The instability of the LHB tendon was observed in 74 of 126 patients (58.7%). Amongst type Ⅰand Ⅱ lesions, instability of the LHB tendon existed in 46

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1 Instability of the Long Head of the Biceps (LHB) Tendon: A New Classification System for LHB Pulley Lesions Qian Zhang 1,Wei-ming Wang 1,Yu-peng Liu 1,Xiao-jun Ma 1,Chun-hui Li 1,Cheng-ye Li 2, Xian-tao Meng 1 1. Affiliated Zhongshan Hospital of Dalian University,China;2. Graduate School of ZunYi Medical College,China; More and more physicians have begun to pay close attention to pulley lesions because instability of the LHB tendon is one of the main reasons for shoulder pain. Thus far, classification of LHB tendon pulley lesions is ambiguous. The purpose of this study was to better understand the type of LHB tendon dislocations based on arthroscopic findings, develop a new classification system for LHB pulley lesions, and discuss the appropriate treatment method for different LHB pulley lesions. The hypothesis of this study was that, in a consecutive series of patients with LHB pulley lesions, we might find the new types of LHB pulley lesions. Between January 2010 and December 2014, a total of 232 patients with shoulder pain underwent arthroscopic rotator cuff repair by one surgeon. There were 126 patients evaluated for the purpose of this study. The other 106 patients without pulley lesions or follow-up were excluded. Among the 126 patients (72 women and 54 men) who received follow-up care, the mean age was 43.6 years (range, years). All of the patients underwent magnetic resonance imaging and a physical examination preoperatively. The patients were evaluated using a visual analogue scale the American Society of Shoulder and Elbow Surgeons, and the University of California Los Angeles scores pre- and postoperatively. The study group had a minimum of 12 months of follow-up care. Patients were evaluated with the scoring systems at 3, 6, 12, and 24 months. All of the patients underwent arthroscopic shoulder surgery performed by the same surgeon. The first step is to perform standard arthroscopy, visualize the internal shoulder structures, especially the LHB tendon and tendon sheath damage. The second step was to detect the stability of the LHB tendon. Finally, based on the lesions of the biceps tendon and the tendon sheath, a specific operative method was selected, as follows: debridement; tenotomy; or tenodesis in the nodules between the groove. A tenotomy is the preferred procedure for patients > 65 years of age and with low functional requirements. If the LHB tendon is unstable, tenodesis and tenotomy are preferred procedures. Tenodesis is the preferred procedure for patients < 65 years of age or with high functional requirements. If the tendon sheath has lesions, but the LHB tendon is stable, debridement is the preferred procedure. All types of damage and the number of cases with various types of damage were evaluated. The VAS ASES, and UCLA scores were collected and analyzed pre- and postoperatively. The scores were analyzed with t-tests ( P 0.05). On the basis of the classification of pulley lesions according to Habermeyer, the LHB pulley lesions included the IV types. In addition, we identified two new types of LHB pulley lesions that defined as types Ⅴ and Ⅵ. Type Ⅴ lesions are isolated lesions of the lateral sheath of the LHB pulley. Type Ⅵ lesions are characterized by bucket handle tears of the LHB pulley sheath. This study included the following distribution of lesions: type I, 15 (11.9%); Ⅱ, 18 (14.3%); Ⅲ, 28 (22.2%); Ⅳ, 33 (26.2%); Ⅴ, 26 (20.6%); and Ⅵ, 6 (4.8%). 1

Graduate School of ZunYi Medical College,China; More and more physicians have begun to pay close attention to pulley lesions because instability of the LHB tendon is one of the main reasons for

2 The instability of the LHB tendon was observed in 74 of 126 patients (58.7%). Amongst type Ⅰand Ⅱ lesions, instability of the LHB tendon existed in 46.7% and 55.6% respectively. Combination of the medial sheath and the subscapularis (type Ⅲ) or this combination plus lesions of the lateral sheath of the LHB pulley (type Ⅳ) increased the percentage of instability to 64.3% and 75.8%. An isolated lesion of the lateral sheath of the LHB pulley (type Ⅴ) or bucket handle tears of the LHB pulley sheath (type Ⅵ) decreased to 46.2% and 33.3%. In the current study, 7 patients underwent arthroscopic debridement surgery, 17 patients tenotomy and 102 patients tenodesis according to the lesions of the biceps tendon and the tendon sheath. Of the 126 patients evaluated no one had Popeye signs and major complications. The follow-up ASES UCLA, and VAS scores had significant improvement compared with the preoperative score ( P 0.05). According to the anterosuperior impingement, Habermeyer presented four types of pulley lesions. Bennett reported a classification system of biceps pulley lesions based on anatomic structure injuries. On the basis of these observations, Lafosse created a new arthroscopic classification of LHB instability, taking into account the direction and extent of LHB instability, the grade of LHB lesions, and the type of rotator cuff lesions. According to clinical observation of LHB tendon injury during arthroscopy, this study put forward a new classification of LHB pulley lesions. The purpose of this classification is to guide clinical decisions, thus requiring the arthroscopic surgeon to choose the most suitable operative method. Based on observations, biceps tenotomy or tenodesis is suitable for patients with types I-IV lesions, and debridement is suitable for some patients with types Ⅴ and Ⅵ lesions. Debridement is not suitable for patients with LHB tendon dislocation or humerus head cartilage wear. We selected tenotomy or tenodesis according to patient age and functional requirements. For patients > 65 years and with lower movement requirements, the main purpose of treatment is to relieve pain, a tenotomy is sufficient; however, young patients had high demand for life function is also needed to be considered. With this mind, tenodesis is necessary. Regarding the position of the LHB tendon reconstruction, there are several choices, including the groove between the nodule, sub-pectoral biceps tenodesis, and even transfer of the LHB tendon to the conjoint tendon. This study mainly adopted tendonesis in the groove between the nodule and release of the transverse humeral ligament. In this study, types Ⅴand Ⅵ lesions were identified as two new types of LHB pulley lesions. This new classification of LHB instability is based on intra-operative observations during arthroscopy. The new classification may provide more useful information for the surgeon to choose the most suitable operation method. 2

3% and 75.8%. An isolated lesion of the lateral sheath of the LHB pulley (type Ⅴ) or bucket handle tears of the LHB pulley sheath (type Ⅵ) decreased to 46.2% and 33.3%. In the current study, 7 patients underwent arthroscopic debridement surgery, 17 patients tenotomy and 102 patients tenodesis according to the lesions of the biceps tendon and the tendon sheath.

3 关节镜下补片技术修复不可修复性肩袖撕裂丁少华李瑾郑敏哲丁伟宁波市医疗中心李惠利医院 ; 浙江省 ; 中国摘要背景 : 随着关节镜技术的发展, 巨大撕裂的修复技术亦得到了很大的扩充, 而补片作为不可修复性撕裂的修复手段, 已得到逐步完善我们评估了对巨大不可修复肩袖撕裂患者使用镜下补片技术修复的初期效果材料 : 从 2015 年 1-12 月, 我科对 5 例患者进行补片修复包括 1 例桥接 2 例加强以及 2 例上关节囊重建技术方法 : 桥接技术 : 将补片内侧缘与肩袖残端边 - 边缝合, 在大结节足印区将补片以 Speed bridge 方式进行缝合修复加强技术 : 将肩袖止点内移 0.5-1cm, 单排修复回缩肩袖, 然后将补片以叠瓦形式覆于肩袖上方, 内侧与肩袖预留缝线打结, 外侧行 Speed bridge 方式修复上关节囊重建技术 : 以 2 枚 4.5mm Corkscrew 铆钉置于关节盂上方, 补片内侧与关节盂相连, 外侧以 Speed bridge 术式缝合在大结节足印区结果 : 术后 ASES 平均 83.7 分,UCLA 平均 30.5,Constant 评分平均所有 5 例患者均对结果满意讨论 : 桥接加强技术患者术后 MRI 提示补片愈合良好, 上关节囊重建技术术后 MRI 提示补片存在,AHD 增加但由于随访时间尚短, 需更长时间的随访以进行验证后期补片结果结论 : 补片技术能有效解决不可修复性肩袖撕裂的问题, 缓解患者疼痛恢复肩关节功能

缘与肩袖残端边 - 边缝合, 在大结节足印区将补片以 Speed bridge 方式进行缝合修复加强技术 : 将肩袖止点内移 0.

4 三维仿生支架促进肩袖修复的研究郑泽峰 1 1, 2,, 沈炜亮 *, 戴雪松 1, 欧阳宏伟 2, ** 1 浙江大学医学院附属第二医院, 中国 2 浙江大学李达三叶耀珍干细胞与再生医学研究中心, 中国 * 通讯作者 ; ** 共同通讯作者背景 : 大块的肩袖损伤常常导致肩部的疼痛及功能受限目前临床上常用的修复材料包括异体肌腱和脱细胞支架然而, 这些材料容易引起排斥反应, 且支架内孔径较小, 不利于细胞进入, 难以再生新的肌腱组织该研究模仿正常肌腱的平行纤维, 制备出合适孔径的三维仿生胶原 / 蚕丝支架, 并探究其用于肩袖大块缺损的可行性材料与方法 : 应用单向冰冻技术制备出不同孔径的三维生胶原 / 蚕丝支架通过皮下异位移植, 确定合适孔径大小的胶原浓度 ; 通过体外种植肌腱干细胞, 观察不同拓扑结构胶原 / 蚕丝支架对种植细胞的形态和排列的影响 ; 通过兔子肩袖损伤模型, 观察其对肩袖损伤修复的促进作用结果与讨论 : 三维仿生胶原 / 蚕丝支架有着与正常肌腱类似的平行胶原结构低胶原浓度 (6mg/ml) 制成的支架难以维持正常的三维立体结构, 容易坍塌, 导致细胞无法进入致密的坍塌部位 ; 高胶原浓度 (18mg/ml) 制成的支架孔隙太小, 妨碍了修复细胞的长入 ; 中等胶原浓度 (10mg/ml) 能够制备出合适孔径, 且能维持立体结构的胶原 / 蚕丝支架种植在三维仿生胶原支架上的肌腱干细胞表现出肌腱样细胞的纺锤形, 同时沿胶原纤维呈平行排列,7 天后形成有平行结构的致密细胞片而在三维紊乱胶原支架上, 干细胞显示出无规律的多形性, 且无序分布体内兔肩袖损伤修复研究中, 合适孔径 (10mg/ml) 的三维仿生支架较紊乱支架表现出更强的促肩袖修复的能力术后 4 周, 三维仿生支架组拥有更有序和成熟的胶原结构术后 12 周, 三维仿生支架组拥有更强的力学性能结论 : 合适孔径的三维仿生胶原 / 蚕丝支架能够促进损伤肌腱的再生, 可用于大块肩袖损伤的组织工程修复

出合适孔径的三维仿生胶原 / 蚕丝支架, 并探究其用于肩袖大块缺损的可行性材料与方法 : 应用单向冰冻技术制备出不同孔径的三维生胶原 / 蚕丝支架通过皮下异位移植, 确定合适孔径大小的胶原浓度 ; 通过体外种植肌腱干细胞,

5 肩袖损伤合并肩锁关节炎行关节镜下肩袖修补伴或不伴锁骨切除疗效对比葛恒安, 程飚上海市第十人民医院骨科, 延长中路 301 号, 闸北区, 上海市, 中国 Tel: 摘要目的 : 肩袖撕裂伴有症状性的肩锁关节炎的治疗仍存争论本文目的为比较行关节镜下肩袖修补 (RCR) 伴或不伴远端锁骨切除 (DCR) 的疗效方法 : 从 2010 年 10 月至 2014 年 12 月期间, 共有 63 位患者被纳入本研究其中 RCR+DCR 组有 30 位, 仅行 RCR 组有 33 位术后 3,6,12 月分别进行随访并评价治疗效果通过 American Shoulder and Elbow Surgeons (ASES) 评分, Constant 评分, 活动度 (ROM), 以及 VAS 评分进行肩关节功能评价结果 : 两组患者在年龄, 性别上无统计学差异 RCR+DCR 组的随访时间为 13.3±7.6 月,RCR 组的随访时间为 14.2±6.9 月两组术前在症状, 肩袖撕裂大小, 以及术前的功能评分对比无统计学差异在随访过程中, 我们发现两组的功能性评分相对于术前均有明显提升 (P < 0.001) 两组在功能性评分中未发现明显统计学差异 (P>0.05) 结论 :RCR 同时进行 DCR 术对于肩袖损伤伴有肩锁关节炎症的治疗效果并无提升但仍需更大样本量的 RCT 进行进一步验证

随访并评价治疗效果通过 American Shoulder and Elbow Surgeons (ASES) 评分, Constant 评分, 活动度 (ROM), 以及 VAS 评分进行肩关节功能评价结果 : 两组患者在年龄, 性别上无统计学差异 RCR+DCR 组的随访时间为 13.3±7.

6 肩袖损伤序贯治疗的初步评价张亦军吕秉仑庄建姜文晓山东大学齐鲁医院 ( 青岛 ) 青岛市市北区合肥路 758 号邮编 : 摘要 : 目的 : 分析肩袖损伤冲击波治疗康复训练等保守治疗方法和关节镜下修复的疗效, 进行对比分析, 探讨肩袖损伤规范化的序贯治疗体系, 并进行初步评价方法 : 自 2013 年 3 月至 2015 年 3 月间,46 例肩袖损伤病人, 根据核磁共振及超声检查, 肩袖损伤小于 3cm 的病人, 随机给予关节镜下肩袖缝合或保守治疗镜下修复组 21 例, 行肩峰下滑囊清除肩峰成型单排或双排缝合 ; 保守治疗组 17 例, 给予冲击波治疗康复训练疼痛较重者给予非甾体类消炎镇痛药 ; 保守治疗失败行镜下修复者 8 例随访时间一年术前术后采用 UCLA 评分进行评价, 评分结果进行统计学分析结果 : 全部病人均获随访一期镜下修复组 UCLA 评分从术前的 (13.2±2.1) 分增至术后 (32.5±2.0) 分, 有统计学差异保守治疗组 UCLA 评分治疗前 (14.2±1.9), 治疗后 (29.5±2.3), 有统计学差异保守治疗失败二次手术组从术前的 (14.0±2.4) 分增至术后 (30.2±2.2) 分, 有统计学差异一期镜下修复疗效优于保守治疗及保守治疗失败二期手术组, 但差异不大结论 : 关节镜下肩袖修复损伤小, 临床效果令人满意, 但保守治疗在大部分病人亦可以获得较好的疗效肩袖损伤的治疗在严格掌握适应症的前提下应采用序贯治疗的规范治疗体系

下滑囊清除肩峰成型单排或双排缝合 ; 保守治疗组 17 例, 给予冲击波治疗康复训练疼痛较重者给予非甾体类消炎镇痛药 ; 保守治疗失败行镜下修复者 8 例随访时间一年术前术后采用 UCLA 评分进行评价, 评分结果进行统计学分析结

7 关节镜下治疗肩胛下肌钙化性肌腱炎王珂杰, 丁文鸽, 严伟洪, 李欢, 刘锦波江苏省常州市第一人民医院骨二科成人重建与运动医学组目的 : 肩袖钙化性肌腱炎是指肩袖内的钙化物沉积引起肩关节疼痛及活动受限等症状的临床病症, 据报道其发病率在 2.7% 至 22%, 发病年龄多为 30~50 岁, 女性多见肩袖钙化性肌腱炎以累及冈上肌为多见, 极少见于肩胛下肌, 其典型的临床症状表现为肩部剧烈疼痛, 肩关节活动受限, 其病程大多具有自限性, 大多数的患者通过保守治疗症状即可达到明显缓解然而当保守治疗效果不佳而患者临床症状较重影响其日常生活时, 手术治疗尤其是关节镜下手术治疗是一种切实可行的治疗方案目前大多数文献报道都仅涉及岗上肌腱钙化的关节镜下治疗, 作者在本文中将探讨全关节镜下治疗的肩胛下肌腱钙化性肌腱炎方法 : 从 2013 年 12 月至 2015 年 11 月, 常州市第一人民医院骨二科成人重建与运动医学组收治肩胛下肌钙化性肌腱炎患者 2 例, 均为女性, 左右肩各一例一例术前病程一月, 另一例两周两例患者均有肩关节疼痛伴活动受限病史, 均有夜间痛术前均行患侧肩关节 X 线及 MRI 检查, 两例患者均行关节镜下钙化灶清理术以及肩峰成型术, 术后均通过 X 线及 CT 检查证实钙化灶已去除两例患者分别在术前和末次随访时采用 UCLA 肩关节评分标准进行评价结果 : 两例患者一例随访 24 个月, 一例随访 16 个月, 术前 UCLA 评分为 11 分及 13 分, 术后最后一次随访分别为 32 分级 33 分两例患者均对手术效果满意结论 : 钙化性肌腱炎是引起肩关节疼痛及活动受限的常见原因, 也是导致肩峰撞击综合征或者肩袖损伤的常见诱因之一, 尤多见于岗上肌腱其病因至今任然有争议, 肩胛下肌腱钙化性肌腱炎在文献中的报道并不多, 可能和现阶段临床医生对其认识还不够深入有关其诊断是在临床症状的基础上结合肩关节 X 线及磁共振做出的, 其治疗方法大致可以分为两类, 即保守治疗及手术治疗本文报道了 2 例并不常见的肩胛下肌腱钙化性肌腱炎的全关节镜下手术治疗,2 例患者均取得了较好的临床效果, 对探索关节镜下治疗肩关节钙化性肌腱炎有一定借鉴作用结论 : 关节镜下治疗肩胛下肌钙化性肌腱炎创伤小, 临床效果优良

7% 至 22%, 发病年龄多为 30~50 岁, 女性多见肩袖钙化性肌腱炎以累及冈上肌为多见, 极少见于肩胛下肌, 其典型的临床症状表现为肩部剧烈疼痛, 肩关节活动受限, 其病程大多具有自限性, 大多数的患者通过保守治疗症状即可达到明

8 Arthroscopic treatment for acute calcific tendinitis of rotator cuff Su Xuntong, Wu Guiqin, Cai Daozhang, Zhao Chang Department of Orthopaedics, The 3rd Affiliated Hospital of Southern Medical University, China Background: To explore the clinical effect of arthroscopic treatment for acute calcific tendinitis of rotator cuff. Material: 13 patients with acute calcific tendinitis of rotator cuff were included from January 2011 to December Methods: They were diagnosed by symptoms, X-ray and MRI. The surgery was performed under total anesthesia, with lateral position. We diagnosed calcific tendinitis by finding toothpaste-like and white viscous substance. If the calcific focus was less than 0.5cm, we just cleared out the focus, which did not affect the integrity of rotator cuff. If the calcific focus was more than 1.5cm or more than half of the thickness, we would expansively clear out the focus, including incising peripheral degenerative hard tissues, and repair the rotator cuff with single row or double rows rivets. After surgery, patients received individual rehabilitation training. Results: In the follow-up of 3 to 12 months, pain disappeared in all patients after surgery and UCLA score was significant difference (P<0.05) between before surgery (12.5±2.5) and after surgery (35.2±4.0). Review X-ray films shown all the deposit in pathological focus was cleared out after surgery, and no patient happened stiffness of shoulder joint, rotator cuff tear or new calcific focus. Discussion: The key points of the surgery were total clearing out the pathological focus, and repair the rotator cuff at the same time if necessary. Conclusion: Because of small trauma, little bleeding and fast recovery, arthroscopic treatment for acute calcific tendinitis of rotator cuff is an ideal method, and it worthies spreading widely.

Material: 13 patients with acute calcific tendinitis of rotator cuff were included from January 2011 to December 2014. Methods: They were diagnosed by symptoms, X-ray and MRI.

9 关节镜下治疗肩袖损伤中肱二头肌长头腱的处理策略陈志军施培华陈剑蔡宏歆黄悦浙江大学医学院附属邵逸夫医院目的 : 分析肩袖损伤中肱二头肌长头腱的病变分型, 探讨肩袖损伤合并肱二头肌长头腱病变的临床处理策略方法 : 分析 2010 年 1 月至 2014 年 1 月接受手术治疗且随访超过 12 个月的 120 例肩袖损伤患者的临床资料, 其中男 50 例, 女 70 例 ; 年龄 (55±8.0) 岁所有患者均在关节镜下应用缝合锚钉双排重建技术对损伤肩袖进行修复, 同时探查肱二头肌长头腱的病变情况肱二头肌长头腱病变分为五种类型,I 型为肱二头肌长头腱肌腱炎,II 型为长头腱半脱位,III 型为长头腱完全脱位,IV 型为长头腱部分撕裂,V 型为长头腱完全撕裂对于 I 型, 保留肱二头肌长头腱, 对肱二头肌长头腱进行关节腔内清理对于 Ⅱ III IV 及 V 型, 根据患者年龄及要求进行关节镜下肱二头肌长头腱切断或切断固定所有患者术前行肩关节磁共振检测评估肩袖损伤大小, 并对患者术前及术后进行疼痛 VAS 评分肩关节 ASES 评分及 Constan 评分分析肩袖损伤中肱二头肌长头腱病变的发生率及与肩袖损伤大小发病时间及临床症状的相关性分析不同处理肱二头肌长头腱的临床手术疗效结果 :120 例患者均行关节镜下手术, 术后平均随访 16 个月 (12~24 个月 ) 120 例患者中伴有肱二头肌长头腱病变共 80 例, 其中 I 型共 42 例,Ⅱ III IV 及 V 型共 38 例 38 例患者, 有 28 例行长头腱切断固定术,10 例行单纯长头腱切断术肩袖巨大撕裂 ( 撕裂 >5cm 或证实损伤累及至少 2 条肌腱 ) 患者共 22 例, 存在肱二头肌长头腱病变共 19 例对肩袖巨大撕裂的 22 例患者单独分析发现, 伴有肱二头肌长头腱病变的 VAS 评分明显高于不伴肱二头肌长头腱病变者, 但肩关节 ASES 评分及 Constant 评分并无显著性差异在疼痛评分肩关节 ASES 及 Constant 评分术前及术后末次随访时差异均有统计学意义 (P<0.01) 结论 : 肩袖损伤中肱二头肌腱病变的发生率与肩袖损伤的大小及发病时间正相关, 是引起肩关节疼痛的重要原因关节镜下治疗肩袖损伤中, 根据肱二头肌腱病变分型处理肱二头肌长头腱, 可获得满意的临床疗效

0) 岁所有患者均在关节镜下应用缝合锚钉双排重建技术对损伤肩袖进行修复, 同时探查肱二头肌长头腱的病变情况肱二头肌长头腱病变分为五种类型,I 型为肱二头肌长头腱肌腱炎,II 型为长头腱半脱位,III 型为长头腱完全脱位,IV

10 Tenodesis by Single-Anchor and Double-Catch Technique for Lesions of the Long Head of the Biceps Yu-shun Fang 1, Qing-song Zhang 2 Department of Sports Medicine, Puai Hospital Affiliated to Huazhong University of Science and Technology, CHINA Backgrounsd The long head of biceps originates around the supraglenoid tubercle. Functionally, proximal biceps has a weak active inhibition against the upward movement of head of humerus, and distal biceps has a synergistic effect on the elbow flexion and on the forearm rotation. Lesions of the long head of the biceps brachii can be a significant source of pain in the shoulder. The lesions may vary from degeneration to mechanical irritation, inflammation, or trauma- or sports-related lesions. Thus, a proper treatment on the diseased or injured biceps tendon is the key to improve symptoms and recovery the function of shoulder. Material There are 39 patients with lesions of biceps tendon who were selected from January 2012 to March Including 22 males and 17females, age range 39~63 years (mean51.8 years). All of them often complain of an ache in the anterior shoulder, which may worsen when repetitive overhead arm motion. We could found bicipital groove point tenderness. Yergason test, Speed test and DeAnquin test may help diagnosis. Method The Patient is placed in the lateral decubitus position in a deflated beanbag. Balanced suspension is used to position the arm in approximately 60 of abduction and 15 of extension. The operation was started by inserting the arthroscope into the glenohumeral joint through the posterior portal. And the long head of biceps which injured was cut off from the supraglenoid tubercle. Then, the arthroscope was placed into subacromial space, and the biceps was separated from intertubercular sulcus. We could implanted dual threaded suture anchor into distal intertubercular sulcus by assistant anterior portal. The sutures of anchor were used to bind the tendon by double-catch technique. The proximal tendon could be removed after the tenodesis has completed. Postoperatively, the patient is placed in a neutral rotation sling for 4-6weeks. Passive motion is initiated immediately. Active range of motion is begun at 4 weeks. Progressive resistive exercise may be started at 7 to 8 weeks. With return to unrestricted activities anticipated at 6 months. Constant scores is used to evaluate the improvement of symptoms and functional. Results All cases were followed for 12 months. The ache in the anterior shoulder has be alleviate obviously. Yergason test, Speed test and DeAnquin test of all the patients are negative. No Popeye deformity was found postoperatively. And none of them complained elbow flexion weakness. The Constant scores was improved significantly. There is a statistically significant difference between preoperative and postoperative (P < 0.05). Discussion A variety of open and arthroscopic methods of tenodesis have been reported in the literature. And

Functionally, proximal biceps has a weak active inhibition against the upward movement of head of humerus, and distal biceps has a synergistic effect on the elbow flexion and on the forearm rotation.

11 the tenodesis techniques can generally be classified into soft tissue and bony fixation. Soft tissue fixation includes intra-articular and extra-articular transtendon techniques. Bony fixation techniques consist of osseous fixation using suture anchors or knotless anchors, intraosseous fixation using biointerference screws, and other techniques such as key-hole fixation. The single-anchor and double-catch technique use a dual threaded suture anchor. The anchor was implanted into distal intertubercular sulcus, which could ensure the tendon lesions be removed maximally. The dual threaded independently engages both cortical and cancellous bone, and provided a batter bone contact compared to common anchor. Tenodesis was performed by tow sutures of anchor. A double-catch technique would be applied in the process of tenodesis. A limb of a suture was crossed the tendon and formed a ring, and make the limb cross the ring. The other limb of the suture was around the back of tendon. Tow limb of the suture was tensioned and knotted together, which formed a catch of tendon. Another catch was performed same as above-mentioned. The technique could increase the contact of tendon and sutures, and make the fixation firmly. Conclusion It is worth promoting that the single-anchor and double-catch technique used in the tenodesis for lesions of biceps tendon, because of the advantages of strong fixation, little complication, less trauma.

The single-anchor and double-catch technique use a dual threaded suture anchor. The anchor was implanted into distal intertubercular sulcus, which could ensure the tendon lesions be removed maximally.

12 Arthroscopic Decompression of Suprascapular Nerve Entrapment by the direct Spinoglenoid Notch Portal Zhang Ying 1, Chen Guangxing 1, Yang Liu 1 1 Joint Surgery Center, Southwest Hospital, Third Military Medical University, Chongqing 40038, China P.R. BACKGROUND: Entrapment of the suprascapular nerve (SSN) by the spinoglenoid notch cyst (SGNC) specifically affects the infraspinatus, and isolated external rotation (ER) weakness can resulted. Arthroscopic decompression of the SGNC and nerve releasing can lead to resolution of a patient's symptoms and complete functional recovery. MATERIALS AND METHODS: We describe 6 shoulders, between , underwent arthroscopic decompression and excision of the SGNC with a SSN portal directly, which 2cm more medial to the regular Nevaiser portal. The mean age was 46 years, and the mean follow-up was 12 month. On manual muscle testing, ER strength was abnormal in all patients. Atrophy of the infraspinatus was visible in electromyogram (EMG). RESULTS: All patients experienced resolution of symptoms and achieved better ASES scores within 12 months of surgery, without any complications. DISCUSSION AND CONCLUSION: A SGNC is not necessary to produce SSN compression. But SSN compression at the SGN can present as a conjunction with rotator cuff pathology and a cyst. The direct SSN portal will be a helpful tool and easy procedure with the releasing in the arthroscopy process.

BACKGROUND: Entrapment of the suprascapular nerve (SSN) by the spinoglenoid notch cyst (SGNC) specifically affects the infraspinatus, and isolated external rotation (ER) weakness can resulted.

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