Tenotomy Versus no Tenotomy LHB in Rotator Cuff Repair

Consorci Sanitari de Terrassa

Status: Completed

Conditions: Long Head of Biceps Brachii Lesions; Rotator Cuff Tears

Treatments: Procedure: ROTATOR CUFF REPAIR

Study type: Interventional

Funder types: Other

Identifiers

NCT07289334

02-14-105-018

Details and patient eligibility

About

The function of the long head of the biceps tendon (LHBT) in the glenohumeral joint generates controversy among researchers. For some, the tendon does not have a significant function in the shoulder, while others consider it acts as a depressor of the humeral head and a stabilizer of the joint. These functions may be enhanced in cases of rotator cuff injuries, where compensatory hypertrophy and/or instability of the LHBT can occur, which can also be a source of pain. One of the imaging techniques used for diagnosing these injuries is ultrasound.

Initially, G. Walch proposed tenotomy of the LHBT in massive rotator cuff tears to improve pain and, in some cases, shoulder function. Currently, many authors advocate tenotomy of the LHBT as an adjunct to rotator cuff repair to avoid postoperative pain. However, there is no evidence that this procedure improves the clinical outcomes of isolated rotator cuff repair.

Based on the pathophysiology of the LHBT associated with rotator cuff injuries and the current trend to perform tenotomies in conjunction with cuff repair, the objectives of this doctoral thesis project were:

To compare the clinical and imaging outcomes of arthroscopic rotator cuff repairs with and without LHBT tenotomy.

To analyze the position and cross-sectional area of the LHBT in the bicipital groove using ultrasound in cases with and without tenotomy.

Enrollment: 60 patients

Sex: All

Ages: 40 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Age between 40 and 65 years
• Partial supraspinatus tears (≥ 50% thickness)
• Complete supraspinatus tears ≤ 3 cm in the coronal plane
• Muscle atrophy less than stage 2 according to Thomazeau
• Presence of the LHBT in the bicipital groove

Exclusion criteria

• Patients younger than 40 or older than 65 years
• LHBT rupture
• Partial supraspinatus tears < 50% thickness
• Supraspinatus tears > 3 cm
• Tears of other rotator cuff tendons, with or without supraspinatus involvement
• Traumatic tears with surgery performed less than 3 months after injury
• Muscle atrophy ≥ stage 2 Thomazeau
• Associated degenerative glenohumeral pathology (> Samilson 1)
• Previous shoulder surgeries
• Previous shoulder infections
• Associated peripheral neurological injuries
• Degenerative neurological conditions
• Patients who refused to sign informed consent

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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60 participants in 2 patient groups, including a placebo group

NO TENOTOMY

Placebo Comparator group

Description:

NO TENOTOMY OF LHBT + ROTATOR CUFF REPAIR

Treatment:

Procedure: ROTATOR CUFF REPAIR

TENOTOMY

Experimental group

Description:

TENOTOMY OF LHBT + ROTATOR CUFF REPAIR

Treatment:

Procedure: ROTATOR CUFF REPAIR