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
ARTICLE HIGHLIGHTS
Research background

Supracapsular reconstruction (SCR) combined with transposition of the biceps long head biceps tendon (LHBT) is an approach designed to meet the severe challenges posed by massive rotator cuff tears (MIRCT).

Research motivation

Although LHBT transposition has been adopted, its exact impact remains to be clearly elucidated.

Research objectives

There are gaps in our knowledge of the outcomes produced by this technique, and thus further research is needed to reveal its potential benefits and limitations.

Research methods

We conducted a methodical search of electronic databases to identify relevant literature based on inclusion and exclusion criteria. We first conducted a systematic review of the main findings and conclusions of the biomechanical studies. Subsequently, we conducted a comprehensive meta-analysis of the clinical outcomes of the included studies.

Research results

Biomechanical studies have reported that after performing LHBT transposition in MIRCT, there was a comprehensive improvement in subacromial contact pressure and a prevention of proximal humeral migration, without any resultant limitation in range of motion. The meta-analysis of LHBT transposition outcomes has encompassed five clinical studies demonstrated that, compared to other surgical methods for MIRCTs, LHBT transposition exhibited significant advantages in enhancing patients’ ROM (forward flexion, mean difference [MD] = 6.54, 95% confidence interval [CI]: 3.00-8.08, external rotation [MD = 5.15, 95%CI: 1.59-8.17], acromiohumeral distance [AHD] [MD = 0.90, 95%CI: 0.21 to 1.59], and reducing the risk of retear [odds ratio = 0.27, 95%CI: 0.15-0.48]). There were no discernible differences between the two groups of patients in terms of American Shoulder and Elbow Surgeons scores, visual analogue scale scores, and University of California, Los Angeles scores.

Research conclusions

In summary, the utilization of LHBT transposition in SCR proved to be a dependable and cost-effective approach for addressing MIRCTs. This technique demonstrated favorable results not only in terms of biomechanical factors but also in clinical outcomes. It exhibited comparable efficacy to conventional SCR and other established techniques, while presenting notable improvements in ROM, AHD, and a reduced incidence of retear. Nevertheless, it is essential to emphasize the necessity for additional high-quality randomized controlled trials focusing on the long-term effects of SCR with LHBT transposition to further evaluate its efficacy.

Research perspectives

Future high-quality research of SCR using LHBT transposition for MIRCTs is necessary.