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Abstract Presented at the 26th Annual Meeting of the Arthroscopy Association of North America| Volume 23, ISSUE 6, SUPPLEMENT , e14, June 2007

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Arthroscopic Biceps Tenotomy And Tenodesis For Massive Irreparable Rotator Cuff Tears (SS-27)

      Purpose

      The purpose of this study was to evaluate outcome following arthroscopic biceps tenotomy or tenodesis for massive irreparable rotator cuff tears associated with biceps lesions.

      Methods

      This is a retrospective study of 68 consecutive patients (mean age 68 ± 6 years) with 72 irreparable rotator cuff tears treated with arthroscopic biceps tenotomy (39 cases) or tenodesis (33 cases). All patients were evaluated clinically and radiographically at a mean follow-up of 35 months (range, 24-52).

      Results

      Fifty-three patients (78%) were satisfied. The Constant score improved from 46 to 67 points (p<0.001). Presence of a healthy, intact teres minor on preoperative imaging correlated with increased postoperative external rotation (40 vs. 18°, p< 0.05) and higher Constant score (p<0.05). Three patients with a pseudoparalyzed shoulder did not benefit from the procedure and did not regain active elevation above the horizontal level. By contrast, 15 patients with painful loss of active elevation recovered active elevation. The acromiohumeral distance decreased 1 mm on average, and only one patient developed glenohumeral osteoarthritis. There was no difference between tenotomy and tenodesis (Constant Score 61 vs. 73). A “Popeye” sign was clinically apparent in 24 tenotomy patients (61%), but none were bothered by it. Two patients required reoperation with a reverse prosthesis.

      Conclusions

      Arthroscopic biceps tenotomy and tenodesis effectively treats severe pain or dysfunction caused by an irreparable rotator cuff tear associated with biceps pathology. Shoulder function is significantly lower if the teres minor is atrophic or fatty infiltrated. Pseudoparalysis or severe cuff arthropathy are contraindications.