Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2023; 14(11): 813-826
Published online Nov 18, 2023. doi: 10.5312/wjo.v14.i11.813
Long head of biceps tendon transposition for massive and irreparable rotator cuff tears: A systematic review and meta-analysis
Ren-Wen Wan, Zhi-Wen Luo, Yi-Meng Yang, Han-Li Zhang, Jia-Ni Chen, Shi-Yi Chen, Xi-Liang Shang
Ren-Wen Wan, Zhi-Wen Luo, Yi-Meng Yang, Han-Li Zhang, Jia-Ni Chen, Shi-Yi Chen, Xi-Liang Shang, Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
Co-corresponding authors: Shi-Yi Chen and Xi-Liang Shang.
Author contributions: Wan RW and Luo ZW contributed equally to this study; Wan RW, Chen SY, and Shang XL participated in the study design, data analysis, and drafting of the critically revised the manuscript; Wan RW and Luo ZW were responsible for selecting articles for inclusion, and conducted the risk of bias assessment, and data extraction; Yang YM, Zhang HL, and Chen JN helped to revise the manuscript; Chen SY and Shang XL made invaluable contributions to conceptualizing the study and providing meticulous final review; All authors read and approved the manuscript.
Supported by the National Natural Science Foundation of China, No. 81972125 and No. 82172510.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xi-Liang Shang, MD, PhD, Chief Doctor, Doctor, Department of Sports Medicine, Huashan Hospital, Fudan University, No. 12 Urumqi Middle Road, Shanghai 200040, China. sxl00720@163.com
Received: August 16, 2023
Peer-review started: August 16, 2023
First decision: September 19, 2023
Revised: September 21, 2023
Accepted: October 16, 2023
Article in press: October 16, 2023
Published online: November 18, 2023
Abstract
BACKGROUND

Superior capsular reconstruction (SCR) with long head of biceps tendon (LHBT) transposition was developed to massive and irreparable rotator cuff tears (MIRCTs); however, the outcomes of this technique remain unclear.

AIM

To perform a systematic review of biomechanical outcomes and a meta-analysis of clinical outcomes after LHBT transposition for MIRCTs.

METHODS

We performed a systematic electronic database search on PubMed, EMBASE, and Cochrane Library. Studies of SCR with LHBT transposition were included according to the inclusion and exclusion criteria. Biomechanical studies were assessed for main results and conclusions. Included clinical studies were evaluated for quality of methodology. Data including study characteristics, cohort demographics, and outcomes were extracted. A meta-analysis was conducted of the clinical outcomes.

RESULTS

According to our inclusion and exclusion criteria, a total of six biomechanical studies were identified and reported an overall improvement in subacromial contact pressures and prevention of superior humeral migration without limiting range of motion (ROM) after LHBT transposition for MIRCTs. A total of five clinical studies were included in the meta-analysis of LHBT transposition outcomes, consisting of 253 patients. The results indicated that compared to other surgical methods for MIRCTs, LHBT transposition had advantages of more significant improvement in ROM (forward flexion mean difference [MD] = 6.54, 95% confidence interval [CI]: 3.07-10.01; external rotation [MD = 5.15, 95%CI: 1.59-8.17]; the acromiohumeral distance [AHD] [MD = 0.90, 95%CI: 0.21-1.59]) and reducing retear rate (odds ratio = 0.27, 95%CI: 0.15-0.48). No significant difference in American Shoulder and Elbow Surgeons score, visual analogue scale score, and University of California at Los Angles score was demonstrated between these two groups for MIRCTs.

CONCLUSION

In general, SCR with LHBT transposition was a reliable and economical technique for treating MIRCTs, both in terms of biomechanical and clinical outcomes, with comparable clinical outcomes, improved ROM, AHD, and reduced the retear rates compared to conventional SCR and other established techniques. More high-quality randomized controlled studies on the long-term outcomes of SCR with LHBT transposition are required to further assess.

Keywords: Massive and irreparable rotator cuff tears, Long head of biceps tendon transposition, Rotator cuff repair, Superior capsular reconstruction

Core Tip: Superior capsular reconstruction (SCR) with long head of biceps tendon (LHBT) transposition was developed to massive and irreparable rotator cuff tears (MIRCTs). However, the outcomes of this technique remain unclear. SCR with LHBT transposition is a reliable and economical technique for treating MIRCTs, both in terms of biomechanical and clinical outcomes, with comparable clinical outcomes, improved range of motion, acromiohumeral distance, and reduced the retear rates compared to conventional SCR and other established techniques.