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Arthroscopy. 2018 Sep;34(9):2590-2600. doi: 10.1016/j.arthro.2018.05.012. Epub 2018 Aug 2.

Anterior Cable Reconstruction Using the Proximal Biceps Tendon for Large Rotator Cuff Defects Limits Superior Migration and Subacromial Contact Without Inhibiting Range of Motion: A Biomechanical Analysis.

Author information

1
Southern California Permanente Medical Group, Woodland Hills, California, U.S.A.. Electronic address: Maxwellpark1@yahoo.com.
2
Tibor Rubin VA Medical Center, Long Beach, California, U.S.A.; Osaka Medical College, Takatsuki, Japan.
3
Tibor Rubin VA Medical Center, Long Beach, California, U.S.A.
4
San Diego State University, San Diego, California, U.S.A.

Abstract

PURPOSE:

To assess an anterior cable reconstruction (ACR) using autologous proximal biceps tendon for large to massive rotator cuff tears.

METHODS:

Nine cadaveric shoulders (mean age, 58 years) were tested with a custom testing system. Range of motion, superior translation of the humeral head, and subacromial contact pressure were measured at 0°, 30°, 60°, and 90° of external rotation (ER) with 0°, 20°, and 40° of glenohumeral abduction. Five conditions were tested: intact, stage II tear (supraspinatus), stage II tear + ACR, stage III tear (supraspinatus + anterior half of infraspinatus), and stage III tear + ACR. ACR involved a biceps tendon tenotomy at the transverse humeral ligament, preserving its labral attachment. ACR included nonpenetrating suture-loop fixation using 2 side-to-side sutures and an anchor at the articular margin to restore anatomy and secure the tendon along the anterior edge of the cuff defect. ACR was performed in 20° glenohumeral abduction and 60° ER.

RESULTS:

ACR for both stage II and stage III showed significantly higher total range of motion compared with intact at all angles (P ≤ .001). ACR significantly decreased superior translation for stage II tears at 0°, 30°, and 60° ER for both 0° and 20° abduction (P ≤ .01) and for stage III tears at 0° and 30° ER for both 0° and 20° abduction (P ≤ .004). ACR for stage III tear significantly reduced peak subacromial contact pressure at 30° and 60° ER with 0° and 40° abduction and at 30° ER with 20° abduction (P ≤ .041).

CONCLUSIONS:

ACR using autologous biceps tendon biomechanically normalized superior migration and subacromial contact pressure, without limiting range of motion.

CLINICAL RELEVANCE:

ACR may improve rotator cuff tendon repair longevity by providing basic static ligamentous support to the dynamic tendon while helping to limit superior migration without restricting glenohumeral kinematics.

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