Superior labrum anterior posterior (SLAP) injury is a major challenge for orthopedic surgeons, due to the poor healing ability of the injured labrum. Although arthroscopic surgery is the gold standard for the treatment of SLAP injury, there are still disputes about the adaptation of different surgical techniques, the choice of anchors during operation, knotted or knotless anchors, and fixation methods. The authors believe that arthroscopic repair of SLAP lesions is effective for young patients with intact glenoid labrum(<35 years old) or with extensive activity, where single and knotless anchor is preferred. For the older patients(≥35 years old) with degeneration and wear of glenoid labrum, biceps tenodesis is more preferable, and interference screw fixation technique is recommended. As for patients with failed SLAP repair, biceps tenodesis can achieve a high success rate as a revision surgery. By review of the relevant literature in recent years, this paper summarizes the adaptation of different surgical methods of arthroscopic treatment of SLAP injury, intraoperative anchoring techniques, fixation methods and other improved surgical techniques.
Humans ; Adult ; Shoulder Joint/surgery* ; Arthroscopy/methods* ; Tendon Injuries/surgery* ; Shoulder Injuries/surgery* ; Tenodesis/methods*

BACKGROUND: Biceps tenodesis is a technique frequently performed in shoulder surgeries. Various techniques have been described, but there is no consensus on which technique restores the length-tension relationship. Restoration of the physiologic length-tension relationship has been correlated to better functional outcomes, such as decreased incidence of residual pain or weakness of the biceps. The objective of this study was to measure the anatomic relationship of the origin of the biceps tendon with its zones in the upper extremity. This would provide an anatomic guide or an acceptable placement of the tenodesis to reestablish good biceps tension during surgery METHODS: The study used nine adult cadavers (five males, four females) from the [withheld for blinded review]. Nine shoulder specimens were dissected and markers were placed at five points along each biceps tendon: (1) Labral origin (LO) (2) Superior bicipital groove (SBG) (3) Superior border of the pectoralis tendon (SBPMT) (4) Musculotendinous junction (MTJ) and (5) Inferior border of the pectoralis tendon (IBPMT). Using the origin of the tendon as the initial point of reference, measurements were made to the four subsequent sites. The humeral length was recorded by measuring the distance between the greater tuberosity and the lateral epicondyle as well as the tendon diameter at the articular surface. RESULTS: The intraclass correlation coefficient was excellent across all measures. A total of nine cadavers were included. Mean age of patients was 66.33 years old, ranging from 52-82 years old. These were composed of five male and four female cadavers. The mean tendon length was 24.83mm ± 4.32 from the origin to the superior border of the bicipital groove, 73.50mm ± 6.96 to the Superior Border Pectoralis Major Tendon, 100.89mm ± 6.88 to the Musculotendinous Junction, and 111.11mm ± 7.45 to the Inferior Border Pectoralis Major Tendon. The mean tendon diameter at the articular origin was 6.44mm ± 1.76. CONCLUSION This study provided measurement guidelines that could restore the natural length-tension relationship during biceps tenodesis using the interference screw technique in Filipinos. A simple method of restoring a normal length-tension relationship is by doing tenodesis close to the articular origin and creating a bone socket of approximately 25mm in depth, using the superior border of the bicipital groove as a landmark.
Tenotomy ; Tenodesis

OBJECTIVE: To compare clinical efficacy of arthroscopic tenodesis and tenotomy in treating biceps long head tendinitis. METHODS: From January 2015 to January 2017, 40 patients with long head of the biceps tendinitis were randomly divided into tenotomy group (18 patients) and tenodesis group(22 patients). In tenotomy group, there were 6 males and 12 females with an average age of (62.2±6.1) yeas old, and the average course of disease was (8.5±2.2) months; while in tenodesis group, there were 8 males and 14 females with an average age of(60.5±6.3) years old, and the average course of disease was (8.1±2.3) months. Operative time and deformity of Popeye were compared between two groups, VAS score was used to evaluate degree of pain, and UCLA score was used to assess clinical effects before operation, 3, 6 and 12 months after operation. RESULTS: Forty patients were followed up for 12 to 17 months with an average of(14.3±2.1) months. Eight patients occurred Popeye deformity in tenotomy group, and nobody in tenodesis group. There was significant difference between tenotomy group(40.55±7.51) min and tenodesis group(75.33±9.45) min. VAS score after operation at 3, 6 and 12 months were decreased than that of before operation, and VAS score in tenotomy group was lower than that of in tenodesis group at 3 months after operation(<0.05); while there were no difference in VAS score between two groups at 6 and 12 months after operation(>0.05). UCLA score at at 3, 6 and 12 months after operation in tenodesis group were increased than that of before operation, and UCLA score in tenotomy group was lower than that of in tenodesis group at 3 months after operation(<0.05); while there were no difference in UCLA score between two groups at 6 and 12 months after operation(>0.05). According to UCLA score, 5 got excellent results, 10 moderate and 3 poor in tenotomy group, while 8 got excellent results, 12 moderate and 2 poor in tenodesis group, but without difference between two groups(χ² =0.057, =0.81). CONCLUSIONS Both of arthroscopic tenotomy and tenodesis in treating long head of the biceps tendinitis could receive good clinical effects, and early functional outcomes by arthroscopic tenotomy was better than that of tenodesis, but no difference in later period.
Aged ; Arthroscopy ; Female ; Humans ; Male ; Middle Aged ; Rotator Cuff ; Rotator Cuff Injuries ; Tendinopathy ; Tenodesis

PURPOSE: This study examined the clinical outcomes and assessed the average time to return to play following a peroneal tendon repair in Korean athletes. MATERIALS AND METHODS: Between March 2004 and February 2017, a total of 30 athletes underwent peroneal tendon repair for a peroneal tendon tear. The indications of surgical treatment were chronic pain or intractable symptoms after a previous ankle sprain affecting sports activity refractory to conservative treatment for at least six months. The patient underwent tubulization for a longitudinal tendon rupture. Peroneus longus to peroneus brevis tenodesis was performed when tendon repair was impossible due to total rupture or multiple longitudinal rupture. RESULTS: Twenty patients not included in this study were as follows: insufficient follow-up, previous surgery, and additional bone surgery. All 10 patients had a previous ankle sprain history, tenderness and swelling on the retromalleolar area. In the 10 patient population, there were five peroneus brevis tendon tears, three peroneus longus tendon tears, one peroneus longus and brevis tendon tear, and one peroneus brevis and superior peroneal retinaculum tear. In the 10 patients, six cases of peroneal brevis tendon repair and four cases of peroneal longus to brevis tenodesis were performed. The preoperative American Orthopaedic Foot and Ankle Society score was improved from a mean of 60.6 (standard deviation [SD], 8.64) to a mean of 90.2, postoperatively (SD, 4.4; p<0.012). The preoperative visual analogue scale was improved from a mean of 5.43 (SD, 1.2) to 0.5 (SD, 0.16), postoperatively (p<0.023). The mean length of time to return to play was 12.2 weeks (range, 8~16 weeks). CONCLUSION: Peroneal tendon tear can occur due to sports injuries. If there is tenderness at the retromalleolar area, the surgeon should consider a peroneal tendon lesion. Surgical repair of the peroneal tendon can be an effective treatment to help athletes to return to play.
Ankle ; Ankle Injuries ; Athletes ; Athletic Injuries ; Chronic Pain ; Follow-Up Studies ; Foot ; Humans ; Return to Sport ; Rupture ; Sports ; Tears ; Tendon Injuries ; Tendons ; Tenodesis

Diabetic calcaneal insufficiency avulsion (CIA) fracture are unusual injury. The treatment may be challenging due to the low healing potential from diabetes or Charcot neuroarthropathy, so far. The poor surgical outcomes and surgical failures from treatment of the traumatic calcaneal avulsion fractures were associated with poor bone stock, lack of proper fixation, and the wound problem. Thus, the proper treatment for diabetic CIA fracture was still controversy. This report described two cases of diabetic CIA fracture treated with fixation of fracture fragment and calcaneal tenodesis. In both cases, fracture fragments were re-avulsed despite of fixation. Through investigation for the fate of fracture fragment from these cases, we discussed the proper treatment strategy in diabetic CIA fracture.
Tenodesis ; Wounds and Injuries

BACKGROUND: The purpose of this study was to compare the clinical outcome in patients aged less than 55 years who underwent arthroscopic tenodesis and arthroscopic repair for type 2 superior labrum anterior and posterior (SLAP) lesions. METHODS: Between April 2008 and December 2014, surgery was performed on a total of 45 patients with isolated type 2 SLAP lesions. Arthroscopic repair was performed in 22 patients and arthroscopic tenodesis was performed in 23 patients. In both groups, the clinical outcomes at follow-ups were evaluated using the University of California at Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and visual analogue scale (VAS) score. RESULTS: In both groups, the VAS scores for pain had improved significantly throughout the postoperative follow-up period. The VAS score showed a statistically significant difference at postoperative 3 and 6 months (p<0.05); however, there was no statistically significant difference between preoperative and postoperative results at 12 months (p>0.05). In both groups, the functional outcome was statistically improved postoperatively. In a comparison of the UCLA and ASES scores between the two groups, there was a statistically significant difference at postoperative 3 and 6 months (p<0.05), but there was no statistically significant difference between preoperative and postoperative results at 12 months (p>0.05). CONCLUSIONS: Based on the results of this and other studies, patients with isolated type 2 SLAP lesions showed better short-term clinical outcome with tenodesis than with repair. However, there was no difference between the two groups at the final follow-up.
California ; Elbow ; Follow-Up Studies ; Humans ; Shoulder ; Surgeons ; Tenodesis*

The pathophysiology of impingement syndrome and labral tear was variable and not clear. In general populations, lesions occur mainly in acute cases. But in athletes, lesions are caused by repetitive exposure to excessive force, resulting in different patterns. For diagnosis, thorough physical examinations and radiologic findings should be combined. In athletes, conservative treatment including posterior capsular stretching and periscapular muscle strengthening is recommended as the first choice of treatment considering chronic progression and adaptive change. When choosing surgical treatment because of failure of conservative treatment, careful attention should be paid to the choice of repair or debridement of the rotator cuff partial tear, and the choice of the labral repair or biceps tenodesis.
Athletes* ; Debridement ; Diagnosis* ; Humans ; Physical Examination ; Rotator Cuff ; Shoulder Impingement Syndrome ; Tears* ; Tenodesis

BACKGROUND: The purpose of this study was to compare the clinical outcome in patients aged less than 55 years who underwent arthroscopic tenodesis and arthroscopic repair for type 2 superior labrum anterior and posterior (SLAP) lesions. METHODS: Between April 2008 and December 2014, surgery was performed on a total of 45 patients with isolated type 2 SLAP lesions. Arthroscopic repair was performed in 22 patients and arthroscopic tenodesis was performed in 23 patients. In both groups, the clinical outcomes at follow-ups were evaluated using the University of California at Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and visual analogue scale (VAS) score. RESULTS: In both groups, the VAS scores for pain had improved significantly throughout the postoperative follow-up period. The VAS score showed a statistically significant difference at postoperative 3 and 6 months (p<0.05); however, there was no statistically significant difference between preoperative and postoperative results at 12 months (p>0.05). In both groups, the functional outcome was statistically improved postoperatively. In a comparison of the UCLA and ASES scores between the two groups, there was a statistically significant difference at postoperative 3 and 6 months (p<0.05), but there was no statistically significant difference between preoperative and postoperative results at 12 months (p>0.05). CONCLUSIONS: Based on the results of this and other studies, patients with isolated type 2 SLAP lesions showed better short-term clinical outcome with tenodesis than with repair. However, there was no difference between the two groups at the final follow-up.
California ; Elbow ; Follow-Up Studies ; Humans ; Shoulder ; Surgeons ; Tenodesis

Stiffness and pain are major causes of failed superior labral anterior to posterior (SLAP) repair. The term, ‘failed SLAP repair’, can be defined as stiffness or pain without rotator cuff tears, acromio-clavicular pathology, arthritis, impingement syndrome, and other shoulder diseases. Moreover, it does not respond to conservative management. Generally, for failed SLAP repair, the initial conservative management includes physical therapy, strengthening exercise, oral medications, and injections. In addition, with failed conservative treatment, surgical intervention can be carried out. Surgical indications must be in consideration with patients' age, mechanism of injury, stability of the lesion, activity, former history of sports activity, and types of sports. Surgical treatments include debridement, SLAP repair, biceps tenodesis and tenotomy. However, each type of surgical method is controversial on both indications and prognosis. Surgical treatment on SLAP lesion is increasing, and studies on failed SLAP repair are expanding. The recommended first line therapy for failed SLAP lesion is conservative management, and with limited and thorough indications, surgical treatment yields good results, depending on concurrent lesions. However, authors recommend that it is important to seek for adjacent lesions prior to the initial SLAP repair to decrease failed SLAP repair.
Arthritis ; Debridement ; Methods ; Pathology ; Problem Solving* ; Prognosis ; Rotator Cuff ; Shoulder ; Sports ; Tears ; Tenodesis ; Tenotomy

PURPOSE: The purpose of this study is to review the indications of ankle lateral complex reconstruction using tendon graft. MATERIALS AND METHODS: We searched PubMed using the index, "ankle, instability, lateral ligament, reconstruction" from 1990 to present (September 30, 2015). We excluded 1) modified Brostrom operation (MBO), 2) conventional tenodesis surgery, 3) review article, 4) technical note, and 5) articles written in another foreign language. We reviewed 24 papers through the publication events, operational method, the indications of surgery, and the specific features of the patient group. RESULTS: There were the indications of 1) previous ligament surgery failure, 2) situation when ligament repair is impossible due to the ligament defect, 3) severe instability (preoperative talar tilt >15degrees, anterior draw >10 mm or the difference of contralateral side talar tilt >5degrees, anterior draw >3 mm), and 4) overweight (body mass index >30 kg/m2). Other considerations included 1) generalized joint laxity and 2) workers, highly-demanded or athlete highly-affected by instability. CONCLUSION: The ankle lateral complex reconstruction using tendon graft could be indicated in patients with the possibility of MBO failure with several considerations.
Ankle* ; Athletes ; Collateral Ligaments ; Humans ; Joint Instability ; Lateral Ligament, Ankle* ; Ligaments ; Overweight ; Publications ; Tendons* ; Tenodesis ; Transplants*