Functional Recovery After Rotator Cuff Repair: The Role of Biceps Surgery

in Journal of Sport Rehabilitation
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $76.00

1 year online subscription

USD  $101.00

Student 2 year online subscription

USD  $144.00

2 year online subscription

USD  $192.00

Context: Surgical cuff repair is recommended in a full-thickness rotator cuff tear when nonoperative treatment fails. Surgical cuff repair can include surgery of the long head of the biceps when concomitant biceps pathology is present. However, the studies executed up till now have not yet clearly defined if additional biceps surgery affects the shoulder functionality in patients who underwent rotator cuff repair. Objective: To verify if the concomitant biceps surgery prejudices shoulder functionality during the short-term period in rotator cuff repair patients. Design: Prospective and observational study. Setting: Outpatient service for rehabilitation. Patients: Ninety-three consecutive patients who had undergone surgery for full-thickness symptomatic rotator cuff tear were enrolled for rehabilitation; 25 underwent rotator cuff repair and tendon biceps surgery (ABS), while 68 underwent rotator cuff repair only (RCR). Interventions: Motor rehabilitation after surgical treatment of rotator cuff repair. Measures: Final Constant score was used as primary outcome measure, and efficiency and effectiveness in Constant score were evaluated both at the end of the last cycle of rehabilitation and 6 mo postsurgery. Results: Patients with rotator cuff repair and tendon biceps surgery had lower final scores (36.5 ± 12.0 vs 49.3 ± 13.0, P < .001), effectiveness (40.6 ± 18.0 vs 60.3 ± 20.0, P < .001), and efficiency (0.80 ± 0.5 vs 1.19 ± 0.6, P = .010) in Constant score than those with rotator cuff repair only at the end of rehabilitation. Moreover, they had a lower final score (53.3 ± 14.0 vs 64.5 ± 10.0, P < .001) and effectiveness (66.9 ± 21.0 vs 84.0 ± 16, P < .001) in Constant score 6 mo postsurgery. Gender was a determinant of final score, efficiency, and effectiveness in Constant score at the end of the rehabilitation period, while tendon biceps surgery was a determinant of final score and effectiveness in Constant score at the end of the rehabilitation period and at 6 mo postsurgery. Conclusions: This study highlights that concomitant tendon biceps surgery negatively affects functional outcome of patients who underwent rotator cuff repair and is an important determinant of shoulder functionality in the first 6 mo postsurgery.

Gialanella, Mazza, Danna, and Comini are with the Scientific Inst of Lumezzane, Clinical Scientific Insts Maugeri, Lumezzane, Italy. Grossetti is with MOX–Modeling and Scientific Computing, Dept of Mathematics, Polytechnic University of Milan, Milan, Italy.

Gialanella (gialanellab@gmail.com) is corresponding author.
  • 1.

    Pai VS, Lawson DA. Rotator cuff repair in a district hospital setting: outcomes and analysis of prognostic factors. J Shoulder Elbow Surg. 2001;10:236241. PubMed doi:10.1067/mse.2001.113963

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Redziniak DE, Hart J, Turman K, et al. Arthroscopic rotator cuff repair using the Opus knotless suture anchor fixation system. Am J Sports Med. 2009;37:11061110. PubMed doi:10.1177/0363546508331203

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Didden K, Leirs G, Aerts P. The impact of the belgian workers’ compensation system on return to work after rotator cuff surgery. Acta Orthop Belg. 2010;76:592597. PubMed

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Fermont AJ, Wolterbeek N, Wessel RN, Baeyens JP, de Bie RA. Prognostic factors for successful recovery after arthroscopic rotator cuff repair: a systematic literature review. J Orthop Sports Phys Ther. 2014;44:153163. PubMed doi:10.2519/jospt.2014.4832

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Kempf JF, Gleyze P, Bonnomet F, et al. A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty. Arthroscopy. 1999;15:5666. PubMed doi:10.1053/ar.1999.v15.015005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Klinger HM, Spahn G, Baums MH, Steckel H. Arthroscopic debridement of irreparable massive rotator cuff tears—a comparison of debridement alone and combined procedure with biceps tenotomy. Acta Chir Belg. 2005;105:297301. PubMed doi:10.1080/00015458.2005.11679720

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Walch G, Edwards TB, Boulahia A, Nové-Josserand L, Neyton L, Szabo I. Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg. 2005;14:238246. PubMed doi:10.1016/j.jse.2004.07.008

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Boileau P, Maynou C, Balestro JC, et al. Long head of the biceps pathology. Rev Chir Orthop Reparatrice Appar Mot. 2007;93:5S195S53. PubMed

  • 9.

    Nho SJ, Frank RM, Reiff SN, Verma NN, Romeo AA. Arthroscopic repair of anterosuperior rotator cuff tears combined with open biceps tenodesis. Arthroscopy. 2010;26:16671674. PubMed doi:10.1016/j.arthro.2010.04.008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Dezaly C, Sirveaux F, Philippe R, et al. Arthroscopic treatment of rotator cuff tear in the over-60s: repair is preferable to isolated acromioplasty-tenotomy in the short term. Orthop Traumatol Surg Res. 2011;97:125130. PubMed doi:10.1016/j.otsr.2011.06.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11.

    DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am.1984;66:563567. PubMed doi:10.2106/00004623-198466040-00011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Parmelee PA, Thuras PD, Katz IR, Lawton MP. Validation of the cumulative illness rating scale in a geriatric residential population. J Am Geriatr Soc. 1995;43:130137. PubMed doi:10.1111/j.1532-5415.1995.tb06377.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13.

    Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68:11361144. PubMed doi:10.2106/00004623-198668080-00002

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;214:160164. PubMed

  • 15.

    DeLoach LJ, Higgins MS, Caplan AB, Stiff JL. The visual analogue scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale. Anesth Analg. 1998;86:102106. PubMed

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Shah S, Vanclay F, Cooper B. Efficiency, effectiveness and duration of stroke rehabilitation. Stroke. 1990;21:241246. PubMed doi:10.1161/01.STR.21.2.241

  • 17.

    R Core Development Team: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2015.

    • Search Google Scholar
    • Export Citation
  • 18.

    Cohen J. Statistical Power Analysis or the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum; 1988.

  • 19.

    Gulotta LV, Nho SJ, Dodson CC, Adler RS, Altchek DW, MacGillivray JD. Prospective evaluation of arthroscopic rotator cuff repairs at 5 years: part II--prognostic factors for clinical and radiographic outcomes. J Shoulder Elbow Surg. 2011;20:941946. PubMed doi:10.1016/j.jse.2011.03.028

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Pill SG, Walch G, Hawkins RJ, Kissenberth MJ. The role of the biceps tendon in massive rotator cuff tears. Instr Course Lect. 2012;61:113112. PubMed

  • 21.

    Oh JH, Kim SH, Ji HM, Jo KH, Bin SW, Gong HS. Prognostic factors affecting anatomic outcome of rotator cuff repair and correlation with functional outcome. Arthroscopy. 2009;25:3039. PubMed doi:10.1016/j.arthro.2008.08.010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Gialanella B, Altieri G, Clemente M. Determinants in predicting duration of treatment in an outpatient rehabilitation orthopedic-traumatologic service. Eur J Phys Rehabil Med. 2014;50:247254. PubMed

    • Search Google Scholar
    • Export Citation
  • 23.

    Codsi MJ. The painful shoulder: when to inject and when to refer. Cleve Clin J Med. 2007;74:473474. PubMed doi:10.3949/ccjm.74.7.473

  • 24.

    Schiavone Panni A, Cerciello S, Vasso M, Tartarone M. Stiffness in total knee arthroplasty. J Orthop Traumatol. 2009;10:111118. PubMed doi:10.1007/s10195-009-0054-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Razmjou H, Davis AM, Jaglal SB, Holtby R, Richards RR. Disability and satisfaction after rotator cuff decompression or repair: a sex and gender analysis. BMC Musculoskelet Disord. 2011;12:66. PubMed doi:10.1186/1471-2474-12-66

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Peltz CD, Haladik JA, Hoffman SE, et al. Associations among shoulder strength, glenohumeral joint motion, and clinicaloutcome after rotator cuff repair. Am J Orthop (Belle Mead NJ). 2014;43:220226. PubMed

    • Search Google Scholar
    • Export Citation
  • 27.

    Mariani EM, Cofield RH, Askew LJ, Li GP, Chao EY. Rupture of the tendon of the long head of the biceps brachii. Surgical versus nonsurgical treatment. Clin Orthop Relat Res. 1988;228:233239. PubMed

    • Search Google Scholar
    • Export Citation
  • 28.

    Virk MS, Nicholson GP. Complications of proximal biceps tenotomy and tenodesis. Clin Sports Med. 2016;35:181188. PubMed doi:10.1016/j.csm.2015.08.011

  • 29.

    Szabó I, Boileau P, Walch G. The proximal biceps as a pain generator and results of tenotomy. Sports Med Arthrosc. 2008;16:180186. PubMed doi:10.1097/JSA.0b013e3181824f1e

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Patel VR, Singh D, Calvert PT, Bayley JI. Arthroscopic subacromial decompression: results and factors affecting outcome. J Shoulder Elbow Surg. 1999;8:231237. PubMed doi:10.1016/S1058-2746(99)90134-9

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Henn RF 3rd, Kang L, Tashjian RZ, Green A. Patients’ preoperative expectations predict the outcome of rotator cuff repair. J Bone Joint Surg Am. 2007;89:19131919. PubMed doi:10.2106/00004623-200709000-00004

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Tashjian RZ, Hollins AM, Kim HM, et al. Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med. 2010;38:24352442. PubMed doi:10.1177/0363546510382835

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Chung SW, Park JS, Kim SH, Shin SH, Oh JH. Quality of life after arthroscopic rotator cuff repair: evaluation using SF-36 and an analysis of affecting clinical factors. Am J Sports Med. 2012;40:631639. PubMed doi:10.1177/0363546511430309

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Katz PP, Criswell LA. Differences in symptom reports between men and women with rheumatoid arthritis. Arthritis Care Res. 1996;9:441448. PubMed doi:10.1002/art.1790090605

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 226 167 19
Full Text Views 6 5 2
PDF Downloads 4 3 1