Tenotomy 2013 final
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Transcript of Tenotomy 2013 final
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The Biceps Tendon: Tenotomy v. Tenodesis
Christopher M. Aland MDRothman Institute, Newtown, PA
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Disclaimer
• I own stock in Arthrocare and Johnson and Johnson
• I am on the Membership committee of AANA• I have no conflicts of interest that affect my
ability to teach this course
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What We Know--maybe
• We understand the basics
• Debate regarding function
• Debate regarding treatment
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Anatomy
• Originates from posterior superior labrum
• Coracohumeral, SGHL• Tuberosities• Rich innervation
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Function
• Long felt to be humeral head depressor
• Stability?• Dynamic role– EMG variable
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Diagnosis
• PE is sensitive, not specific
• Variety of tests– Yergasons– Speeds– Subscap lift off
• MRI• Dx at surgery
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What We Don’t• Why it hurts• What is best treatment
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Treatment options
• Tenotomy– Easy to do– Popeye muscle– Cramping
• Tenodesis– Preserves length– Minimizes Popeye– Less cramping– Requires implant– Longer surgery
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However
• Ospar (2002)– No significant difference
• Slenker (2012)– Increase in cosmetic
deformity, otherwise no significant difference
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Tenotomy• Fifty percent rule• Fix associated pathology• Variety of devices• Don’t leave a stump• Pre-op planning
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TenodesisVariety of MethodsSoft tissueSemi softSubpectoral
http://www.youtube.com/watch?v=qCQwSDcslp8
BoneSocketAnchor
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Tenodesis
• Soft/ semi soft– Involves suturing to
rotator cuff– Suture anchors– Conjoint tendon– Pectoralis major– May not be much
different that tenotomy
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Tenotomy
• Keyhole technique
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Socket with Screw
• Variety of systems• Essentially creating
socket and using interference screw, or push-lock type device
• Burkhart (2012) has quantified length relationship– 25 mm
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Sub pectoral
• Small incision• Good for chronic tears• Length tension
relationship important• Burkhart (2012)– 15 mm from MT junction– Suture 2cm above lower
margin
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Results
• Systemic review by Slenker et al. (2012)– No consensus– Few controlled trials– Cosmesis only signif. diff
• Most studies fail to show significant difference– Steadman
• Arthroscopy 1/2011
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Discussion
• If tear is less than 50%, debridement
• Greater than 50%, over sixty, tenotomy
• Younger, high demand, tenodesis– Bony procedures have
higher rate of success
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Thank you