ISSN 0972-978X 

 
 
 
 
 
 
 
 
 
 
 
 
  About COAA
 

 

 

 

 

 

 

CASE REPORT

Biceps Bridgeplasty In Massive Rotator Cuff Tears: Report Of 2 Cases

 Sandeep Shewale*,Vikram Paode**,Alexander Campbell*

* Consultant Orthopaedic Surgeon
** Registrar in Orthopaedics
Department of Orthopaedics, Monklands Hospital,Monkscourt Avenue, Airdrie, Scotland, U.K.ML6 0JS.

Address for Correspondence:

Department of Orthopaedics, Monklands Hospital,Monkscourt Avenue, Airdrie, Scotland, U.K.ML6 0JS.
Tel: 00-44-1236-748748
E-Mail: shewalesandeep@yahoo.com

 

Abstract:

The treatment of massive rotator cuff tears remains controversial and difficult with a number of open and arthroscopic techniques described in the literature. These are associated with a high rate of failures. The differences in the reported results vary significantly. 1,2,5,6

Lesions of the long head of biceps tendon are commonly associated with rotator cuff tears. Using the biceps tendon for repair in certain cases of massive rotator cuff tears is a useful technique in the surgical armamentarium.

We describe the technique and results of two cases. We suggest the name of Biceps Bridgeplasty for the procedure of using the long head of biceps (LHB) for rotator cuff repair.

J.Orthopaedics 2007;4(4)e16
 index.htm

Case Report:

Case 1:

            A 60 year old right handed man was referred to us by the rheumatologists with a 3 month history of reduced range of shoulder movement. Active abduction was 50 and elevation till 70. Passive range was slightly greater.

            Ultrasound of the shoulder confirmed a rotator cuff tear involving the supra and infraspinatus. He was enrolled into a shoulder rehabilitation programme. After 6 months of physiotherapy, there was no significant improvement and surgical repair was therefore done 12 months from first presentation.

            The rotator cuff tear was found to be greater than 5 cm in size and was repaired using no.2 Panacryl and Mitek stich with the long head of biceps attached to the rotator cuff.

At final follow up 14 months post surgery forward elevation had improved from 70 to 120, external rotation from 5 to 15 and abduction from 50 to 95. The Constant score had improved from 27 to 66. 

Case 2: 

            A 67 year old right handed man sustained a fall onto his outstretched hand whilst on holiday and developed right shoulder pain. He did not sustain any bony injury. The pain initially improved but 9 weeks later developed severe pain whilst rotating his shoulder and was unable to effectively abduct or elevate his shoulder. He was admitted to another hospital for analgesia.

 Ultrasound of his shoulder showed a rotator cuff tear of greater than 5 centimetres in size involving the supraspinatus and infraspinatus. He was subsequently treated with analgesia and physiotherapy. Three months later there was no significant improvement with elevation at 50 and abduction at 60 and was referred here. He was operated 9 months post injury.

At final follow up 12 months post surgery, forward elevation had improved from 50 to 115, external rotation from 5 to 15 and abduction from 60 to 120. His Constant score had improved from 15 to 60.

Figure1:    Biceps tendon being held for the rotator cuff tear repair.

Figure2:    Active abduction in patient 2.

 

Technique:

            With the patient in a beach chair position a 5-6 cm lateral incision centered over the acromioclavicular joint is made. After subcutaneous flaps have been developed, the deltoid is split in line with its fibres from just anterior to the AC joint extending distally for approximately 5cm. using blunt dissection the subdeltoid adhesions to the bursa are released and retractors placed. The coracoacromial ligament is identified and excised. The deltoid is elevated of the anterior acromion with its periosteal attachment and a standard anterior acromioplasty is performed.

            The rotator cuff tear is identified and the cuff mobilised by blunt dissection. The biceps tendon is tenodesed in the bicipital groove and divided close to the glenoid origin. The rotator cuff is then sutured to the biceps tendon in a double breasting fashion to draw the supraspinatus as close to the fixed end of the biceps tendon as possible.

            The deltoid is then meticulously repaired back using non absorbable sutures and standard skin closure techniques are used.

            The post operative regime depends upon the quality of the tissues undergoing tendon repair and the security of the sutures achieved. We placed the patients in a shoulder sling with early passive motion beginning in the first 24 -48 hours for the initial 3 weeks. This is followed by active motion for a further 3 weeks followed by isometric strengthening excercises and unrestricted activities allowed at about 10-12 weeks postoperatively.

Discussion:

An irreparable tear of the rotator cuff is described as a tear that cannot be repaired primarily by reattachment of the torn cuff tendon to the greater tuberosity after debridement of the avascular margin.2 Cofield defined massive tears as those greater than 5 centimetres in diameter. 8

            Debridement of an irreparable and massive cuff tears do provide some satisfactory results. There however deteriorate with time and lead to cuff arthropathy in the long term.1,6,7,8

            Lesions of the long head of Biceps tendon are frequently seen in association with rotator cuff tears.3,4,7 The frequency of the MR(Magnetic Resonance Imaging) findings in the biceps tendon is about 25% while surgical correlation shows that this maybe as high as 75%, when the whole spectrum of biceps lesions are considered, ranging from mild tendonitis to complete rupture.4 The Biceps tendon is frequently subluxed and found to be hypertrophied, flattened as it assumes the function of the rotator cuff and its head depressor responsibility increases thus making it more useful.3,4

            The use of the biceps tendon for irreparable defects of the rotator cuff was first proposed by Bush in 1958.2 Various other surgeons have used the Biceps tendon for repair of the rotator cuff tears in different surgical techniques/ways.5,7 Using the biceps tendon has several advantages, including treating the biceps tendon itself, supporting the rotator cuff, improves the fixation strength / security of repair and it works as a fixed head depressor.

            Both patients had significant improvement in their Range of movement and had excellent results. These cases highlight the importance of recognising the presence of biceps tendon lesions in these patients and considering its use in massive rotator cuff tears. Biceps Bridgeplasty is thus a valuable tool in the armamentarium of the shoulder surgeon. 

Reference :

  1. Bigliani LU, Cardasco FA, Mcllveen SJ, Musso ES. Operative repair of massive rotator cuff tears: long term results. J Shoulder Elbow Surg 1992; 1: 120-30.

  2. Guven O, Bezer M, Guven Z, Kemal G, Tetik C. Surgical technique and functional results of irreparable cuff tears reconstructed with the long head of the biceps tendon. Bull Hosp Jt Dis. 2001; 60(1): 13-7.

  3. Nidecker A, Guckel C, von Hoshstetter A. Imaging the long head of biceps tendon-a pictoral essay emphasizing magnetic resonance. Eur L Radiol. 1997 Nov; 25(3); 177-87.

  4. Chih-Hwa Chen, Kuo-Yaw Hsu, Wen-Jer Chen, Chun-Hsiung Shih. Incidence ans severity of biceps long head tendon lesion in patients with complete rotator cuff tears. J Trauma. 2005: 58: 1189-1193.

  5. Checchia SL, Doneux PS, Miyazaki AN, Silva LA, Fregoneze M, Ossada A, Tsutida CY, Masiole C. Biceps tenodesis associated with arthroscopic repair of rotator cuff tears. J Shoulder Elbow Surg 2005; 14(2): 138-144.

  6. Cofield RH, Parvizi J, Hoffmeyer PJ, Lanzer WL, Ilsrup DM, Rowland CM. Surgical repair of chronic rotator cuff tears: a prospective long term study. J Bone Joint Surg. 83-A; 1: 71-77.

  7. Wolfgang GL. Surgical repair of tears of the rotator cuff of the shoulder: factors influencing the result.

  8. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg. 82-A; 4: 505-515.

 


 

This is a peer reviewed paper 

Please cite as : Sandeep Shewale : Biceps Bridgeplasty In Massive Rotator Cuff Tears: Report Of 2 Cases

J.Orthopaedics 2007;4(4)e16

URL: http://www.jortho.org/2007/4/4/e16

ANNOUNCEMENTS

 


 

Arthrocon 2011


Refresher Course in Hip Arthroplasty

13th March,  2011

At Malabar Palace,
Calicut, Kerala, India

Download Registration Form

For Details
Dr Anwar Marthya,
Ph:+91 9961303044

E-Mail:
anwarmh@gmail.com

 

Powered by
VirtualMedOnline

 

 

   
Copyright of articles belongs to the respective authors unless otherwise specified.Verbatim copying, redistribution and storage of this article permitted provided no restrictions are imposed on the access and a hyperlink to the original article in Journal of Orthopaedics maintained. All opinion stated are exclusively that of the author(s).
Journal of Orthopaedics upholds the policy of Open Access to Scientific literature.