All-Arthroscopic Suprapectoral Versus Open Subpectoral Tenodesis of the Long Head of the Biceps Brachii

Abstract

Objectives: Pathology of the long head of the biceps tendon is a recognized source of shoulder pain in adults that can be treated with tenotomy or tenodesis when non-operative measures are not effective. It is not clear whether arthroscopic or open biceps tenodesis has a clinical advantage. To date, we are not aware of any studies that directly compare clinical outcomes between an arthroscopic and an open technique for tenodesis of the long head of the biceps brachii. The purpose of this study was to determine whether a difference in outcomes and complications exists between matched cohorts after biceps tenodesis utilizing an open subpectoral versus an allarthroscopic suprapectoral technique. Methods: A prospective database was reviewed for patients undergoing an all-arthroscopic suprapectoral or open subpectoral biceps tenodesis. Adult patients with a minimum 18-month follow-up were included. Patients undergoing a concomitant rotator cuff or labral repair were excluded. The groups were matched to age within 3 years, sex, and time to follow-up within 3 months. Pain improvement, development of a popeye deformity, muscle cramping, post-operative ASES scores, satisfaction scores, and complications were evaluated. Results: Forty-six patients (23 all-arthroscopic, 23 open) patients with an average age of 57.2 years (range, 45-70) were evaluated at a mean 28.7 months (range, 18-42) follow-up. No patients in either group developed a popeye deformity or complained of arm cramping. There was no significant difference in mean ASES scores between the open and all-arthroscopic groups (92.7 vs. 88.9, P = 0.42, Table 1). Similarly, there was no significant difference between patient satisfaction scores (8.9 vs. 9.1, P = 0.73). Eighteen patients (78.3%) in the arthroscopic cohort and sixteen patients (69.6%) in the open cohort fully returned to athletic activity (P = 0.50). There were no complications in the all-arthroscopic group. There were two complications in the open group (superficial incisional erythema, and brachial plexopathy) that resolved by final follow-up. Conclusion: Biceps tenodesis is a reliable treatment option for pathology of the long head of the biceps that may avoid arm cramping and a cosmetic "popeye" deformity that can occur following tenotomy. Open subpectoral and all-arthroscopic suprapectoral are two commonly used techniques to reattach the biceps tendon distal to the bicipital groove. In this study, patients undergoing an all-arthroscopic tenodesis experienced similar pain relief, shoulder function, and return to athletic activity as patients undergoing an open tenodesis. An open subpectoral technique may increase the risk of complications secondary to a larger incision and increased surgical dissection. Larger studies with longer follow-up would help delineate the long-term effects and potential differences between an allarthroscopic suprapectoral and open subpectoral biceps tenodesis.

Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodeses Produce Similar Outcomes: A Randomized Prospective Analysis

“…However, investigators in a few studies, such as ours, directly compared clinical outcomes after ASPBT and OSPBT. 12,19 In a retrospective study of clinical outcomes after ASPBT and OSPBT performed using an interference screw, Werner et al 12 published results similar to ours. Their study included 32 patients in the ASPBT group and 50 patients in the OSPBT group, with a minimum 2-year follow-up period.…”

“…11 Several clinical studies have compared ASPBT and OSPBT directly; however, they have been retrospective in nature. 12,19 The purpose of this investigation was to directly compare subjective and objective outcomes of ASPBT below the bicipital groove and OSPBT performed with interference screw fixation. Our hypothesis was that there would be no clinical difference in shoulder outcome scores, biceps function, pain relief, and complications with the application of the ASPBT and OSPBT surgical techniques.…”

“…To determine the minimal number of patients per group, an a priori power analysis was performed (G*Power 3; Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany). A minimal clinically important difference of 12 points was used for the ASES score as the group difference, 20 and considering the range of ASES score deviations, 9,19,25 a standard deviation (SD) of 9 was assumed. A minimum of 16 patients per group provides 95% power to detect the minimal clinically important difference at a significance level of .05.…”

Subscapularis Tendon Tears: Classification, Diagnosis and Repair

“…Some authors described other techniques of biceps tenodesis according to the bone fixation: the tendon can be tenodesed beneath the pectoralis tendon and removed entirely from the bicipital groove [35]. Controversies still exist regarding the best localization for the biceps tenodesis [36][37][38][39][40][41][42].…”

Editorial Commentary: Back to Work After Shoulder Biceps Tenodesis!!

“…They did not report the time taken to return to the previous level of activity, however. Gombera et al 8 compared patients who underwent arthroscopic suprapectoral tenodesis with open subpectoral tenodesis. They had 23 patients in both groups: 78.3% of patients in the arthroscopic suprapectoral tenodesis group could fully return to athletic activities, and 69.6% of patients in the open tenodesis group could fully return to athletic activities.…”