign. FI scores were classified as low-grade FI (Goutallier score of 0 or 1) or high-grade FI (Goutallier score = 2). Patient reported outcome measures (PROMs) including the ASES Score, the VAS Pain, SANE score, and the VR-12 mental and physical scores were collected preoperatively and postoperatively. Changes in PROMs were compared to previously reported minimum clinically important difference (MCID) values for VAS (1.5), ASES (21.0), and SANE (13.0).
Results
A total of 21 patients were enrolled in this study. All patients presented with full thickness tears of the supraspinatus (SS) and 16 patients (76.2%) had full thickness tears of the infraspinatus (IS). 11 patients had a positive tangent sign of the SS. The cohort had a mean age of 62.6 years (range: 46 - 75) with mean follow-up of 30.0 months (range: 24 - 58). VAS pain decreased preoperatively to postoperatively (p < 0.001), while SANE (p = 0.002), ASES (p < 0.001), and VR-12 Physical (p < 0.001) scores increased. There was no difference in the VR-12 Mental Component (p = 0.284). 15 patients (71.4%) achieved MCID for VAS, 14 (66.7%) for ASES, and 15 (71.4%) for SANE.
Conclusion
Early results have demonstrated that a partial rotator cuff repair with an in-situ biceps tenodesis is a viable and effective alternative for the treatment of MCTs. Patient reported outcome scores are good to excellent with the majority of patients reaching previously reported MCID values.