Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodesis

Werner, Brian C.; Evans, Cody L.; Holzgrefe, Russel E.; Tuman, Jeffrey M.; Hart, Joseph M.; Carson, Eric W.; Diduch, David R.; Miller, Mark D.; Brockmeier, Stephen F.

doi:10.1177/0363546514547226

Cited by 139 publications

(63 citation statements)

References 79 publications

(86 reference statements)

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“…7,11,14,24,27,30 One reason for this school of thought is that younger patients may be more concerned with the cosmesis of a Popeye sign, should it develop. In the current study, 7 tenotomies were performed on the “cosmetically concerned” demographic, age 40 to 49 years.…”

Section: Discussionmentioning

confidence: 99%

“…3,5,7,11,16,24 Advantages of tenodesis include closer approximation of the normal muscle-tendon length, which can minimize the Popeye sign (cosmesis) and cramping pain, as well as potentially improved ability to return to physical activity requiring biceps force. 11,14,24,27,28 On the other hand, the downsides of tenodesis include longer healing times, implant costs, postoperative stiffness, persistent pain, and risks of subsequent failure, fracture, and neurovascular injury. 12,19,20,21,28 Selection criteria for each procedure are often driven by a surgeon’s personal algorithm and experience as well as the age, activity level, and desires of the patient.…”

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confidence: 99%

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Patient Satisfaction After Biceps Tenotomy

Meeks

Froehle

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Biceps tenotomy and tenodesis are frequently performed for proximal biceps lesions; however, there continues to be debate as to which method is superior. This study examined patient-reported outcomes after biceps tenotomy.Hypothesis:Biceps tenotomy in the setting of concomitant shoulder pathology is a reasonable option with high satisfaction rates and a low incidence of pain and cramping in middle-aged to older individuals.Study Design:Case series; Level of evidence, 4.Methods:A total of 104 patients (mean age, 63.5 years; range, 40-81 years) were evaluated at the time of surgery and at a mean follow-up of 38.4 months (range, 22-57 months). Biceps tenotomy was performed as a component of more extensive shoulder surgery in all patients. Patient satisfaction, frequency of cramping and spasms, biceps pain, weakness, and cosmetic deformity were evaluated at over 1-year follow-up.Results:Ninety-one percent of patients were satisfied or very satisfied with their surgical outcome, and 95% would have their surgery again. Three patients who reported being unsatisfied or very unsatisfied had either advanced glenohumeral arthritis or an irreparable rotator cuff tear. Cosmetic deformity occurred in 13% of patients. Twenty percent reported spasms and cramping in their biceps, and 19% reported some biceps pain; however, frequency of spasms and cramping was typically once weekly, and biceps pain was reported as severe or very severe in only 2 patients. Subjective biceps weakness was reported in 17% of patients. Age had no effect on outcome measures, and female sex was associated with less limitation and greater satisfaction after tenotomy compared with men.Conclusion:Our results indicate that patient-reported downsides to biceps tenotomy were usually mild and/or infrequent and did not affect patient satisfaction. We conclude that biceps tenotomy is a viable option that can lead to a high rate of patient satisfaction and outcomes in middle-aged to older individuals undergoing shoulder surgery with biceps pathology.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Patient Satisfaction After Biceps Tenotomy

Meeks

Froehle

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…LHB tenodesis can be positioned on the bicipital groove, the “suprapectoral” position below the bicipital groove at the superior border of the pectoralis major tendon, the subpectoral position, or on others such as the conjoint tendon, cuff or soft tissue by means of suture fixation. 14 It can be performed under arthroscopy proximally on the groove but several authors report residual pain from the so-called “hidden lesions,” or pathologic LHB that is left in the gutter unreleased from its sheath, which turn the subpectoral fixation an attractive option. 15 , 16 , 17 Likewise, a subpectoral fixation eliminates any further sawing of the LHB tendon through the rotator cuff tendons.…”

Section: Discussionmentioning

confidence: 99%

Long Biceps Subpectoral Tenodesis With Suspensory Button and Bicortical Fixation

Gomes

Silva

Pereira

et al. 2017

Arthroscopy Techniques

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Tenodesis of the long head of the biceps (LHB) tendon has long been recognized as a valid alternative to address pathologic conditions of this tendon. However, the location and type of fixation is still a matter of discussion, because common complications associated with this procedure include failure of the repair, persistent pain, reaction to the fixation device, cosmetic deformity, and fracture. The authors describe a method of subpectoral LHB tenodesis that aims to preserve bone stock and allows a strong, easy, and reproducible type of fixation with a minimal approach. LHB tenotomy is performed arthroscopically in a standard fashion, and the tenodesis is completed with bicortical fixation in the humerus using a knotless suspensory button with an appropriate pusher originally developed for another purpose. Magnetic resonance imaging showed a safe distance between the implant and important vasculonervous structures. In the cases where subpectoral fixation is chosen, this method seems to offer additional safety as a result of the minimal amount of bone removed and the very small size of the implant.

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“…1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 Published studies comparing open subpectoral with arthroscopic tenodesis have shown mixed results. 13 , 14 , 15 However, a recent systematic review 3 demonstrated no significant differences when techniques were compared. Even for surgeons who prefer open subpectoral tenodesis, the described technique for identification and exposure of the proximal biceps tendon can still offer potential benefits as it facilitates both visual assessment of the entire course of the biceps and subsequent externalization of the biceps tendon by allowing for release of biceps adhesions within the groove.…”

mentioning

confidence: 99%

“… 11 , 12 Alternatively, an open, subpectoral tenodesis technique can be used. 1 , 2 , 3 , 6 , 13 , 15 Proponents of the open subpectoral technique argue that it eliminates the risk of residual tenosynovitis by completely removing the tendon from the biceps groove. Reported complications using this open subpectoral technique, however, include infection, nerve injury, and fracture.…”

mentioning

confidence: 99%

Identifying and Exposing the Proximal Biceps in Its Groove: The “Slit” Technique

Mazoch

Frevert

Field

2017

Arthroscopy Techniques

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Proximal biceps tendon pathology is a common source of shoulder symptoms. Thus, visualization of the entire extent of the biceps tendon is often required for both diagnostic and therapeutic purposes. Accurately recognizing the presence and extent of biceps pathology intraoperatively is made more difficult, however, due to the extra-articular location of a significant portion of the biceps tendon as it courses within the bicipital groove. Unfortunately, identification of the biceps groove in the subacromial space is often challenging due to the lack of visual and tactile landmarks. A technique that facilitates efficient and reliable bicipital groove identification and biceps tendon visualization along its entire course within the groove is presented.

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Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodesis

Cited by 139 publications

References 79 publications

Patient Satisfaction After Biceps Tenotomy

Patient Satisfaction After Biceps Tenotomy

Long Biceps Subpectoral Tenodesis With Suspensory Button and Bicortical Fixation

Identifying and Exposing the Proximal Biceps in Its Groove: The “Slit” Technique

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