Pub Date : 2023-11-17DOI: 10.1177/17585732231215504
C. Prada, Zhi Li, Praveen Sritharan, Moin Khan, Francesc Marcano-Fernández, Latifah Al Mana, B. Alolabi
Distal biceps tendon (DBT) injuries are relatively uncommon. Controversies exist regarding the best approach, leading to variations in treatment. This study aims to understand the preferences and practices of orthopedic surgeons regarding management of DBT injuries, as well as assess the feasibility of a future pilot randomized controlled trial (RCT) to evaluate the impact of various surgical factors on patient outcomes. A cross-sectional international survey was conducted amongst surgeons treating patients with DBT injuries. The survey included questions about treatment preferences, surgical techniques, case volumes, and interest in participating in a future RCT. Responses from 491 orthopedic surgeons from 26 countries/territories were obtained. Most surgeons had limited exposure to DBT ruptures. Variations were observed in the work-up process, with some relying solely on clinical examinations while others used diagnostic imaging. A single incision approach was the most common surgical technique, and tendon fixation with suspensory cortical buttons was frequently preferred. Most surgeons did not explore or repair the bicipital aponeurosis. Interest in participating in a future RCT varied for different surgical controversies. This survey provides valuable insights into surgeons’ preferences and practices for DBT injury management. The study highlights the need for standardization in the work-up process and the use of evidence-based guidelines. Current practices may be influenced by factors such as training, implant availability, and costs. The survey also identified surgeons and centers interested in collaboration for future multicenter trials, allowing for equitable access to surgical collaboration opportunities and addressing the lack of evidence in DBT rupture treatment. Level V, expert-opinion.
{"title":"Distal biceps tendon injuries treatment: A survey of orthopaedic surgeons’ current practice and preferences","authors":"C. Prada, Zhi Li, Praveen Sritharan, Moin Khan, Francesc Marcano-Fernández, Latifah Al Mana, B. Alolabi","doi":"10.1177/17585732231215504","DOIUrl":"https://doi.org/10.1177/17585732231215504","url":null,"abstract":"Distal biceps tendon (DBT) injuries are relatively uncommon. Controversies exist regarding the best approach, leading to variations in treatment. This study aims to understand the preferences and practices of orthopedic surgeons regarding management of DBT injuries, as well as assess the feasibility of a future pilot randomized controlled trial (RCT) to evaluate the impact of various surgical factors on patient outcomes. A cross-sectional international survey was conducted amongst surgeons treating patients with DBT injuries. The survey included questions about treatment preferences, surgical techniques, case volumes, and interest in participating in a future RCT. Responses from 491 orthopedic surgeons from 26 countries/territories were obtained. Most surgeons had limited exposure to DBT ruptures. Variations were observed in the work-up process, with some relying solely on clinical examinations while others used diagnostic imaging. A single incision approach was the most common surgical technique, and tendon fixation with suspensory cortical buttons was frequently preferred. Most surgeons did not explore or repair the bicipital aponeurosis. Interest in participating in a future RCT varied for different surgical controversies. This survey provides valuable insights into surgeons’ preferences and practices for DBT injury management. The study highlights the need for standardization in the work-up process and the use of evidence-based guidelines. Current practices may be influenced by factors such as training, implant availability, and costs. The survey also identified surgeons and centers interested in collaboration for future multicenter trials, allowing for equitable access to surgical collaboration opportunities and addressing the lack of evidence in DBT rupture treatment. Level V, expert-opinion.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139264527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-16DOI: 10.1177/17585732231215441
A. B. Boyle, Simon Bm MacLean
The underlying shoulder pathology in radiographic superior escape of the humeral head and association between acromiohumeral interval (AHI) on radiographs and magnetic resonance imaging (MRI) are poorly understood. A retrospective review of shoulder radiographs and MRI scans was undertaken. AHI was measured using both modalities. Deltoid bulk, long head of biceps brachii subluxation/tear, and rotator cuff disease (tendon involvement, severity, fatty infiltration) were noted using MRI. A total of 167 patients were included. MRI measurements of AHI were significantly smaller than radiographic measurements ( p = 0.010). AHI was significantly smaller in patients with at least one partial or full thickness rotator cuff tear ( p < 0.0001) and in patients with increased fatty infiltration based on Goutallier grade ( p = 0.004). In the presence of two or more tendon tears, long head of biceps brachii rupture was associated with superior escape ( p < 0.001). In patients with superior escape (AHI <6 mm), the number of rotator cuff tendon tears ranged from 0 to 3 and Goutallier grades from 0 to 4 representing a wide disease spectrum. Radiographic superior escape of the humeral head is correlated with full thickness rotator cuff tears, fatty infiltration, and long head of biceps brachii rupture. However, superior escape can occur with a single or no tendon injury with minimal fatty infiltration. Level III; Retrospective Case-Control Design; Prognosis Study.
{"title":"Redefining superior escape of the humeral head: A radiographic and magnetic resonance imaging study","authors":"A. B. Boyle, Simon Bm MacLean","doi":"10.1177/17585732231215441","DOIUrl":"https://doi.org/10.1177/17585732231215441","url":null,"abstract":"The underlying shoulder pathology in radiographic superior escape of the humeral head and association between acromiohumeral interval (AHI) on radiographs and magnetic resonance imaging (MRI) are poorly understood. A retrospective review of shoulder radiographs and MRI scans was undertaken. AHI was measured using both modalities. Deltoid bulk, long head of biceps brachii subluxation/tear, and rotator cuff disease (tendon involvement, severity, fatty infiltration) were noted using MRI. A total of 167 patients were included. MRI measurements of AHI were significantly smaller than radiographic measurements ( p = 0.010). AHI was significantly smaller in patients with at least one partial or full thickness rotator cuff tear ( p < 0.0001) and in patients with increased fatty infiltration based on Goutallier grade ( p = 0.004). In the presence of two or more tendon tears, long head of biceps brachii rupture was associated with superior escape ( p < 0.001). In patients with superior escape (AHI <6 mm), the number of rotator cuff tendon tears ranged from 0 to 3 and Goutallier grades from 0 to 4 representing a wide disease spectrum. Radiographic superior escape of the humeral head is correlated with full thickness rotator cuff tears, fatty infiltration, and long head of biceps brachii rupture. However, superior escape can occur with a single or no tendon injury with minimal fatty infiltration. Level III; Retrospective Case-Control Design; Prognosis Study.","PeriodicalId":507613,"journal":{"name":"Shoulder & Elbow","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139269581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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