Avaliação funcional, isocinética e radiológica da reinserção do tendão do bíceps braquial por mecanismo de botão cortical ajustável
Data
2024
Autores
Ribas, Luiz Henrique Boraschi Vieira 
Orientadores
Belangero, Paulo Santoro
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: O tendão do bíceps braquial (TBB) é fundamental para a flexão do cotovelo e a supinação do antebraço, sendo particularmente suscetível a rupturas em indivíduos fisicamente ativos. O objetivo deste estudo foi avaliar a eficácia da reinserção do TBB utilizando o mecanismo de botão cortical ajustável (BC), com ênfase na recuperação funcional, força muscular e achados radiológicos. Métodos: Trata-se de um estudo de coorte retrospectivo com 10 homens (média de idade 44 ± 8 anos), submetidos à reinserção do TBB. Foram avaliadas a amplitude de movimento (ADM), força isocinética nas velocidades de 60º/s e 180º/s, testes funcionais (Upper Quarter Y Balance Test [YBT-UQ] e Teste de Potência de Arremesso para Membros Superiores [TPA-MMSS]) e exames de ressonância magnética (RM). Resultados: A flexão do cotovelo apresentou uma recuperação satisfatória no lado operado (135° ± 5°) em relação ao contralateral (138° ± 4°), sem diferença estatisticamente significativa (p = 0,212). No entanto, houve uma redução significativa de 16,7% na supinação no lado operado (75° ± 7°) em comparação ao lado contralateral (90° ± 6°) (p < 0,001). A força isocinética a 60º/s não mostrou diferenças significativas na flexão (p = 0,751) e na supinação (p = 0,910). Foi identificada uma correlação inversa significativa entre o volume do túnel ósseo (VTO) e a força de supinação (FS) a 60º/s (p = 0,015), sugerindo que os VTO estão associados a menores torques de supinação. No YBT-UQ, os valores médios foram de 82,9% (± 11,7) no lado operado e 84,3% (± 11,8) no contralateral, sem diferença significativa (p = 0,791). No TPA-MMSS, as distâncias de arremesso foram de 3,6 metros no lado operado e 3,8 metros no contralateral, também sem diferença significativa (p = 0,211). Radiologicamente, o comprimento médio do tendão (CT) no lado operado foi de 6,46 cm (± 0,75 cm), e tendões com esse comprimento apresentaram menor alargamento do túnel ósseo (p = 0,001). Houve um aumento significativo no diâmetro do túnel ósseo (DTO) de 0,68 cm no pré-operatório para 1,06 cm no pós-operatório (p < 0,001) e no VTO de 0,58 cm³ para 1,50 cm³ (p < 0,001). Conclusão: A reinserção do TBB com o uso do BC resultou em uma recuperação funcional satisfatória, com manutenção da força e ADM, especialmente na flexão e pronação. Entretanto, observou-se uma redução significativa da supinação no lado operado (p < 0,001). O CT em torno de 6 cm esteve associado a um menor alargamento do túnel ósseo (p = 0,001). Adicionalmente, a correlação inversa significativa entre o VTO e a FS a 60º/s (p = 0,015) sugere que o aumento do VTO pode impactar negativamente a FS. O aumento significativo no DTO e VTO reforça a necessidade de investigações adicionais sobre o impacto dessas alterações na recuperação funcional.
Introduction: The biceps brachii tendon (BTT) plays a key role in elbow flexion and forearm supination, making it particularly susceptible to ruptures in physically active individuals. This study aimed to evaluate the efficacy of BBT reinsertion using the adjustable cortical button mechanism (CB), focusing on functional recovery, muscle strength, and radiological findings. Methods: This is a retrospective cohort study involving 10 men (mean age 44 ± 8 years) who underwent BBT reinsertion. Range of motion, isokinetic strength at 60°/s and 180°/s, functional tests (Upper Quarter Y Balance Test [YBTUQ] and Upper Limb Power Throw Test [TPAMMSS]), and magnetic resonance imaging (MRI) were evaluated. Results: Elbow flexion showed satisfactory recovery on the operated side (135° ± 5°) compared to the contralateral side (138° ± 4°), with no statistically significant difference (p = 0.212). However, there was a significant 16.7% reduction in supination on the operated side (75° ± 7°) compared to the contralateral side (90° ± 6°) (p < 0.001). Isokinetic strength at 60°/s showed no significant differences in flexion (p = 0.751) and supination (p = 0.910). A significant inverse correlation was identified between tunnel volume and supination strength at 60°/s (p = 0.015), suggesting that larger tunnel volumes are associated with lower supination torques. In the YBTUQ, mean values were 82.9% (± 11.7) on the operated side and 84.3% (± 11.8) on the contralateral side, with no significant difference (p = 0.791). In the TPAMMSS, throwing distances were 3.6 meters on the operated side and 3.8 meters on the contralateral side, also with no significant difference (p = 0.211). Radiologically, the mean tendon length on the operated side was 6.46 cm (± 0.75 cm), and tendons of this length showed less tunnel widening (p = 0.001). There was a significant increase in tunnel diameter from 0.68 cm preoperatively to 1.06 cm postoperatively (p < 0.001) and in tunnel volume from 0.58 cm³ to 1.50 cm³ (p < 0.001). Conclusion: Reinsertion of the BBT using the adjustable cortical button resulted in satisfactory functional recovery, with maintenance of strength and range of motion, particularly in flexion and pronation. However, a significant reduction in supination was observed on the operated side (p < 0.001). Tendon lengths around 6 cm were associated with less tunnel widening (p = 0.001). Additionally, the significant inverse correlation between tunnel volume and supination strength at 60°/s (p = 0.015) suggests that increased tunnel volume may negatively impact supination strength. The significant increase in tunnel diameter and volume highlights the need for further investigation into the impact of these changes on functional recovery.
Introduction: The biceps brachii tendon (BTT) plays a key role in elbow flexion and forearm supination, making it particularly susceptible to ruptures in physically active individuals. This study aimed to evaluate the efficacy of BBT reinsertion using the adjustable cortical button mechanism (CB), focusing on functional recovery, muscle strength, and radiological findings. Methods: This is a retrospective cohort study involving 10 men (mean age 44 ± 8 years) who underwent BBT reinsertion. Range of motion, isokinetic strength at 60°/s and 180°/s, functional tests (Upper Quarter Y Balance Test [YBTUQ] and Upper Limb Power Throw Test [TPAMMSS]), and magnetic resonance imaging (MRI) were evaluated. Results: Elbow flexion showed satisfactory recovery on the operated side (135° ± 5°) compared to the contralateral side (138° ± 4°), with no statistically significant difference (p = 0.212). However, there was a significant 16.7% reduction in supination on the operated side (75° ± 7°) compared to the contralateral side (90° ± 6°) (p < 0.001). Isokinetic strength at 60°/s showed no significant differences in flexion (p = 0.751) and supination (p = 0.910). A significant inverse correlation was identified between tunnel volume and supination strength at 60°/s (p = 0.015), suggesting that larger tunnel volumes are associated with lower supination torques. In the YBTUQ, mean values were 82.9% (± 11.7) on the operated side and 84.3% (± 11.8) on the contralateral side, with no significant difference (p = 0.791). In the TPAMMSS, throwing distances were 3.6 meters on the operated side and 3.8 meters on the contralateral side, also with no significant difference (p = 0.211). Radiologically, the mean tendon length on the operated side was 6.46 cm (± 0.75 cm), and tendons of this length showed less tunnel widening (p = 0.001). There was a significant increase in tunnel diameter from 0.68 cm preoperatively to 1.06 cm postoperatively (p < 0.001) and in tunnel volume from 0.58 cm³ to 1.50 cm³ (p < 0.001). Conclusion: Reinsertion of the BBT using the adjustable cortical button resulted in satisfactory functional recovery, with maintenance of strength and range of motion, particularly in flexion and pronation. However, a significant reduction in supination was observed on the operated side (p < 0.001). Tendon lengths around 6 cm were associated with less tunnel widening (p = 0.001). Additionally, the significant inverse correlation between tunnel volume and supination strength at 60°/s (p = 0.015) suggests that increased tunnel volume may negatively impact supination strength. The significant increase in tunnel diameter and volume highlights the need for further investigation into the impact of these changes on functional recovery.