Arthroscopic Repair of Anterosuperior Rotator Cuff Tears Combined With Open Biceps Tenodesis
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Anterosuperior Rotator Cuff Tears
Anterosuperior rotator cuff tears have been recognized as a distinct pattern of rotator cuff tears involving the subscapularis tendon in combination with supraspinatus with or without infraspinatus tendons. Gerber previously reported that subscapularis tears in conjunction with supraspinatus tears were more common than isolated subscapularis tears. Warner reported that patients with anterosuperior tears comprised 4% of all patients who underwent rotator cuff repairs. Other authors have reported that combined subscapularis and supraspinatus tears occur at a rate of 9.3% to 23.9%. The clinical presentation, operative technique, and prognosis were thought to be associated with less favorable outcomes compared with isolated subscapularis tears and posterosuperior (supraspinatus and infraspinatus) rotator cuff tears. Since the initial clinical series of open anterosuperior rotator cuff repair, this clinical entity has become more widely recognized and earlier diagnosis has led to earlier operative intervention.
Arthroscopic Rotator Cuff Repair
Arthroscopic repair of rotator cuff tears continues to improve with mastery of surgical techniques and stronger biomechanical repair constructs. Published reports of arthroscopic repair of supraspinatus and combined supraspinatus and infraspinatus tears have shown significant improvements in clinical outcomes and improvement in shoulder function, with comparable, if not better, results compared with open techniques. Previous studies on arthroscopic repairs of the subscapularis have also reported good to excellent results in 79% to 92% of cases. Furthermore, arthroscopic surgical approaches require smaller incisions, provide improved operative exposure, are less traumatic to the supporting tissues of the shoulder, and allow for a faster recovery time, overall decreasing the complication and surgical morbidity rate when compared with open surgical approaches. Thus, because arthroscopic approaches for anterosuperior rotator cuff repair provide comparable, if not better, surgical outcomes while decreasing surgical morbidity to the joint, it is clear that the arthroscopic approach may be advantageous to the patient.
Two recent studies on arthroscopic repair of anterosuperior rotator cuff tears reported significant improvement in clinical outcome scores. Both studies reported a high association with injuries to the long head of the biceps tendon (LHB) that were recognized either before surgery or during arthroscopic examination. Other studies have reported that the association of anterosuperior rotator cuff tears and LHB pathology occurs in 30% to 69% of cases. The treatment of the biceps pathology in the setting of anterosuperior rotator cuff tears has been debated in the literature.
Anterosuperior Rotator Cuff Tears Versus Open Biceps Tenodesis
The treatment of anterosuperior rotator cuff tears has improved with early diagnosis and enhanced surgical techniques. The purpose of this study was to report the clinical results after arthroscopic repair of anterosuperior rotator cuff tears and open biceps tenodesis. Our hypothesis was that patients undergoing arthroscopic repair of anterosuperior rotator cuff tears with open biceps tenodesis would show significant improvement in shoulder function and pain relief, as well as a high rate of satisfaction.