Ion-Andrei Popescu1,2,3, Frédéric Teboul4,5, Jean-Nöel Goubier4,5, Amir Ghazanfari6,7,8. 1. Centre International de Chirurgie de la Main, 92, Boulevard de Courcelles, 75017, Paris, France. ionandrei.popescu@yahoo.com. 2. Institut de Chirurgie du Nerf et du Plexus Brachial, Paris, France. ionandrei.popescu@yahoo.com. 3. MIRABIS Institute-Surgical Innovation Center, Constanta, Romania. ionandrei.popescu@yahoo.com. 4. Centre International de Chirurgie de la Main, 92, Boulevard de Courcelles, 75017, Paris, France. 5. Institut de Chirurgie du Nerf et du Plexus Brachial, Paris, France. 6. MIRABIS Institute-Surgical Innovation Center, Constanta, Romania. 7. Centre Hospitalier Privé du Montgardé - SOS main-épaule, Aubergenvilles, France. 8. Centre Hospitalo-Universitaire de Saint-Antoine, Paris, France.
Abstract
PURPOSE: Studies have shown that isolated tenotomy of the long head of the biceps (LHB) improves significantly pain scores, active range of motion and Constant score in elderly patients with massive and irreparable cuff tears with no osteoarthritis. This cadaveric study was performed to assess the feasibility of a tenotomy of the LHB and subacromial corticosteroid injection using a minimally invasive in-office setting under local anaesthesia on awake patients. MATERIALS AND METHODS: Twenty scare-free shoulders were included in the study. We performed the procedure in an in-office setting using a wrist arthroscope with no fluid, connected to wireless camera and light source. A standard shoulder arthroscopy was finally performed in order to analyse the tenotomy quality and detect possible iatrogenic lesions. RESULTS: The LHB tendon was cut fully in all cases, the mean length of the proximal stump of the LHB was 0.4 cm (range, 0.3-0.7 mm) and the mean duration of the surgery was 3.5 minutes (range, 2.43-3.86 min). No iatrogenic lesion occurred during the in-office procedure. CONCLUSION: This cadaveric study suggests that it is feasible and safe to perform, under local anaesthesia, a minimally invasive arthroscopic tenotomy of the LHB and subacromial injection using an in-office setting. Further clinical studies are needed to confirm the reliability, indication and effectiveness of this technique.
PURPOSE: Studies have shown that isolated tenotomy of the long head of the biceps (LHB) improves significantly pain scores, active range of motion and Constant score in elderly patients with massive and irreparable cuff tears with no osteoarthritis. This cadaveric study was performed to assess the feasibility of a tenotomy of the LHB and subacromial corticosteroid injection using a minimally invasive in-office setting under local anaesthesia on awake patients. MATERIALS AND METHODS: Twenty scare-free shoulders were included in the study. We performed the procedure in an in-office setting using a wrist arthroscope with no fluid, connected to wireless camera and light source. A standard shoulder arthroscopy was finally performed in order to analyse the tenotomy quality and detect possible iatrogenic lesions. RESULTS: The LHB tendon was cut fully in all cases, the mean length of the proximal stump of the LHB was 0.4 cm (range, 0.3-0.7 mm) and the mean duration of the surgery was 3.5 minutes (range, 2.43-3.86 min). No iatrogenic lesion occurred during the in-office procedure. CONCLUSION: This cadaveric study suggests that it is feasible and safe to perform, under local anaesthesia, a minimally invasive arthroscopic tenotomy of the LHB and subacromial injection using an in-office setting. Further clinical studies are needed to confirm the reliability, indication and effectiveness of this technique.
Entities:
Keywords:
Biceps tenotomy; In-office arthroscopy; In-office surgery; Long head of the biceps; Massive rotator cuff tear; Shoulder arthroscopy
Authors: Andrew R Hsu; Neil S Ghodadra; Matthew T Provencher; Paul B Lewis; Bernard R Bach Journal: J Shoulder Elbow Surg Date: 2010-11-04 Impact factor: 3.019
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