Comparativa de los resultados clínicos y biomecánicos del tratamiento de la patología de la porción larga del bíceps braquial: tenotomía o tenodesis

Based on the results provided by a recent systematic review, biomechanical differences can not be concluded in the functional results after acting on the long portion of the biceps (LHBT) using tenotomy or tenodesis techniques. Both techniques are used interchangeably by arthroscopic surgeons according to their personal preferences and training. Both are accepted techniques, with their pros and cons, but with good functional results. This doctoral thesis focuses on biomechanical results after this type of intervention. There are multiple studies that discuss the loss of point strength after one or another action on the LHBT. In the present study, the study of fatigue (arm claudication time) as the main parameter has been considered more interesting. It is a clinical trial, with the acceptance of the corresponding ethics committees, randomized, controlled and simple blinded by an external examiner. The main parameter of the study is established as the time in seconds until claudication of the biceps when it performs an isometric contraction maintained with the elbow at 90º of flexion, maintaining the contraction at 33% of the Maximum Voluntary Contraction (CVM), measured in Newtons , previously collected. This biomechanical study was performed in the preoperative of the selected patients, and at three, six and twelve months after the surgical intervention. Within the biomechanical study, in addition to fatigue time, the force of contraction in flexion, the supination force before and after the biceps fatigue test has been measured. In addition to the biomechanical study, clinical parameters and functionality of the operated arm have been studied.Conclusions about biomechanics: Fatigue time to claudication of the biceps is less in patients who underwent TBI tenotomy twelve months after surgery. Patients who have undergone PTL tenotomy are fatigued before those in whom tenodesis has been performed. The time of fatigue at twelve months improves (increases) with respect to the preoperative period in patients undergoing surgery through tenodesis, while it worsens (decreases) in those undergoing surgery by means of tenotomy. The force of isometric contraction of the elbow increases gradually after the surgical intervention, surpassing the preoperative values ​​from the sixth month, both in the patients who underwent tenotomy of the long biceps portion as well as in those who underwent tenodesis, but without differences between both groups. . This is true both in the study at rest and after the performance of the fatigue test. The supination force of the forearm is modified after the intervention on the long portion of the biceps. Twelve months after the intervention, there is a better supination function after fatigue in the arm operated by tenodesis than in which the tenotomy has been performed. Conclusions about the clinical parameters:Both treatment groups, tenotomy and tenodesis, improve clinically after the intervention, both in the pain parameters, as well as in the functional assessment scales of Constant, SSI and UCLA, without differences between the groups. There is high satisfaction on the part of the patients after the intervention, without differences between the groups. There are no differences between the groups in the presence of residual pain in the slide or in the muscular cramps of the biceps after the interventions. There are also no differences between complications or reinterventions between the groups. Conclusions related to the aesthetic deformity: The presence of biceps aesthetic deformity (Popeye's sign) is greater in the tenotomy group (56.5%) than in the tenodesis group (13.3%). Only 27% of the patients with aesthetic deformity had noticed their presence. The routine measurement of the distance between the apex of the biceps (point of greatest volume) to the olecranon when the arm is in 90º of abduction and 90º of flexion is useful to objectify the presence of aesthetic deformity. The presence of the deformity can be affirmed if the difference of this value with respect to the healthy arm is greater than 1.5 cm.