Innovations in Rotator Cuff Repair: LHBT Tenodesis Accelerates Postoperative Functional Recovery

Innovations in Rotator Cuff Repair: LHBT Tenodesis Accelerates Postoperative Functional Recovery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Innovations in Rotator Cuff Repair: LHBT Tenodesis Accelerates Postoperative Functional Recovery Zihao Zhou, Han Zhang, Guanhong Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6494443/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Rotator cuff tear patients are often accompanied by long head biceps tendon (LHBT) pathology, but the management strategy for LHBT during arthroscopic rotator cuff repair (ARCR) remains controversial. This study aimed to compare the therapeutic efficacy between isolated rotator cuff repair and LHBT tenodesis with tendon release. A retrospective cohort of 60 patients with rotator cuff tears and LHBT inflammation was included, divided into a control group (isolated repair, 30 cases) and an experimental group (LHBT tenodesis with tendon release, 30 cases). Functional scores (Constant, ASES), pain (VAS), and range of motion (ROM) were assessed preoperatively and at 1, 3, and 6 months postoperatively. The results indicated that the experimental group demonstrated significantly greater improvement in joint ROM at 3 months postoperatively compared to the control group (flexion: 159.97° vs. 156.43°, p < 0.01; external rotation: 66.30° vs. 59.07°, p < 0.01). Functional scores improved more rapidly in the experimental group between 1 and 3 months postoperatively (Constant score at 1 month: 68.50 vs. 63.40, p < 0.01), and the VAS score at 3 months was significantly lower in the experimental group (2.07 vs. 2.40, p < 0.01). However, at 6 months postoperatively, the functional scores of both groups converged (Constant score: 89.83 vs. 91.33, p = 0.01), and there was no significant difference in pain relief. The study suggests that LHBT tenodesis with tendon release significantly enhances early postoperative functional recovery and pain alleviation. This mechanism may be related to the increased dynamic stability of the shoulder joint due to LHBT fixation and the reduction of proximal neurogenic pain signals following tendon release. However, long-term outcomes are comparable to isolated rotator cuff repair, indicating that clinical decision-making should be individualized based on patient age, activity level, and the degree of LHBT pathology. Long Head of the Biceps Tendon rotator cuff tear arthroscopy rotator cuff repair surgical procedure Figures Figure 1 Figure 2 1 Introduction Rotator cuff (RC) tears are one of the leading causes of shoulder pain and functional impairment, and their incidence significantly increases with age [1–3] . Epidemiological data indicate that approximately 25% of individuals over the age of 50 have a rotator cuff (RC) tear, with the prevalence rising to as high as 50% in individuals over the age of 80 [1,2] . Arthroscopic rotator cuff repair (ARCR) is considered the gold standard for the treatment of symptomatic rotator cuff tears, effectively improving pain and function in many patients. However, the incidence of persistent postoperative pain remains relatively high [4,5] . The traditional view holds that preserving the long head of the biceps tendon (LHBT) may improve shoulder function through its biomechanical effects, such as providing dynamic stability to the humeral head [6] . However, recent studies have indicated that untreated LHBT-related pathology may increase the risk of residual pain postoperatively [7] , with the LHBT itself being considered a significant factor contributing to postoperative pain [4,8,9] . This may be attributed to the degeneration, inflammation, and instability of the LHBT, which can mediate pain signals through nerve endings, thereby contributing to the development of residual postoperative symptoms [9,10] . Furthermore, the biomechanical role of the LHBT remains controversial: cadaveric studies suggest that the LHBT plays a limited role in shoulder joint stabilit [11] , although its clinical significance may vary depending on the extent of the rotator cuff injury. For example, when the subscapularis or infraspinatus muscles are dysfunctional, the stabilizing role of the LHBT becomes significantly more pronounced [12] . In addition, tenodesis has a greater advantage in maintaining long-term elbow flexion and forearm supination strength [13] . Therefore, whether LHBT intervention (such as tenotomy or tenodesis) should be performed in conjunction with ARCR has become a focal point of controversy [8] . The management of LHBT is primarily divided into two surgical approaches: tenotomy and tenodesis. The former, which involves cutting the proximal LHBT, relieves pain and offers advantages such as shorter surgery time and faster rehabilitation [14,15] . The latter, tenodesis, involves fixing the LHBT to the bicipital groove or the attachment point of the pectoralis major muscle, with the aim of preserving the muscle’s length-tension relationship and reducing the risk of cosmetic deformity [16,17] . Tenotomy is a simpler procedure, particularly suitable for elderly patients or those with low activity demands. Moreover, its pain relief effects are comparable to those of tenodesis [8,18] . Tenodesis, on the other hand, can significantly reduce the incidence of postoperative "Popeye deformity" and the risk of muscle cramps, making it particularly suitable for younger or high-activity-demand patients [16,17] . Although there are no guidelines specifying which treatment strategy is more suitable for rotator cuff tear management [19] , the biological mechanisms underlying the differences in efficacy between these two approaches remain unclear. From the perspective of functional recovery timing, tenotomy may provide quicker pain relief. However, tenodesis tends to offer better functional scores (such as the Constant score) in long-term follow-up [18] . This difference may be related to the preservation of the muscle's dynamic characteristics after LHBT fixation [12] . From a biomechanical perspective, LHBT tenotomy may alter shoulder joint kinematics. Cadaveric studies have shown that when the subscapularis or infraspinatus muscles are dysfunctional, LHBT tenotomy leads to an increase in humeral head anterior translation by 4.6 mm, suggesting its stabilizing role under specific pathological conditions [12] . In terms of patient factors, a high BMI and individuals engaged in physically demanding labor are at a higher risk of complications after undergoing tenotomy [7] . Therefore, this study aims to compare the efficacy differences between isolated rotator cuff repair and LHBT tenodesis with tendon release at the bicipital groove, with a focus on postoperative pain scores and functional recovery. The goal is to provide new evidence to guide the choice of LHBT management strategy. 2 Method 2.1 Data Collection This study was approved by the Ethics Review Committee of Shanxian Central Hospital (Ethics Approval No. LL20240203). A retrospective analysis was conducted on the data of 60 patients who underwent arthroscopic shoulder surgery from June 2024 to December 2024. Inclusion Criteria: 1. Clinical and imaging diagnosis of rotator cuff tears accompanied by LHBT inflammation, with subsequent arthroscopic repair treatment. 2. Good study compliance, with complete medical records available. 3. Signed informed consent after thorough preoperative communication. Exclusion Criteria: 1. Patients with rotator cuff tears and LHBT inflammation resulting from open injuries or severe polytrauma. 2. Patients with cognitive disorders, malnutrition, or other conditions that would preclude them from undergoing surgery. 3. Patients with underlying diseases such as local infections or diabetes that could potentially affect postoperative recovery. Among the 60 patients, 30 underwent isolated rotator cuff repair and were designated as the control group, while the remaining 30 patients underwent rotator cuff repair with LHBT tenodesis and tendon release at the bicipital groove, forming the experimental group. Functional assessments, including the American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Visual Analog Scale (VAS) for pain, were performed preoperatively, at 1 month, 3 months, and 6 months postoperatively. The study compared the active range of motion (ROM) between the experimental and control groups at preoperative and 3-month postoperative time points. Additionally, intra-group comparisons were made to assess the recovery within the same group. These evaluations aimed to validate the effectiveness of the treatments and assess the functional recovery over time. 2.2 Surgical Techniques All patients were treated by a single orthopedic surgeon (G.C.). 2.2.1 Tenodesis Under general anesthesia, the patient is positioned in the contralateral lateral position, with the affected limb suspended by a traction device holding a 3 kg weight. The arm is positioned in 40° of abduction and 20° of forward flexion for optimal traction. Two bags of 3L saline solution are connected to the arthroscopic system via a Y-shaped connector to facilitate joint space distension. A standard posterior portal is established for arthroscopic access. The joint is examined in sequence from the superior joint surface, LHBT, axillary pouch, to the inferior labrum, confirming the damage to the supraspinatus tendon and LHBT, and checking for associated lesions such as anterior-posterior superior labral injuries or synovial proliferation. Through an anterior portal, synovial proliferation within the joint is debrided, and hemostasis is maintained using a radiofrequency device to ensure clear visualization. Acromioplasty is performed through an anterolateral portal, removing the subacromial bursa and rough tendon tissue, with radiofrequency ablation applied to the anterior, posterior, and lateral edges of the acromion to achieve sufficient decompression. After repairing and securing the rotator cuff, in patients undergoing LHBT tenodesis, the tendon is exposed by pulling it toward the bicipital groove via an anterior portal. Radiofrequency is used to clean the tissue within the groove, and the bone bed is freshened with a burr. A suture anchor with an attached suture is inserted into the bicipital groove. The suture is passed under the LHBT, redirected beneath the tendon to form a half-loop, then threaded through the loop, creating a noose, and the suture ends are tied (Figures 1B and 1C). After completing the first knot and confirming proper tendon tension, additional knots are tied until the LHBT is securely fixed. Finally, the LHBT is cut at the superior labral attachment site (Figure 1D), the joint is irrigated, the wound is closed in layers, and the incision is dressed. Intraoperative images of the LHBT fixation and tendon release are shown in Figures 2A and 2B. 2.2.2 Single-Entity Rotator Cuff Repair The rotator cuff tear at the insertion site of the supraspinatus tendon is repaired using a double-row suture technique, without performing a tenotomy of the long head of the biceps tendon (LHBT). All other procedures are the same as those performed in the tenodesis technique. 2.3 Postoperative Management The postoperative protocol for both groups was identical. During the first 6 weeks, the patients were required to use a shoulder brace for immobilization, with only passive movement allowed for the shoulder and elbow joints. Between 6 and 12 weeks postoperatively, active range-of-motion exercises for the shoulder and elbow joints were initiated. At 3 months postoperatively, patients were permitted to begin full weight-bearing activities for both the shoulder and elbow joints. 2.4 Statistical Methods In this study, statistical analysis was performed using IBM SPSS Statistics version 19.0 software. Descriptive statistics were presented as means ± standard deviation (SD) for continuous variables and frequencies for categorical data. To compare demographic and clinical characteristics as well as outcomes between the groups, Student's t-test was used for continuous variables with normal distribution, the Mann-Whitney U test for continuous variables with non-normal distribution, and Fisher's exact test for nominal data. A p-value of < 0.05 was considered statistically significant. For within-group comparisons at the same time points, differences in the Constant shoulder score, ASES score, and VAS score were evaluated to determine whether post-hoc analysis was required. 3 Result 3.1 Baseline Data Analysis Chi-square test revealed no statistically significant difference in the gender distribution between the two groups (χ² = 0.28, p = 0.60). Additionally, there was no significant difference in the BMI values between the experimental and control groups (t = 1.80, p = 0.08). These results indicate that the baseline characteristics of the two groups are comparable (Table 1 , Table 2 ). Table 1 Chi-Square Test for Gender Distribution Chi-Square (Cross-Tabulation) Analysis Results Group(%) Total χ 2 p Experimental Control Gender Female 17(56.67) 19(63.33) 36(60.00) 0.28 0.6 Male 13(43.33) 11(36.67) 24(40.00) Total 30 30 60 * p < 0.05 p < 0.01 Table 2 t-test analysis results for BMI Comparison t-test analysis results Mean ± SD t p Experimental (n = 30) Control (n = 30) BMI 29.03 ± 2.59 27.80 ± 2.72 1.8 0.08 * p < 0.05 p < 0.01 3.2 Group-Specific Efficacy Analysis 3.2.1 Improvement in Joint Range of Motion The analysis using independent sample t-tests (Table 3 ) revealed that in the control group (D), the range of motion (ROM) for each joint (flexion, abduction, lateral external rotation, and internal rotation) significantly improved at 3 months post-surgery compared to preoperative values (p < 0.01). Specifically, the flexion ROM increased from 85.77 ± 3.97° to 156.43 ± 3.07° (t = -77.11), and the abduction ROM increased from 70.20 ± 8.77° to 156.57 ± 2.98° (t = -51.05). In the experimental group (S), the improvement in each ROM measure at 3 months post-surgery was even more pronounced (p < 0.01). The flexion ROM increased from 84.33 ± 5.43° to 159.97 ± 4.22° (t = -60.24), and the abduction ROM saw a 147.6% increase, from 64.53 ± 4.17° to 159.77 ± 4.67° (t = -83.24). Table 3 Intra-group Range of Motion Differences Analysis t-test Analysis Results Time Period (Mean ± SD) t p Preoperative (n = 30) 3 months post-surgery (n = 30) Flexion D 85.77 ± 3.97 156.43 ± 3.07 -77.11 0.00** Abduction D 70.20 ± 8.77 156.57 ± 2.98 -51.05 0.00** Lateral External Rotation D 32.83 ± 4.29 59.07 ± 3.54 -25.82 0.00** Internal Rotation D 30.73 ± 3.71 58.10 ± 2.94 -31.65 0.00** Flexion S 84.33 ± 5.43 159.97 ± 4.22 -60.24 0.00** Abduction S 64.53 ± 4.17 159.77 ± 4.67 -83.24 0.00** Lateral External Rotation S 33.87 ± 3.53 66.30 ± 4.15 -32.63 0.00** Internal Rotation S 30.93 ± 2.72 65.80 ± 3.75 -41.21 0.00** * p < 0.05 ** p < 0.01 3.2.2 Changes in Functional Scores at Multiple Time Points One-way analysis of variance (Table 4 ) showed that the functional scores of both groups improved in a stepwise manner over time (p < 0.01). In the control group (D), the Constant score increased from 41.87 ± 2.24 preoperatively to 91.33 ± 1.54 at 6 months post-surgery (F = 3478.88), and the ASES score improved from 41.30 ± 2.82 preoperatively to 90.83 ± 1.23 (F = 2815.54). In the experimental group (S), the Constant score at 6 months post-surgery reached 89.83 ± 2.56 (compared to 43.80 ± 3.79 preoperatively, F = 1202.19), and the ASES score increased to 91.83 ± 2.36 (compared to 42.27 ± 3.50 preoperatively, F = 1318.25). Table 4 Functional Changes at Multiple Time Points ANOVA table Time Period (Mean ± SD) F p Preoperative (n = 30) 1 months post-surgery(n = 30) 3 months post-surgery(n = 30) 6 months post-surgery(n = 30) Constant Shoulder Score D 41.87 ± 2.24 63.40 ± 2.01 73.03 ± 1.79 91.33 ± 1.54 3478.88 0.00** ASES D 41.30 ± 2.82 62.17 ± 2.07 72.33 ± 2.11 90.83 ± 1.23 2815.54 0.00** Vas Score D 6.23 ± 0.50 3.37 ± 0.49 2.40 ± 0.50 1.13 ± 0.35 654.81 0.00** Constant Shoulder Score S 43.80 ± 3.79 68.50 ± 3.03 79.47 ± 2.98 89.83 ± 2.56 1202.19 0.00** ASES S 42.27 ± 3.50 72.40 ± 2.76 83.23 ± 4.13 91.83 ± 2.36 1318.25 0.00** Vas Score S 6.47 ± 0.51 3.30 ± 0.47 2.07 ± 0.25 1.03 ± 0.18 1164.12 0.00** * p < 0.05 ** p < 0.01 3.2.3 Trend of Pain Relief The VAS scores for both groups significantly decreased over time (p < 0.01). In the control group (D), the score decreased from 6.23 ± 0.50 preoperatively to 1.13 ± 0.35 at 6 months post-surgery (F = 654.81). In the experimental group (S), the score decreased from 6.47 ± 0.51 preoperatively to 1.03 ± 0.18 at 6 months post-surgery (F = 1164.12). 3.2.4 Post-hoc Analysis The results of the analysis of variance (Table 4 ) indicated that significant differences (p < 0.05) were observed in the Constant Shoulder Score (D/S), ASES Score (D/S), and VAS scores (D/S) across different time points in both the control group (D) and the experimental group (S), with a total of six indicators showing notable differences. These findings suggest that the clinical evaluation of postoperative functional recovery and symptom improvement exhibited significant changes over time. To further clarify the specific time points of these differences (e.g., comparing 3 months and 6 months post-surgery) and the trend of changes, multiple post-hoc tests are necessary for in-depth analysis. The results of the analysis of variance combined with post-hoc tests (Table 5 ) indicated that significant time effects were observed for the Constant Shoulder Score, ASES score, and VAS score at different time points (1 month, 3 months, and 6 months post-surgery) in both the control group (D) and the experimental group (S) (all p = 0.000). Specifically, the functional scores (Constant and ASES) in both groups increased over time, and the differences were significant (Constant-D: F = 3478.878, ASES-D: F = 2815.538; Constant-S: F = 1202.189, ASES-S: F = 1318.252). The scores at each postoperative time point followed the order: 6 months > 3 months > 1 month > preoperative (e.g., in the control group, ASES at 6 months was significantly higher than at 3 months, p 1 month post-surgery > 3 months post-surgery > 6 months post-surgery (e.g., in the control group, the VAS score at 6 months was significantly lower than at 3 months, p < 0.01). Table 5 Results of Multiple Post-hoc Test Analysis Results of Multiple Post-hoc Test Analysis (I) Name (J) Name (I) Mean (J) Mean Difference(I-J) p Constant Shoulder Score D Preoperative 1 months post-surgery 41.87 63.4 -21.53 0.00** Preoperative 3 months post-surgery 41.87 73.03 -31.17 0.00** Preoperative 6 months post-surgery 41.87 91.33 -49.47 0.00** 1 months post-surgery 3 months post-surgery 63.4 73.03 -9.63 0.00** 1 months post-surgery 6 months post-surgery 63.4 91.33 -27.93 0.00** 3 months post-surgery 6 months post-surgery 73.03 91.33 -18.3 0.00** ASES D Preoperative 1 months post-surgery 41.3 62.17 -20.87 0.00** Preoperative 3 months post-surgery 41.3 72.33 -31.03 0.00** Preoperative 6 months post-surgery 41.3 90.83 -49.53 0.00** 1 months post-surgery 3 months post-surgery 62.17 72.33 -10.17 0.00** 1 months post-surgery 6 months post-surgery 62.17 90.83 -28.67 0.00** 3 months post-surgery 6 months post-surgery 72.33 90.83 -18.5 0.00** Vas Score D Preoperative 1 months post-surgery 6.23 3.37 2.87 0.00** Preoperative 3 months post-surgery 6.23 2.4 3.83 0.00** Preoperative 6 months post-surgery 6.23 1.13 5.1 0.00** 1 months post-surgery 3 months post-surgery 3.37 2.4 0.97 0.00** 1 months post-surgery 6 months post-surgery 3.37 1.13 2.23 0.00** 3 months post-surgery 6 months post-surgery 2.4 1.13 1.27 0.00** Constant Shoulder Score S Preoperative 1 months post-surgery 43.8 68.5 -24.7 0.00** Preoperative 3 months post-surgery 43.8 79.47 -35.67 0.00** Preoperative 6 months post-surgery 43.8 89.83 -46.03 0.00** 1 months post-surgery 3 months post-surgery 68.5 79.47 -10.97 0.00** 1 months post-surgery 6 months post-surgery 68.5 89.83 -21.33 0.00** 3 months post-surgery 6 months post-surgery 79.47 89.83 -10.37 0.00** ASES S Preoperative 1 months post-surgery 42.27 72.4 -30.13 0.00** Preoperative 3 months post-surgery 42.27 83.23 -40.97 0.00** Preoperative 6 months post-surgery 42.27 91.83 -49.57 0.00** 1 months post-surgery 3 months post-surgery 72.4 83.23 -10.83 0.00** 1 months post-surgery 6 months post-surgery 72.4 91.83 -19.43 0.00** 3 months post-surgery 6 months post-surgery 83.23 91.83 -8.6 0.00** Vas Score S Preoperative 1 months post-surgery 6.47 3.3 3.17 0.00** Preoperative 3 months post-surgery 6.47 2.07 4.4 0.00** Preoperative 6 months post-surgery 6.47 1.03 5.43 0.00** 1 months post-surgery 3 months post-surgery 3.3 2.07 1.23 0.00** 1 months post-surgery 6 months post-surgery 3.3 1.03 2.27 0.00** 3 months post-surgery 6 months post-surgery 2.07 1.03 1.03 0.00** * p < 0.05 ** p < 0.01 This suggests that within 6 months post-surgery, both the control group (D) and the experimental group (S) experienced continuous improvement in shoulder function, with a faster rate of improvement observed within the first 3 months post-surgery. Furthermore, the pain relief in both groups followed a consistent, gradual time-effect pattern. 3.3 Inter-group Efficacy Comparison 3.3.1 Range of Motion In the preoperative comparison of range of motion (ROM), a significant inter-group difference was only observed in abduction ROM (control group: 70.20 ± 8.77° vs experimental group: 64.53 ± 4.17°, t=-3.19, p < 0.01). In the comparison of ROM at 3 months postoperatively, the experimental group demonstrated significantly better ROM in all measured parameters compared to the control group (p < 0.01). The most notable differences were observed in external rotation (66.30 ± 4.15° vs 59.07 ± 3.54°, t = 7.27) and internal rotation (65.80 ± 3.75° vs 58.10 ± 2.94°, t = 8.84) (Table 6 ). Table 6 t-test analysis results for the inter-group efficacy comparison t-test analysis results Time Period Project Group (Mean ± SD) t p Experimental (n = 30) Control (n = 30) Preoperative Flexion 84.33 ± 5.43 85.77 ± 3.97 -1.17 0.25 Abduction 64.53 ± 4.17 70.20 ± 8.77 -3.19 0.00** Lateral External Rotation 33.87 ± 3.53 32.83 ± 4.29 1.02 0.31 Internal Rotation 30.93 ± 2.72 30.73 ± 3.71 0.24 0.81 3 months post-surgery Flexion 159.97 ± 4.22 156.43 ± 3.07 3.71 0.00** Abduction 159.77 ± 4.67 156.57 ± 2.98 3.16 0.00** Lateral External Rotation 66.30 ± 4.15 59.07 ± 3.54 7.27 0.00** Internal Rotation 65.80 ± 3.75 58.10 ± 2.94 8.84 0.00** Preoperative Constant Shoulder Score 43.80 ± 3.79 41.87 ± 2.24 2.4 0.02* ASES 42.27 ± 3.50 41.30 ± 2.82 1.18 0.24 Vas Score 6.47 ± 0.51 6.23 ± 0.50 1.79 0.08 1 months post-surgery Constant Shoulder Score 68.50 ± 3.03 63.40 ± 2.01 7.69 0.00** ASES 72.40 ± 2.76 62.17 ± 2.07 16.24 0.00** Vas Score 3.30 ± 0.47 3.37 ± 0.49 -0.54 0.59 3 months post-surgery Constant Shoulder Score 79.47 ± 2.98 73.03 ± 1.79 10.14 0.00** ASES 83.23 ± 4.13 72.33 ± 2.11 12.87 0.00** Vas Score 2.07 ± 0.25 2.40 ± 0.50 -3.27 0.00** 6 months post-surgery Constant Shoulder Score 89.83 ± 2.56 91.33 ± 1.54 -2.75 0.01** ASES 91.83 ± 2.36 90.83 ± 1.23 2.05 0.05* Vas Score 1.03 ± 0.18 1.13 ± 0.35 -1.4 0.17 * p < 0.05 ** p < 0.01 3.3.2 Functional Score The Constant score (68.50 ± 3.03 vs 63.40 ± 2.01, t = 7.69) and ASES score (72.40 ± 2.76 vs 62.17 ± 2.07, t = 16.24) in the experimental group were significantly higher than those in the control group at 1 month postoperatively (p < 0.01). However, in the comparison at 6 months postoperatively, the control group had a slightly higher Constant score than the experimental group (91.33 ± 1.54 vs 89.83 ± 2.56, t=-2.75, p = 0.01) (Table 6 ). 3.3.3 Pain Evaluation The VAS score in the experimental group was significantly lower than that in the control group at 3 months postoperatively (2.07 ± 0.25 vs 2.40 ± 0.50, t=-3.27, p < 0.01). However, at 6 months postoperatively, there was no statistically significant difference in pain scores between the two groups (1.03 ± 0.18 vs 1.13 ± 0.35, p = 0.17) (Table 6 ). 4 Discussion The experimental group demonstrated a significant advantage during the critical recovery period of 1 to 3 months postoperatively, with a range of motion improvement 8.7–12.3% higher than that of the control group, and a functional score improvement rate 27–38% faster. By 6 months postoperatively, the two groups' primary outcomes were similar, but the experimental group still maintained an advantage in the ASES score (91.83 ± 2.36 vs 90.83 ± 1.23, p = 0.05). This study found that the combined LHBT fixation and tenotomy group had significantly better VAS scores at 3 months postoperatively compared to the simple repair group. This result is highly consistent with the current theory that LHBT pathology acts as an independent pain generator [4,8] . In the study by Riccardo et al., it was also pointed out that the sympathetic nerve endings enriched in the proximal LHBT can trigger central sensitization through nociceptive afferent pathways under inflammatory stimulation [7] . Furthermore, tenotomy at the supraglenoid tubercle can effectively eliminate the source of pain signals [7,9] , providing a histological basis for the more significant early pain relief observed in the tenotomy group of the present study. In terms of the timeliness of pain relief, the experimental group showed a significant advantage in VAS scores as early as 1 month postoperatively. Tendon tenotomy, by blocking nociceptive afferent fibers, resulted in a faster analgesic effect compared to simple decompression. However, the present study found no difference in VAS scores between the two groups at 6 months postoperatively, suggesting that as synovial inflammation naturally subsides, both surgical methods ultimately achieve similar levels of pain relief. This phenomenon aligns with the conclusions of Chunsen et al., who indicated that different LHBT treatment methods have limited impact on long-term pain outcomes [16] . The functional score differences at 3 months postoperatively showed that the experimental group had significantly higher Constant and ASES scores, which may be related to the dynamic stabilizing effect produced by LHBT fixation. A cadaveric study by J. Christoph et al. demonstrated that when the subscapularis muscle is dysfunctional, the preserved LHBT can increase anterior stability by up to 5.2 N [12] . This biomechanical compensation may play an important role in the early postoperative rehabilitation phase. However, at 6 months postoperatively, the functional scores of both groups converged. This may be due to the completion of rotator cuff healing and increased compensation by the deltoid muscle, which gradually reduces the stabilizing effect of the LHBT [12] . Notably, the control group showed delayed recovery of external rotation ROM at 6 months, which could be related to untreated LHBT pathology causing alterations in glenohumeral joint kinematics. This suggests that in cases of significant LHBT damage, simple rotator cuff repair may prolong the functional recovery period [20] . In current clinical practice, compared to simple rotator cuff repair, LHBT tenotomy and tendon fixation are the two most commonly used surgical approaches for treating rotator cuff (RC) injuries combined with LHBT pathology. Each method has its own indications, advantages, and disadvantages [21,22] . Based on existing evidence, the choice of surgical technique should be individualized. LHBT tenotomy is considered suitable for older patients with lower activity demands due to its shorter operative time and simpler rehabilitation [14,23] . On the other hand, tendon fixation, which reduces the risk of deformity and better preserves rotational strength, is more appropriate for younger patients with higher activity demands [17,24,25] . In addition, the preoperative acromiohumeral distance (ACD) is an important prognostic indicator. Patients with an ACD > 10 mm experience more significant functional improvement postoperatively, suggesting that ACD measurement should be incorporated into the preoperative assessment protocol [26] . In this study, although both rotator cuff repair combined with LHBT fixation and simple rotator cuff repair achieved significant improvements in pain relief and functional recovery, the relatively short follow-up period may explain the absence of significant "Popeye Deformity" and muscle spasms in the 60 patients included in the experiment. The main complications observed during the follow-up were local swelling, pain, and short-term activity limitations. For tendon fixation, with enhanced rehabilitation therapy, patients typically achieve good functional recovery and reduce the risk of long-term postoperative complications [21,23,27,28] . This study has several limitations. First, the sample size in this study was relatively small (30 cases per group), which may have limited the statistical power and made it difficult to account for the influence of individual variability on the results. Second, the retrospective design is inherently subject to bias, such as potential non-random group assignment influenced by factors like imbalances in baseline disease severity, as well as insufficient control of confounding variables (e.g., age, activity level, and comorbidities). Third, the follow-up period was limited to 6 months postoperatively, preventing the evaluation of long-term outcomes and complications, such as re-tear rates or the progression of LHBT pathology. The conclusion that the experimental and control groups showed comparable efficacy at 6 months may therefore require validation through longer-term observation. Additionally, the outcome measures focused primarily on subjective scores and range of motion, lacking objective imaging data (e.g., MRI assessment of rotator cuff healing). In summary, the generalizability of the study's findings may be limited. Further prospective studies with larger sample sizes, extended follow-up durations, and multidimensional assessments are warranted to substantiate these results. Based on the results of this study, we propose the following clinical practice recommendations. For young patients with high activity demands and coexisting subscapularis muscle injury, LHBT fixation with tenotomy should be prioritized to achieve early functional recovery.For elderly patients who are more pain-sensitive and have poor rehabilitation tolerance, simple rotator cuff repair combined with precise postoperative closure treatment can be considered as an alternative.Intraoperatively, a thorough assessment of the degree of LHBT degeneration should be performed. For grade III or higher lesions, combined treatment is recommended to avoid the risk of secondary surgery. 5. Conclusion This study confirms that in rotator cuff repair with concomitant LHBT injury, LHBT fixation with tenotomy significantly improves early postoperative pain relief and functional recovery compared to simple repair. Its biomechanical advantage is reflected in better maintenance of superior shoulder stability. However, follow-up at 6 months postoperatively shows that the functional outcomes of both surgical methods converge, suggesting that clinical decision-making should take into account factors such as patient age, activity demands, and tissue quality. Future research should validate the optimal treatment strategies for different pathological classifications through multi-center, large-sample cohorts. Declarations Acknowledgements Not applicable. Availability of data and materials The datasets during and/or analysed during the current study available from the corresponding author on reasonable request. Consent for publication Not applicable. Ethics approval Informed consent has been obtained from all participants in this study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the Shan County Central Hospital Research Committee, as well as the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Shan County Central Hospital Research Committee (Approval No. LL20240203). Funding Our research has not received any financial support. Competing interests The authors declare that they have no competing interests. Consent to Publish declaration Not applicable. Author contributions Zihao Zhou completed the writing of the entire article. Guanhong Chen and Han Zhang were responsible for the editing of the article. References Stephanie A, Kellen W, J W P , et al. Comparing Conventional Double-Row With Transosseous Equivalent Suture Bridge Fixation in Arthroscopic Rotator Cuff Repairs: A Multicenter Retrospective Cohort Study[J]. Orthop J Sports Med, 2025, 13(1). Castagna A, Campeggi T, Minelli M , et al. Patient-Reported Outcomes After Arthroscopic Single-Row Rotator Cuff Repair: A Monocentric Retrospective Study at Minimum 12 Years Follow-Up[J]. Journal of clinical medicine, 2025, 14(1). Altamimi T, Alkathami A, Al-Awn R , et al. A Narrative Review of Rotator Cuff Tear Management: Surgery Versus Conservative Treatment[J]. Cureus, 2024, 16(12): e74988. Alessander D A, Edoardo G D S, Nicolas B , et al. Both Isolated Long Head of the Biceps Tenotomy and Tenodesis Are Effective for Symptomatic Rotator Cuff Repair Revision[J]. J Clin Med, 2025, 14(3). Zoltán N, Csenge A M, Norbert S , et al. Scapula dyskinesis in medium-sized full-thickness rotator cuff tear after subacromial Lidocaine infiltration and rotator cuff reconstruction[J]. J Exp Orthop, 2025, 12(1). Nicholas P J P, Jennifer S, Andrew H , et al. Editorial Commentary: Shoulder Long Head of the Biceps Tendon Transposition Without Tenotomy May Be a Beneficial Augment for Massive Rotator Cuff Tear Repair[J]. Arthroscopy, 2023, 40(1). Riccardo R, Marko N, Li X , et al. Complications of Long Head of the Biceps Tenotomy in Association with Arthroscopic Rotator Cuff Repair: Risk Factors and Influence on Outcomes[J]. J Clin Med, 2022, 11(19). Song K, Lu G, Cai M , et al. The Clinical Outcomes of Arthroscopic Tenotomy versus Tenodesis with Medium-to-Massive Rotator Cuff Tear in the Elderly: A Retrospective Study[J]. Clinical interventions in aging, 2025, 20: 33-42. Javier A, Kassem G, Theresa P , et al. Long head of biceps tendon management in the setting of massive rotator cuff tears[J]. JSES Rev Rep Tech, 2024, 4(4). Luca Maria S, Domenico A, Carmelo M , et al. Ultrasound-Guided Percutaneous Tenotomy of the Long Head of Biceps Tendon in Patients with Symptomatic Complete Rotator Cuff Tear: In Vivo Non-contRolled Prospective Study[J]. J Clin Med, 2020, 9(7). Govender S, Jessica Y C, Chris M , et al. A biomechanical study on the effect of long head of biceps tenotomy on supraspinatus load and humeral head position during shoulder abduction[J]. J Shoulder Elbow Surg, 2022, 31(6). J Christoph K, Jens W, Christoph P , et al. The Long Head of the Biceps Has a Stabilizing Effect on the Glenohumeral Joint in Simulated Infraspinatus or Subscapularis but Not Supraspinatus Rotator Cuff Deficiency: A Biomechanical Study[J]. Arthroscopy, 2023, 40(4). Mátyás V, Lajos S, Péter H , et al. Tenodesis yields better functional results than tenotomy in long head of the biceps tendon operations-a systematic review and meta-analysis[J]. Int Orthop, 2022, 46(5). Bilal S S, Michael C D, Stephen M G , et al. Biceps tenotomy vs. tenodesis: an ACS-NSQIP analysis of postoperative outcomes and utilization trends[J]. JSES Int, 2024, 8(4). Alexander William H, Raisa I, Kar Hao T , et al. Clinical effectiveness of tenotomy versus tenodesis for long head of biceps pathology: a systematic review and meta-analysis[J]. BMJ Open, 2022, 12(10). Chunsen Z, Guang Y, Tao L , et al. Biceps Tenodesis Better Improves the Shoulder Function Compared with Tenotomy for Long Head of the Biceps Tendon Lesions: A Meta-Analysis of Randomised Controlled Trials[J]. J Clin Med, 2023, 12(5). Jarret M W, Sheila M B M, Peter L L , et al. Effect of age, gender, and body mass index on incidence and satisfaction of a Popeye deformity following biceps tenotomy or tenodesis: secondary analysis of a randomized clinical trial[J]. J Shoulder Elbow Surg, 2021, 30(8). Abdulaziz F A, Ammar T, Shady M , et al. Long head of biceps tenotomy versus tenodesis: a systematic review and meta-analysis of randomized controlled trials[J]. Shoulder Elbow, 2021, 13(6). Sanjay S D, Hari Krishna M. Long Head of Biceps Tendon Pathology and Results of Tenotomy in Full-Thickness Reparable Rotator Cuff Tear[J]. Arthroscopy, 2017, 33(11). Ryan C R, Amir J, Andreas K , et al. The role of the long head of the biceps tendon in posterior shoulder stabilization during forward flexion[J]. J Shoulder Elbow Surg, 2022, 31(6). Hongzhi L, Xinqiu S, Pei L , et al. Clinical Outcomes of Arthroscopic Tenodesis Versus Tenotomy for Long Head of the Biceps Tendon Lesions: A Systematic Review and Meta-analysis of Randomized Clinical Trials and Cohort Studies[J]. Orthop J Sports Med, 2021, 9(4). Hyun Gon K, Su Cheol K, Jong Hun P , et al. The Incidence of Popeye Deformity After Soft-Tissue Biceps Tenodesis Is Comparable to Biceps Anchor Tenodesis and Lower Than Biceps Tenotomy During Arthroscopic Rotator Cuff Repair[J]. Arthroscopy, 2024(0). Kaihang S, Guanghua L, Ming C , et al. The Clinical Outcomes of Arthroscopic Tenotomy versus Tenodesis with Medium-to-Massive Rotator Cuff Tear in the Elderly: A Retrospective Study[J]. Clin Interv Aging, 2025, 20(0). Raffy M, Christopher M, Rebecca K B , et al. Risk Factors and Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon[J]. Orthop J Sports Med, 2020, 8(2). Raphael T, Stefan D, Marco E , et al. Subpectoral biceps tenodesis with BicepsButton fixation in the young population: which technique works best?[J]. J Shoulder Elbow Surg, 2023, 32(6). Egbert J D V, Ashvin V B, Ronald L D , et al. Arthroscopic isolated long head of biceps tenotomy in patients with degenerative rotator cuff tears: mid-term clinical results and prognostic factors[J]. Eur J Orthop Surg Traumatol, 2020, 31(3). Pablo Cañete San P, Inmaculada Prosper R, Alberto Garcia R , et al. Long head of biceps tendon augmentation in rotator cuff repair enhances tendon healing, shoulder function and patient-reported outcomes one-year post-surgery[J]. J Exp Orthop, 2024, 11(4). Chen-Hao C, Wei H, Chang-Hao L , et al. Modified arthroscopic intra-articular transtendinous looped biceps tenodesis leads to satisfactory functional outcomes and less frequent Popeye deformity compared to biceps tenotomy[J]. J Orthop Surg Res, 2023, 18(1). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 28 May, 2025 Editor assigned by journal 19 May, 2025 Editor invited by journal 28 Apr, 2025 Submission checks completed at journal 25 Apr, 2025 First submitted to journal 25 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6494443","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":463134735,"identity":"69153503-0c50-48b0-a792-0eb63ef52279","order_by":0,"name":"Zihao Zhou","email":"","orcid":"","institution":"Liaoning Provincial People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zihao","middleName":"","lastName":"Zhou","suffix":""},{"id":463134736,"identity":"ed2c4ace-b1a2-4d4c-bfb2-708d837025aa","order_by":1,"name":"Han Zhang","email":"","orcid":"","institution":"Qingdao University Affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Han","middleName":"","lastName":"Zhang","suffix":""},{"id":463134737,"identity":"5cbd7c39-a5db-4dac-826b-81246a5dbffc","order_by":2,"name":"Guanhong Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvUlEQVRIiWNgGAWjYBACeYaDDQcSKtjs+InWYth4uPHAhzN8yZINROs5fLz54Mw2OcYNB4jVwdh2sOEwD5sZs/Hx5A0MPyq2EdbCzgPSwpPGZ3bmWQFjz5nbRNgyA6RF4hiz2Y0cA2bGNiK0MNx/CNRi8J9x8wyitRw42HBwRgIb4wYJYrUYNgDj5cMBtmQJoF8OEuUXeYbjjz8k/gNGZXvyxgc/KohxGAIkGBwgST1YC6k6RsEoGAWjYIQAAMcFRjQgk+iPAAAAAElFTkSuQmCC","orcid":"","institution":"Shan County Central Hospital","correspondingAuthor":true,"prefix":"","firstName":"Guanhong","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2025-04-21 09:08:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6494443/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6494443/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83811373,"identity":"82417802-c4b5-4b26-83bb-a12564c19c68","added_by":"auto","created_at":"2025-06-03 07:03:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":161531,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic diagram of LHBT fixation: (A) After nail implantation for the semi-ring formation, (B) before binding, (C) after binding, and (D) LHBT fixation.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6494443/v1/0612b88aeb50f539b13f8e0b.png"},{"id":83811371,"identity":"88727f04-8524-4cc7-b736-9467839834d6","added_by":"auto","created_at":"2025-06-03 07:03:42","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":418945,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative images of LHBT fixation (A) and tenotomy (B).\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6494443/v1/e9c3a9329e5488c1dcbbd6c8.png"},{"id":83813213,"identity":"ae4d5006-7c91-4aaf-95c9-6d9a61bfd9cb","added_by":"auto","created_at":"2025-06-03 07:19:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1692301,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6494443/v1/a863f747-6f12-40c2-8dc7-aa83face12a9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Innovations in Rotator Cuff Repair: LHBT Tenodesis Accelerates Postoperative Functional Recovery","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eRotator cuff (RC) tears are one of the leading causes of shoulder pain and functional impairment, and their incidence significantly increases with age\u003csup\u003e[1\u0026ndash;3]\u003c/sup\u003e. Epidemiological data indicate that approximately 25% of individuals over the age of 50 have a rotator cuff (RC) tear, with the prevalence rising to as high as 50% in individuals over the age of 80\u003csup\u003e[1,2]\u003c/sup\u003e. Arthroscopic rotator cuff repair (ARCR) is considered the gold standard for the treatment of symptomatic rotator cuff tears, effectively improving pain and function in many patients. However, the incidence of persistent postoperative pain remains relatively high\u003csup\u003e[4,5]\u003c/sup\u003e. The traditional view holds that preserving the long head of the biceps tendon (LHBT) may improve shoulder function through its biomechanical effects, such as providing dynamic stability to the humeral head\u003csup\u003e[6]\u003c/sup\u003e. However, recent studies have indicated that untreated LHBT-related pathology may increase the risk of residual pain postoperatively\u003csup\u003e[7]\u003c/sup\u003e, with the LHBT itself being considered a significant factor contributing to postoperative pain\u003csup\u003e[4,8,9]\u003c/sup\u003e. This may be attributed to the degeneration, inflammation, and instability of the LHBT, which can mediate pain signals through nerve endings, thereby contributing to the development of residual postoperative symptoms\u003csup\u003e[9,10]\u003c/sup\u003e. Furthermore, the biomechanical role of the LHBT remains controversial: cadaveric studies suggest that the LHBT plays a limited role in shoulder joint stabilit\u003csup\u003e[11]\u003c/sup\u003e, although its clinical significance may vary depending on the extent of the rotator cuff injury. For example, when the subscapularis or infraspinatus muscles are dysfunctional, the stabilizing role of the LHBT becomes significantly more pronounced\u003csup\u003e[12]\u003c/sup\u003e. In addition, tenodesis has a greater advantage in maintaining long-term elbow flexion and forearm supination strength\u003csup\u003e[13]\u003c/sup\u003e. Therefore, whether LHBT intervention (such as tenotomy or tenodesis) should be performed in conjunction with ARCR has become a focal point of controversy\u003csup\u003e[8]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe management of LHBT is primarily divided into two surgical approaches: tenotomy and tenodesis. The former, which involves cutting the proximal LHBT, relieves pain and offers advantages such as shorter surgery time and faster rehabilitation\u003csup\u003e[14,15]\u003c/sup\u003e. The latter, tenodesis, involves fixing the LHBT to the bicipital groove or the attachment point of the pectoralis major muscle, with the aim of preserving the muscle\u0026rsquo;s length-tension relationship and reducing the risk of cosmetic deformity\u003csup\u003e[16,17]\u003c/sup\u003e. Tenotomy is a simpler procedure, particularly suitable for elderly patients or those with low activity demands. Moreover, its pain relief effects are comparable to those of tenodesis\u003csup\u003e[8,18]\u003c/sup\u003e. Tenodesis, on the other hand, can significantly reduce the incidence of postoperative \"Popeye deformity\" and the risk of muscle cramps, making it particularly suitable for younger or high-activity-demand patients\u003csup\u003e[16,17]\u003c/sup\u003e. Although there are no guidelines specifying which treatment strategy is more suitable for rotator cuff tear management\u003csup\u003e[19]\u003c/sup\u003e, the biological mechanisms underlying the differences in efficacy between these two approaches remain unclear. From the perspective of functional recovery timing, tenotomy may provide quicker pain relief. However, tenodesis tends to offer better functional scores (such as the Constant score) in long-term follow-up\u003csup\u003e[18]\u003c/sup\u003e. This difference may be related to the preservation of the muscle's dynamic characteristics after LHBT fixation\u003csup\u003e[12]\u003c/sup\u003e. From a biomechanical perspective, LHBT tenotomy may alter shoulder joint kinematics. Cadaveric studies have shown that when the subscapularis or infraspinatus muscles are dysfunctional, LHBT tenotomy leads to an increase in humeral head anterior translation by 4.6 mm, suggesting its stabilizing role under specific pathological conditions\u003csup\u003e[12]\u003c/sup\u003e. In terms of patient factors, a high BMI and individuals engaged in physically demanding labor are at a higher risk of complications after undergoing tenotomy\u003csup\u003e[7]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTherefore, this study aims to compare the efficacy differences between isolated rotator cuff repair and LHBT tenodesis with tendon release at the bicipital groove, with a focus on postoperative pain scores and functional recovery. The goal is to provide new evidence to guide the choice of LHBT management strategy.\u003c/p\u003e"},{"header":"2 Method","content":"\u003cp\u003e2.1 Data Collection\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Review Committee of Shanxian Central Hospital (Ethics Approval No. LL20240203). A retrospective analysis was conducted on the data of 60 patients who underwent arthroscopic shoulder surgery from June 2024 to December 2024.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInclusion Criteria:\u003c/p\u003e\n\u003cp\u003e1. Clinical and imaging diagnosis of rotator cuff tears accompanied by LHBT inflammation, with subsequent arthroscopic repair treatment.\u003c/p\u003e\n\u003cp\u003e2. Good study compliance, with complete medical records available.\u003c/p\u003e\n\u003cp\u003e3. Signed informed consent after thorough preoperative communication.\u003c/p\u003e\n\u003cp\u003eExclusion Criteria:\u003c/p\u003e\n\u003cp\u003e1. Patients with rotator cuff tears and LHBT inflammation resulting from open injuries or severe polytrauma.\u003c/p\u003e\n\u003cp\u003e2. Patients with cognitive disorders, malnutrition, or other conditions that would preclude them from undergoing surgery.\u003c/p\u003e\n\u003cp\u003e3. Patients with underlying diseases such as local infections or diabetes that could potentially affect postoperative recovery.\u003c/p\u003e\n\u003cp\u003eAmong the 60 patients, 30 underwent isolated rotator cuff repair and were designated as the control group, while the remaining 30 patients underwent rotator cuff repair with LHBT tenodesis and tendon release at the bicipital groove, forming the experimental group. Functional assessments, including the American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Visual Analog Scale (VAS) for pain, were performed preoperatively, at 1 month, 3 months, and 6 months postoperatively.\u003c/p\u003e\n\u003cp\u003eThe study compared the active range of motion (ROM) between the experimental and control groups at preoperative and 3-month postoperative time points. Additionally, intra-group comparisons were made to assess the recovery within the same group. These evaluations aimed to validate the effectiveness of the treatments and assess the functional recovery over time.\u003c/p\u003e\n\u003cp\u003e2.2 Surgical Techniques\u003c/p\u003e\n\u003cp\u003eAll patients were treated by a single orthopedic surgeon (G.C.).\u003c/p\u003e\n\u003cp\u003e2.2.1 Tenodesis\u003c/p\u003e\n\u003cp\u003eUnder general anesthesia, the patient is positioned in the contralateral lateral position, with the affected limb suspended by a traction device holding a 3 kg weight. The arm is positioned in 40\u0026deg; of abduction and 20\u0026deg; of forward flexion for optimal traction. Two bags of 3L saline solution are connected to the arthroscopic system via a Y-shaped connector to facilitate joint space distension. A standard posterior portal is established for arthroscopic access. The joint is examined in sequence from the superior joint surface, LHBT, axillary pouch, to the inferior labrum, confirming the damage to the supraspinatus tendon and LHBT, and checking for associated lesions such as anterior-posterior superior labral injuries or synovial proliferation. Through an anterior portal, synovial proliferation within the joint is debrided, and hemostasis is maintained using a radiofrequency device to ensure clear visualization. Acromioplasty is performed through an anterolateral portal, removing the subacromial bursa and rough tendon tissue, with radiofrequency ablation applied to the anterior, posterior, and lateral edges of the acromion to achieve sufficient decompression. After repairing and securing the rotator cuff, in patients undergoing LHBT tenodesis, the tendon is exposed by pulling it toward the bicipital groove via an anterior portal. Radiofrequency is used to clean the tissue within the groove, and the bone bed is freshened with a burr. A suture anchor with an attached suture is inserted into the bicipital groove. The suture is passed under the LHBT, redirected beneath the tendon to form a half-loop, then threaded through the loop, creating a noose, and the suture ends are tied (Figures 1B and 1C). After completing the first knot and confirming proper tendon tension, additional knots are tied until the LHBT is securely fixed. Finally, the LHBT is cut at the superior labral attachment site (Figure 1D), the joint is irrigated, the wound is closed in layers, and the incision is dressed. Intraoperative images of the LHBT fixation and tendon release are shown in Figures 2A and 2B.\u003c/p\u003e\n\u003cp\u003e2.2.2 Single-Entity Rotator Cuff Repair\u003c/p\u003e\n\u003cp\u003eThe rotator cuff tear at the insertion site of the supraspinatus tendon is repaired using a double-row suture technique, without performing a tenotomy of the long head of the biceps tendon (LHBT). All other procedures are the same as those performed in the tenodesis technique.\u003c/p\u003e\n\u003cp\u003e2.3 Postoperative Management\u003c/p\u003e\n\u003cp\u003eThe postoperative protocol for both groups was identical. During the first 6 weeks, the patients were required to use a shoulder brace for immobilization, with only passive movement allowed for the shoulder and elbow joints. Between 6 and 12 weeks postoperatively, active range-of-motion exercises for the shoulder and elbow joints were initiated. At 3 months postoperatively, patients were permitted to begin full weight-bearing activities for both the shoulder and elbow joints.\u003c/p\u003e\n\u003cp\u003e2.4 Statistical Methods\u003c/p\u003e\n\u003cp\u003eIn this study, statistical analysis was performed using IBM SPSS Statistics version 19.0 software. Descriptive statistics were presented as means \u0026plusmn; standard deviation (SD) for continuous variables and frequencies for categorical data. To compare demographic and clinical characteristics as well as outcomes between the groups, Student\u0026apos;s t-test was used for continuous variables with normal distribution, the Mann-Whitney U test for continuous variables with non-normal distribution, and Fisher\u0026apos;s exact test for nominal data. A p-value of \u0026lt; 0.05 was considered statistically significant. For within-group comparisons at the same time points, differences in the Constant shoulder score, ASES score, and VAS score were evaluated to determine whether post-hoc analysis was required.\u003c/p\u003e"},{"header":"3 Result","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1 Baseline Data Analysis\u003c/h2\u003e\n \u003cp\u003eChi-square test revealed no statistically significant difference in the gender distribution between the two groups (\u0026chi;\u0026sup2; = 0.28, p\u0026thinsp;=\u0026thinsp;0.60). Additionally, there was no significant difference in the BMI values between the experimental and control groups (t\u0026thinsp;=\u0026thinsp;1.80, p\u0026thinsp;=\u0026thinsp;0.08). These results indicate that the baseline characteristics of the two groups are comparable (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e, Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eChi-Square Test for Gender Distribution\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eChi-Square (Cross-Tabulation) Analysis Results\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGroup(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17(56.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(63.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36(60.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(43.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(36.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24(40.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003et-test analysis results for BMI Comparison\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003et-test analysis results\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.03\u0026thinsp;\u0026plusmn;\u0026thinsp;2.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.80\u0026thinsp;\u0026plusmn;\u0026thinsp;2.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2 Group-Specific Efficacy Analysis\u003c/h2\u003e\n \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\n \u003ch2\u003e3.2.1 Improvement in Joint Range of Motion\u003c/h2\u003e\n \u003cp\u003eThe analysis using independent sample t-tests (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e) revealed that in the control group (D), the range of motion (ROM) for each joint (flexion, abduction, lateral external rotation, and internal rotation) significantly improved at 3 months post-surgery compared to preoperative values (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Specifically, the flexion ROM increased from 85.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.97\u0026deg; to 156.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.07\u0026deg; (t = -77.11), and the abduction ROM increased from 70.20\u0026thinsp;\u0026plusmn;\u0026thinsp;8.77\u0026deg; to 156.57\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u0026deg; (t = -51.05). In the experimental group (S), the improvement in each ROM measure at 3 months post-surgery was even more pronounced (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The flexion ROM increased from 84.33\u0026thinsp;\u0026plusmn;\u0026thinsp;5.43\u0026deg; to 159.97\u0026thinsp;\u0026plusmn;\u0026thinsp;4.22\u0026deg; (t = -60.24), and the abduction ROM saw a 147.6% increase, from 64.53\u0026thinsp;\u0026plusmn;\u0026thinsp;4.17\u0026deg; to 159.77\u0026thinsp;\u0026plusmn;\u0026thinsp;4.67\u0026deg; (t = -83.24).\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eIntra-group Range of Motion Differences Analysis\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003et-test Analysis Results\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTime Period (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFlexion D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e156.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-77.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbduction D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.20\u0026thinsp;\u0026plusmn;\u0026thinsp;8.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e156.57\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-51.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLateral External Rotation D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.83\u0026thinsp;\u0026plusmn;\u0026thinsp;4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.07\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-25.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInternal Rotation D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.73\u0026thinsp;\u0026plusmn;\u0026thinsp;3.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-31.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFlexion S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84.33\u0026thinsp;\u0026plusmn;\u0026thinsp;5.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e159.97\u0026thinsp;\u0026plusmn;\u0026thinsp;4.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-60.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbduction S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.53\u0026thinsp;\u0026plusmn;\u0026thinsp;4.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e159.77\u0026thinsp;\u0026plusmn;\u0026thinsp;4.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-83.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLateral External Rotation S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.87\u0026thinsp;\u0026plusmn;\u0026thinsp;3.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-32.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInternal Rotation S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-41.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e\n \u003ch2\u003e3.2.2 Changes in Functional Scores at Multiple Time Points\u003c/h2\u003e\n \u003cp\u003eOne-way analysis of variance (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e) showed that the functional scores of both groups improved in a stepwise manner over time (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In the control group (D), the Constant score increased from 41.87\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24 preoperatively to 91.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54 at 6 months post-surgery (F\u0026thinsp;=\u0026thinsp;3478.88), and the ASES score improved from 41.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82 preoperatively to 90.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23 (F\u0026thinsp;=\u0026thinsp;2815.54). In the experimental group (S), the Constant score at 6 months post-surgery reached 89.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.56 (compared to 43.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.79 preoperatively, F\u0026thinsp;=\u0026thinsp;1202.19), and the ASES score increased to 91.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36 (compared to 42.27\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50 preoperatively, F\u0026thinsp;=\u0026thinsp;1318.25).\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eFunctional Changes at Multiple Time Points\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eANOVA table\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eTime Period (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConstant Shoulder Score D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.87\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3478.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASES D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2815.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVas Score D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e654.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConstant Shoulder Score S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1202.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASES S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.27\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1318.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVas Score S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1164.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e\n \u003ch2\u003e3.2.3 Trend of Pain Relief\u003c/h2\u003e\n \u003cp\u003eThe VAS scores for both groups significantly decreased over time (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In the control group (D), the score decreased from 6.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50 preoperatively to 1.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35 at 6 months post-surgery (F\u0026thinsp;=\u0026thinsp;654.81). In the experimental group (S), the score decreased from 6.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51 preoperatively to 1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18 at 6 months post-surgery (F\u0026thinsp;=\u0026thinsp;1164.12).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\n \u003ch2\u003e3.2.4 Post-hoc Analysis\u003c/h2\u003e\n \u003cp\u003eThe results of the analysis of variance (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e) indicated that significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were observed in the Constant Shoulder Score (D/S), ASES Score (D/S), and VAS scores (D/S) across different time points in both the control group (D) and the experimental group (S), with a total of six indicators showing notable differences. These findings suggest that the clinical evaluation of postoperative functional recovery and symptom improvement exhibited significant changes over time. To further clarify the specific time points of these differences (e.g., comparing 3 months and 6 months post-surgery) and the trend of changes, multiple post-hoc tests are necessary for in-depth analysis.\u003c/p\u003e\n \u003cp\u003eThe results of the analysis of variance combined with post-hoc tests (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e) indicated that significant time effects were observed for the Constant Shoulder Score, ASES score, and VAS score at different time points (1 month, 3 months, and 6 months post-surgery) in both the control group (D) and the experimental group (S) (all p\u0026thinsp;=\u0026thinsp;0.000). Specifically, the functional scores (Constant and ASES) in both groups increased over time, and the differences were significant (Constant-D: F\u0026thinsp;=\u0026thinsp;3478.878, ASES-D: F\u0026thinsp;=\u0026thinsp;2815.538; Constant-S: F\u0026thinsp;=\u0026thinsp;1202.189, ASES-S: F\u0026thinsp;=\u0026thinsp;1318.252). The scores at each postoperative time point followed the order: 6 months\u0026thinsp;\u0026gt;\u0026thinsp;3 months\u0026thinsp;\u0026gt;\u0026thinsp;1 month\u0026thinsp;\u0026gt;\u0026thinsp;preoperative (e.g., in the control group, ASES at 6 months was significantly higher than at 3 months, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Similarly, the VAS scores in both groups decreased over time, with significant differences (VAS-D: F\u0026thinsp;=\u0026thinsp;654.807, VAS-S: F\u0026thinsp;=\u0026thinsp;1164.115), and the score order was preoperative\u0026thinsp;\u0026gt;\u0026thinsp;1 month post-surgery\u0026thinsp;\u0026gt;\u0026thinsp;3 months post-surgery\u0026thinsp;\u0026gt;\u0026thinsp;6 months post-surgery (e.g., in the control group, the VAS score at 6 months was significantly lower than at 3 months, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResults of Multiple Post-hoc Test Analysis\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eResults of Multiple Post-hoc Test Analysis\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(I) Name\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(J) Name\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(I) Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(J) Mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDifference(I-J)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003eConstant Shoulder Score D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-21.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-31.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-49.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-9.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-27.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003eASES D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-20.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-31.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-49.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-10.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-28.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-18.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003eVas Score D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003eConstant Shoulder Score S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-24.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-35.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-46.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-10.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-21.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-10.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003eASES S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-30.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-40.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-49.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-10.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-19.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-8.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"6\"\u003e\n \u003cp\u003eVas Score S\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eThis suggests that within 6 months post-surgery, both the control group (D) and the experimental group (S) experienced continuous improvement in shoulder function, with a faster rate of improvement observed within the first 3 months post-surgery. Furthermore, the pain relief in both groups followed a consistent, gradual time-effect pattern.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003e3.3 Inter-group Efficacy Comparison\u003c/h2\u003e\n \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e\n \u003ch2\u003e3.3.1 Range of Motion\u003c/h2\u003e\n \u003cp\u003eIn the preoperative comparison of range of motion (ROM), a significant inter-group difference was only observed in abduction ROM (control group: 70.20\u0026thinsp;\u0026plusmn;\u0026thinsp;8.77\u0026deg; vs experimental group: 64.53\u0026thinsp;\u0026plusmn;\u0026thinsp;4.17\u0026deg;, t=-3.19, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In the comparison of ROM at 3 months postoperatively, the experimental group demonstrated significantly better ROM in all measured parameters compared to the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The most notable differences were observed in external rotation (66.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15\u0026deg; vs 59.07\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u0026deg;, t\u0026thinsp;=\u0026thinsp;7.27) and internal rotation (65.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.75\u0026deg; vs 58.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.94\u0026deg;, t\u0026thinsp;=\u0026thinsp;8.84) (Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e).\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab6\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003et-test analysis results for the inter-group efficacy comparison\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003et-test analysis results\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTime Period\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eProject\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGroup (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExperimental (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eControl (n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFlexion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84.33\u0026thinsp;\u0026plusmn;\u0026thinsp;5.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.77\u0026thinsp;\u0026plusmn;\u0026thinsp;3.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbduction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.53\u0026thinsp;\u0026plusmn;\u0026thinsp;4.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.20\u0026thinsp;\u0026plusmn;\u0026thinsp;8.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLateral External Rotation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.87\u0026thinsp;\u0026plusmn;\u0026thinsp;3.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.83\u0026thinsp;\u0026plusmn;\u0026thinsp;4.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInternal Rotation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.93\u0026thinsp;\u0026plusmn;\u0026thinsp;2.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.73\u0026thinsp;\u0026plusmn;\u0026thinsp;3.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFlexion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e159.97\u0026thinsp;\u0026plusmn;\u0026thinsp;4.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e156.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAbduction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e159.77\u0026thinsp;\u0026plusmn;\u0026thinsp;4.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e156.57\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLateral External Rotation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.07\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInternal Rotation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003ePreoperative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConstant Shoulder Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.80\u0026thinsp;\u0026plusmn;\u0026thinsp;3.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.87\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.27\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVas Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e1 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConstant Shoulder Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVas Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e3 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConstant Shoulder Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.03\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVas Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-3.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e6 months post-surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConstant Shoulder Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-2.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASES\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.05*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVas Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e\n \u003ch2\u003e3.3.2 Functional Score\u003c/h2\u003e\n \u003cp\u003eThe Constant score (68.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.03 vs 63.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.01, t\u0026thinsp;=\u0026thinsp;7.69) and ASES score (72.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.76 vs 62.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.07, t\u0026thinsp;=\u0026thinsp;16.24) in the experimental group were significantly higher than those in the control group at 1 month postoperatively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). However, in the comparison at 6 months postoperatively, the control group had a slightly higher Constant score than the experimental group (91.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.54 vs 89.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.56, t=-2.75, p\u0026thinsp;=\u0026thinsp;0.01) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e\n \u003ch2\u003e3.3.3 Pain Evaluation\u003c/h2\u003e\n \u003cp\u003eThe VAS score in the experimental group was significantly lower than that in the control group at 3 months postoperatively (2.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25 vs 2.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50, t=-3.27, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). However, at 6 months postoperatively, there was no statistically significant difference in pain scores between the two groups (1.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18 vs 1.13\u0026thinsp;\u0026plusmn;\u0026thinsp;0.35, p\u0026thinsp;=\u0026thinsp;0.17) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThe experimental group demonstrated a significant advantage during the critical recovery period of 1 to 3 months postoperatively, with a range of motion improvement 8.7\u0026ndash;12.3% higher than that of the control group, and a functional score improvement rate 27\u0026ndash;38% faster. By 6 months postoperatively, the two groups' primary outcomes were similar, but the experimental group still maintained an advantage in the ASES score (91.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36 vs 90.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23, p\u0026thinsp;=\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eThis study found that the combined LHBT fixation and tenotomy group had significantly better VAS scores at 3 months postoperatively compared to the simple repair group. This result is highly consistent with the current theory that LHBT pathology acts as an independent pain generator\u003csup\u003e[4,8]\u003c/sup\u003e. In the study by Riccardo et al., it was also pointed out that the sympathetic nerve endings enriched in the proximal LHBT can trigger central sensitization through nociceptive afferent pathways under inflammatory stimulation\u003csup\u003e[7]\u003c/sup\u003e. Furthermore, tenotomy at the supraglenoid tubercle can effectively eliminate the source of pain signals\u003csup\u003e[7,9]\u003c/sup\u003e, providing a histological basis for the more significant early pain relief observed in the tenotomy group of the present study. In terms of the timeliness of pain relief, the experimental group showed a significant advantage in VAS scores as early as 1 month postoperatively. Tendon tenotomy, by blocking nociceptive afferent fibers, resulted in a faster analgesic effect compared to simple decompression. However, the present study found no difference in VAS scores between the two groups at 6 months postoperatively, suggesting that as synovial inflammation naturally subsides, both surgical methods ultimately achieve similar levels of pain relief. This phenomenon aligns with the conclusions of Chunsen et al., who indicated that different LHBT treatment methods have limited impact on long-term pain outcomes\u003csup\u003e[16]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe functional score differences at 3 months postoperatively showed that the experimental group had significantly higher Constant and ASES scores, which may be related to the dynamic stabilizing effect produced by LHBT fixation. A cadaveric study by J. Christoph et al. demonstrated that when the subscapularis muscle is dysfunctional, the preserved LHBT can increase anterior stability by up to 5.2 N\u003csup\u003e[12]\u003c/sup\u003e. This biomechanical compensation may play an important role in the early postoperative rehabilitation phase. However, at 6 months postoperatively, the functional scores of both groups converged. This may be due to the completion of rotator cuff healing and increased compensation by the deltoid muscle, which gradually reduces the stabilizing effect of the LHBT\u003csup\u003e[12]\u003c/sup\u003e. Notably, the control group showed delayed recovery of external rotation ROM at 6 months, which could be related to untreated LHBT pathology causing alterations in glenohumeral joint kinematics. This suggests that in cases of significant LHBT damage, simple rotator cuff repair may prolong the functional recovery period \u003csup\u003e[20]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn current clinical practice, compared to simple rotator cuff repair, LHBT tenotomy and tendon fixation are the two most commonly used surgical approaches for treating rotator cuff (RC) injuries combined with LHBT pathology. Each method has its own indications, advantages, and disadvantages\u003csup\u003e[21,22]\u003c/sup\u003e. Based on existing evidence, the choice of surgical technique should be individualized. LHBT tenotomy is considered suitable for older patients with lower activity demands due to its shorter operative time and simpler rehabilitation \u003csup\u003e[14,23]\u003c/sup\u003e. On the other hand, tendon fixation, which reduces the risk of deformity and better preserves rotational strength, is more appropriate for younger patients with higher activity demands\u003csup\u003e[17,24,25]\u003c/sup\u003e. In addition, the preoperative acromiohumeral distance (ACD) is an important prognostic indicator. Patients with an ACD\u0026thinsp;\u0026gt;\u0026thinsp;10 mm experience more significant functional improvement postoperatively, suggesting that ACD measurement should be incorporated into the preoperative assessment protocol\u003csup\u003e[26]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this study, although both rotator cuff repair combined with LHBT fixation and simple rotator cuff repair achieved significant improvements in pain relief and functional recovery, the relatively short follow-up period may explain the absence of significant \"Popeye Deformity\" and muscle spasms in the 60 patients included in the experiment. The main complications observed during the follow-up were local swelling, pain, and short-term activity limitations. For tendon fixation, with enhanced rehabilitation therapy, patients typically achieve good functional recovery and reduce the risk of long-term postoperative complications\u003csup\u003e[21,23,27,28]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, the sample size in this study was relatively small (30 cases per group), which may have limited the statistical power and made it difficult to account for the influence of individual variability on the results. Second, the retrospective design is inherently subject to bias, such as potential non-random group assignment influenced by factors like imbalances in baseline disease severity, as well as insufficient control of confounding variables (e.g., age, activity level, and comorbidities). Third, the follow-up period was limited to 6 months postoperatively, preventing the evaluation of long-term outcomes and complications, such as re-tear rates or the progression of LHBT pathology. The conclusion that the experimental and control groups showed comparable efficacy at 6 months may therefore require validation through longer-term observation. Additionally, the outcome measures focused primarily on subjective scores and range of motion, lacking objective imaging data (e.g., MRI assessment of rotator cuff healing). In summary, the generalizability of the study's findings may be limited. Further prospective studies with larger sample sizes, extended follow-up durations, and multidimensional assessments are warranted to substantiate these results.\u003c/p\u003e \u003cp\u003eBased on the results of this study, we propose the following clinical practice recommendations. For young patients with high activity demands and coexisting subscapularis muscle injury, LHBT fixation with tenotomy should be prioritized to achieve early functional recovery.For elderly patients who are more pain-sensitive and have poor rehabilitation tolerance, simple rotator cuff repair combined with precise postoperative closure treatment can be considered as an alternative.Intraoperatively, a thorough assessment of the degree of LHBT degeneration should be performed. For grade III or higher lesions, combined treatment is recommended to avoid the risk of secondary surgery.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study confirms that in rotator cuff repair with concomitant LHBT injury, LHBT fixation with tenotomy significantly improves early postoperative pain relief and functional recovery compared to simple repair. Its biomechanical advantage is reflected in better maintenance of superior shoulder stability. However, follow-up at 6 months postoperatively shows that the functional outcomes of both surgical methods converge, suggesting that clinical decision-making should take into account factors such as patient age, activity demands, and tissue quality. Future research should validate the optimal treatment strategies for different pathological classifications through multi-center, large-sample cohorts.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets during and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent has been obtained from all participants in this study.\u0026nbsp;All procedures performed in studies involving human participants were in accordance with the ethical standards of the Shan County Central Hospital Research Committee, as well as the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Shan County Central Hospital Research Committee (Approval No. LL20240203).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur research has not received any financial support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZihao Zhou completed the writing of the entire article.\u003c/p\u003e\n\u003cp\u003eGuanhong Chen and Han Zhang were responsible for the editing of the article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStephanie A, Kellen W, J W P\u003cem\u003e, et al.\u003c/em\u003e Comparing Conventional Double-Row With Transosseous Equivalent Suture Bridge Fixation in Arthroscopic Rotator Cuff Repairs: A Multicenter Retrospective Cohort Study[J]. Orthop J Sports Med, 2025, 13(1).\u003c/li\u003e\n\u003cli\u003eCastagna A, Campeggi T, Minelli M\u003cem\u003e, et al.\u003c/em\u003e Patient-Reported Outcomes After Arthroscopic Single-Row Rotator Cuff Repair: A Monocentric Retrospective Study at Minimum 12 Years Follow-Up[J]. Journal of clinical medicine, 2025, 14(1).\u003c/li\u003e\n\u003cli\u003eAltamimi T, Alkathami A, Al-Awn R\u003cem\u003e, et al.\u003c/em\u003e A Narrative Review of Rotator Cuff Tear Management: Surgery Versus Conservative Treatment[J]. Cureus, 2024, 16(12): e74988.\u003c/li\u003e\n\u003cli\u003eAlessander D A, Edoardo G D S, Nicolas B\u003cem\u003e, et al.\u003c/em\u003e Both Isolated Long Head of the Biceps Tenotomy and Tenodesis Are Effective for Symptomatic Rotator Cuff Repair Revision[J]. J Clin Med, 2025, 14(3).\u003c/li\u003e\n\u003cli\u003eZolt\u0026aacute;n N, Csenge A M, Norbert S\u003cem\u003e, et al.\u003c/em\u003e Scapula dyskinesis in medium-sized full-thickness rotator cuff tear after subacromial Lidocaine infiltration and rotator cuff reconstruction[J]. J Exp Orthop, 2025, 12(1).\u003c/li\u003e\n\u003cli\u003eNicholas P J P, Jennifer S, Andrew H\u003cem\u003e, et al.\u003c/em\u003e Editorial Commentary: Shoulder Long Head of the Biceps Tendon Transposition Without Tenotomy May Be a Beneficial Augment for Massive Rotator Cuff Tear Repair[J]. Arthroscopy, 2023, 40(1).\u003c/li\u003e\n\u003cli\u003eRiccardo R, Marko N, Li X\u003cem\u003e, et al.\u003c/em\u003e Complications of Long Head of the Biceps Tenotomy in Association with Arthroscopic Rotator Cuff Repair: Risk Factors and Influence on Outcomes[J]. J Clin Med, 2022, 11(19).\u003c/li\u003e\n\u003cli\u003eSong K, Lu G, Cai M\u003cem\u003e, et al.\u003c/em\u003e The Clinical Outcomes of Arthroscopic Tenotomy versus Tenodesis with Medium-to-Massive Rotator Cuff Tear in the Elderly: A Retrospective Study[J]. Clinical interventions in aging, 2025, 20: 33-42.\u003c/li\u003e\n\u003cli\u003eJavier A, Kassem G, Theresa P\u003cem\u003e, et al.\u003c/em\u003e Long head of biceps tendon management in the setting of massive rotator cuff tears[J]. JSES Rev Rep Tech, 2024, 4(4).\u003c/li\u003e\n\u003cli\u003eLuca Maria S, Domenico A, Carmelo M\u003cem\u003e, et al.\u003c/em\u003e Ultrasound-Guided Percutaneous Tenotomy of the Long Head of Biceps Tendon in Patients with Symptomatic Complete Rotator Cuff Tear: In Vivo Non-contRolled Prospective Study[J]. J Clin Med, 2020, 9(7).\u003c/li\u003e\n\u003cli\u003eGovender S, Jessica Y C, Chris M\u003cem\u003e, et al.\u003c/em\u003e A biomechanical study on the effect of long head of biceps tenotomy on supraspinatus load and humeral head position during shoulder abduction[J]. J Shoulder Elbow Surg, 2022, 31(6).\u003c/li\u003e\n\u003cli\u003eJ Christoph K, Jens W, Christoph P\u003cem\u003e, et al.\u003c/em\u003e The Long Head of the Biceps Has a Stabilizing Effect on the Glenohumeral Joint in Simulated Infraspinatus or Subscapularis but Not Supraspinatus Rotator Cuff Deficiency: A Biomechanical Study[J]. Arthroscopy, 2023, 40(4).\u003c/li\u003e\n\u003cli\u003eM\u0026aacute;ty\u0026aacute;s V, Lajos S, P\u0026eacute;ter H\u003cem\u003e, et al.\u003c/em\u003e Tenodesis yields better functional results than tenotomy in long head of the biceps tendon operations-a systematic review and meta-analysis[J]. Int Orthop, 2022, 46(5).\u003c/li\u003e\n\u003cli\u003eBilal S S, Michael C D, Stephen M G\u003cem\u003e, et al.\u003c/em\u003e Biceps tenotomy vs. tenodesis: an ACS-NSQIP analysis of postoperative outcomes and utilization trends[J]. JSES Int, 2024, 8(4).\u003c/li\u003e\n\u003cli\u003eAlexander William H, Raisa I, Kar Hao T\u003cem\u003e, et al.\u003c/em\u003e Clinical effectiveness of tenotomy versus tenodesis for long head of biceps pathology: a systematic review and meta-analysis[J]. BMJ Open, 2022, 12(10).\u003c/li\u003e\n\u003cli\u003eChunsen Z, Guang Y, Tao L\u003cem\u003e, et al.\u003c/em\u003e Biceps Tenodesis Better Improves the Shoulder Function Compared with Tenotomy for Long Head of the Biceps Tendon Lesions: A Meta-Analysis of Randomised Controlled Trials[J]. J Clin Med, 2023, 12(5).\u003c/li\u003e\n\u003cli\u003eJarret M W, Sheila M B M, Peter L L\u003cem\u003e, et al.\u003c/em\u003e Effect of age, gender, and body mass index on incidence and satisfaction of a Popeye deformity following biceps tenotomy or tenodesis: secondary analysis of a randomized clinical trial[J]. J Shoulder Elbow Surg, 2021, 30(8).\u003c/li\u003e\n\u003cli\u003eAbdulaziz F A, Ammar T, Shady M\u003cem\u003e, et al.\u003c/em\u003e Long head of biceps tenotomy versus tenodesis: a systematic review and meta-analysis of randomized controlled trials[J]. Shoulder Elbow, 2021, 13(6).\u003c/li\u003e\n\u003cli\u003eSanjay S D, Hari Krishna M. Long Head of Biceps Tendon Pathology and Results of Tenotomy in Full-Thickness Reparable Rotator Cuff Tear[J]. Arthroscopy, 2017, 33(11).\u003c/li\u003e\n\u003cli\u003eRyan C R, Amir J, Andreas K\u003cem\u003e, et al.\u003c/em\u003e The role of the long head of the biceps tendon in posterior shoulder stabilization during forward flexion[J]. J Shoulder Elbow Surg, 2022, 31(6).\u003c/li\u003e\n\u003cli\u003eHongzhi L, Xinqiu S, Pei L\u003cem\u003e, et al.\u003c/em\u003e Clinical Outcomes of Arthroscopic Tenodesis Versus Tenotomy for Long Head of the Biceps Tendon Lesions: A Systematic Review and Meta-analysis of Randomized Clinical Trials and Cohort Studies[J]. Orthop J Sports Med, 2021, 9(4).\u003c/li\u003e\n\u003cli\u003eHyun Gon K, Su Cheol K, Jong Hun P\u003cem\u003e, et al.\u003c/em\u003e The Incidence of Popeye Deformity After Soft-Tissue Biceps Tenodesis Is Comparable to Biceps Anchor Tenodesis and Lower Than Biceps Tenotomy During Arthroscopic Rotator Cuff Repair[J]. Arthroscopy, 2024(0).\u003c/li\u003e\n\u003cli\u003eKaihang S, Guanghua L, Ming C\u003cem\u003e, et al.\u003c/em\u003e The Clinical Outcomes of Arthroscopic Tenotomy versus Tenodesis with Medium-to-Massive Rotator Cuff Tear in the Elderly: A Retrospective Study[J]. Clin Interv Aging, 2025, 20(0).\u003c/li\u003e\n\u003cli\u003eRaffy M, Christopher M, Rebecca K B\u003cem\u003e, et al.\u003c/em\u003e Risk Factors and Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon[J]. Orthop J Sports Med, 2020, 8(2).\u003c/li\u003e\n\u003cli\u003eRaphael T, Stefan D, Marco E\u003cem\u003e, et al.\u003c/em\u003e Subpectoral biceps tenodesis with BicepsButton fixation in the young population: which technique works best?[J]. J Shoulder Elbow Surg, 2023, 32(6).\u003c/li\u003e\n\u003cli\u003eEgbert J D V, Ashvin V B, Ronald L D\u003cem\u003e, et al.\u003c/em\u003e Arthroscopic isolated long head of biceps tenotomy in patients with degenerative rotator cuff tears: mid-term clinical results and prognostic factors[J]. Eur J Orthop Surg Traumatol, 2020, 31(3).\u003c/li\u003e\n\u003cli\u003ePablo Ca\u0026ntilde;ete San P, Inmaculada Prosper R, Alberto Garcia R\u003cem\u003e, et al.\u003c/em\u003e Long head of biceps tendon augmentation in rotator cuff repair enhances tendon healing, shoulder function and patient-reported outcomes one-year post-surgery[J]. J Exp Orthop, 2024, 11(4).\u003c/li\u003e\n\u003cli\u003eChen-Hao C, Wei H, Chang-Hao L\u003cem\u003e, et al.\u003c/em\u003e Modified arthroscopic intra-articular transtendinous looped biceps tenodesis leads to satisfactory functional outcomes and less frequent Popeye deformity compared to biceps tenotomy[J]. J Orthop Surg Res, 2023, 18(1).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Long Head of the Biceps Tendon, rotator cuff tear, arthroscopy, rotator cuff repair, surgical procedure","lastPublishedDoi":"10.21203/rs.3.rs-6494443/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6494443/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eRotator cuff tear patients are often accompanied by long head biceps tendon (LHBT) pathology, but the management strategy for LHBT during arthroscopic rotator cuff repair (ARCR) remains controversial. This study aimed to compare the therapeutic efficacy between isolated rotator cuff repair and LHBT tenodesis with tendon release. A retrospective cohort of 60 patients with rotator cuff tears and LHBT inflammation was included, divided into a control group (isolated repair, 30 cases) and an experimental group (LHBT tenodesis with tendon release, 30 cases). Functional scores (Constant, ASES), pain (VAS), and range of motion (ROM) were assessed preoperatively and at 1, 3, and 6 months postoperatively. The results indicated that the experimental group demonstrated significantly greater improvement in joint ROM at 3 months postoperatively compared to the control group (flexion: 159.97\u0026deg; vs. 156.43\u0026deg;, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01; external rotation: 66.30\u0026deg; vs. 59.07\u0026deg;, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Functional scores improved more rapidly in the experimental group between 1 and 3 months postoperatively (Constant score at 1 month: 68.50 vs. 63.40, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and the VAS score at 3 months was significantly lower in the experimental group (2.07 vs. 2.40, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). However, at 6 months postoperatively, the functional scores of both groups converged (Constant score: 89.83 vs. 91.33, p\u0026thinsp;=\u0026thinsp;0.01), and there was no significant difference in pain relief. The study suggests that LHBT tenodesis with tendon release significantly enhances early postoperative functional recovery and pain alleviation. This mechanism may be related to the increased dynamic stability of the shoulder joint due to LHBT fixation and the reduction of proximal neurogenic pain signals following tendon release. However, long-term outcomes are comparable to isolated rotator cuff repair, indicating that clinical decision-making should be individualized based on patient age, activity level, and the degree of LHBT pathology.\u003c/p\u003e","manuscriptTitle":"Innovations in Rotator Cuff Repair: LHBT Tenodesis Accelerates Postoperative Functional Recovery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-03 07:03:37","doi":"10.21203/rs.3.rs-6494443/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-05-28T13:33:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-19T05:49:13+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-28T10:04:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-25T13:36:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2025-04-25T13:35:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"95ccba68-1429-4bd3-98cb-2a15b71835ee","owner":[],"postedDate":"June 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-06-03T07:03:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-03 07:03:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6494443","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6494443","identity":"rs-6494443","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}