“Tomydesis” might be a reliable technique for lesions of the long head of the biceps tendon associated with rotator cuff tears: a minimum 6-month prospective clinical follow-up study

Purpose

To compare the clinical outcomes of self-locking T-tenotomy called “tomydesis” to three different techniques of tenodesis for lesions of the long head of the biceps tendon (LHBT) associated with rotator cuff tears.

Hypothesis

Tomydesis could provide similar clinical outcomes than the other LHBT tenodesis techniques.

Methods

This prospective multicentre study included 77 patients who underwent rotator cuff repair concomitant with one of four surgical techniques on the LHBT. All patients had a minimum of 6-month follow-up post-operatively. Outcomes were evaluated based on the Constant score, SSV, pain on visual analogue scale, biceps-specific pain and Popeye deformity on photographs.

Results

There was no difference for the pain at the biceps muscle belly (p = 0.58), the bicipital groove (p = 0.69) and during resisted supination (p = 0.53), as well as for muscle cramps (p = 0.09), VAS for pain (p = 0.12) and Popeye deformity (p = 0.18). There was more pain in resisted flexion in the tomydesis group (p = 0.032), and significantly better Constant scores and SSV (< 0.001) in the patients who underwent the double lasso loop technique, but non-repairable cuff tears were most frequent in the tomydesis group.

Conclusions

Tomydesis might be a reliable alternative that combines advantages of tenodesis and tenotomy. It should be considered in cases of rotator cuff tears, whose repair and healing are the key for good functional outcomes.

Level of evidence

II.

     

The desire to utilize postmastectomy breast reconstruction in Saudi Arabian women: Predictors and barriers

Objectives:

To study factors that influence the desire to utilize breast reconstruction after mastectomy, and to investigate the barriers to reconstruction among women in Saudi Arabia.

Methods:

We conducted a cross-sectional study at 2 surgical centers in Jeddah, Saudi Arabia. A self-administered questionnaire was distributed to all breast cancer patients attending the surgery clinics for follow-up after mastectomy between January and March 2013. Ninety-one patients met the study inclusion criteria. The first part of the questionnaire covered the demographic and socioeconomic information regarding factors that might influence the desire to utilize breast reconstruction including possible barriers. Multivariate logistic regression was used to determine the significant predictors of the desire to undergo reconstruction.

Results:

Overall, 16.5% of patients underwent breast reconstruction after mastectomy. Young age and high educational attainment were significantly associated with an increased desire to undergo reconstruction. The main barriers to reconstruction were the lack of adequate information on the procedure (63%), concerns on the complications of the procedure (68%), and concerns on the reconstruction interfering with the detection of recurrence (54%).

Conclusion:

Age and educational level were significant predictors of the desire to utilize breast reconstruction. Furthermore, modifiable barriers included the lack of knowledge and misconceptions on the procedure. Addressing these issues may increase the rate of breast reconstruction in Saudi Arabia.Surgical resection (mastectomy) is considered the primary treatment for breast cancer. In the past decade, changing attitudes toward breast reconstruction among both patients and providers have led to an increasing number of women seeking breast reconstruction after mastectomy.1 In 2009, there were approximately 86,000 breast reconstruction procedures performed in the United States.2 There has been a significant rise in immediate reconstruction rates, attributable to a notable increase in implant use.3 Many types of breast reconstruction are available including silicone and silane implants, tissue expanders, and pedicle and free musculocutaneous flaps.4,5 Although these reconstruction options have been proven to be oncologically safe,5 and many women still refuse breast reconstruction.6 The choice to proceed with breast reconstruction after mastectomy is difficult, and is affected by many factors. Most breast reconstruction procedures are performed in women younger than 60 years of age.7 The decision to proceed with reconstruction can be influenced by patient factors, physician factors, cancer related factors, and insurance status.7-10 Patient factors include patient age, socioeconomic status, race, site of mastectomy, and patient preference.1 Of these factors, age >50 years is the most common negative predictor of breast reconstruction after mastectomy.8,9,11-13 According to the Saudi Cancer Registry,14 breast cancer has been the most common cancer among Saudi females over the past 12 years. In a recent study, Ibrahim et al15 estimated that the burden of breast cancer in Saudi Arabia will increase by approximately 350% by 2025. In a previously published study, almost half of the general surgeons surveyed reported that they had treated patients who refused breast reconstruction despite its availability.4 Previous studies on the factors influencing postmastectomy breast reconstruction in the Middle East were conducted in Egypt13,14 and we are not aware of any similar studies conducted in Saudi Arabia or the Gulf Region. The objectives of this exploratory study were to study the demographic and socioeconomic factors influencing the desire to utilize postmastectomy breast reconstruction and to evaluate the barriers to postmastectomy breast reconstruction among women in Saudi Arabia.