Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodesis: A Comparison of Minimum Two Year Clinical Outcomes

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

doi:10.1177/2325967114s00061

Cited by 43 publications

(89 citation statements)

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“…In addition, the mean postoperative SANE was 89.9 (±15.3)., indicating a high level of satisfaction with the outcome of the procedure. These data were similar to those reported in previous series on isolated subpectoral tenodesis [42,43] [42]. Though many surgeons believe that a patient age over 65 is a contraindication to biceps tenodesis, the present study did not show an increased incidence of complications in this specific patient population whereas confirm the satisfactory outcomes previously reported in younger patients.…”

Section: Discussionsupporting

confidence: 92%

Open subpectoral biceps tenodesis in patients over 65 does not result in an increased rate of complications

Voß¹,

Cerciello

Dyrna³

et al. 2017

Revue de Chirurgie Orthopédique et Traumatologique

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Background: Long head biceps tendon pathology is a common cause of anterior shoulder pain and is often associated with other shoulder conditions, such as rotator cuff tears and osteoarthritis. It is well accepted that older patients are at increased risk for major and minor peri-and postoperative complications. The purpose of this study is to investigate patients over 65 years old who underwent subpectoral biceps tenodesis and compare the complication rates of this group to those of patients younger than 65 years old. The hypothesis is, that there would be no difference in complication rates and that clinical outcome scores for patients over 65 were satisfying and showed improvements over time. Methods: There were 337 patients who underwent open subpectoral biceps tenodesis, between January 2005 and June 2015, 23 were identified as being over the age of 65 with a minimum follow up of 12 months. All patients over the age of 65 were evaluated pre-and postoperatively using Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), Constant-Murley (CM) and Single Assessment Numeric Evaluation (SANE). Intraoperative and postoperative adverse events (fracture, infection, wound opening, rupture/failure and neurovascular injuries) related to the tenodesis procedure and to the surgery itself were collected from all 337 patients in a routine postoperative follow-up. Results: The under 65 group (range 27-64 years) at an average follow up (FU) of 30 months (range 12-91 months) showed a 5.4% (17 out of 314) post-operative complication rate related to the subpectoral tenodesis, whereas the group over 65 (range 65-77 years) at an average follow up of 33 months (range 12-79 months) showed an 8.7% (2 out of 23) complication rate. Conclusion: This study demonstrates that in patients over the age of 65, biceps tenodesis is a successful procedure when performed for biceps tendinopathy and concomitantly with other surgical procedures of the shoulder, and does not result in an increased rate of complications when compared to a group of patients under the age of 65.

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Section: Discussionsupporting

confidence: 92%

Open subpectoral biceps tenodesis in patients over 65 does not result in an increased rate of complications

Voß¹,

Cerciello

Dyrna³

et al. 2017

Revue de Chirurgie Orthopédique et Traumatologique

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“…33 The findings in this series are similar to those reported in the literature. Werner et al 35 In the 17 patients, the mean ASES score at an average 28-month follow-up was 78. They reported no instances of a change in the contour of the arm and no substantial complications.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2015

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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.

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“…9,10 Although there have been several biomechanical analyses of differing tenodesis techniques, 6,7,11,12 compelling clinical data showing the superiority of one technique over another have not yet been presented. Patzer et al 7 described a similar technique with a lasso loop Orthocord suture (DePuy Mitek, Raynham, MA) and a SwiveLock anchor (Arthrex).…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Both open subpectoral and arthroscopic tenodesis techniques have been advocated in the literature. [3][4][5][6][7][8][9] In a biomechanical study comparing these 2 techniques, Mazzocca et al 6 found no difference in cyclic loading or yield to failure using different interference screw tenodesis strategies. In addition, no clinical difference has been found between arthroscopic suprapectoral biceps tenodesis and open subpectoral biceps tenodesis.…”

mentioning

confidence: 99%

“…In addition, no clinical difference has been found between arthroscopic suprapectoral biceps tenodesis and open subpectoral biceps tenodesis. 9,10 We present a simple surgical technique for allarthroscopic tenodesis of the long head of the biceps above the pectoral major insertion and at the top of the biceps groove using a 1.5-mm LabralTape (Arthrex, Naples, FL) lasso loop technique and a single 2.9-mm BioComposite interference screw (2.9-mm PushLock anchor; Arthrex). Advantages with our technique include increased biomechanical fixation with LabralTape compared to suture tying, maintenance of appropriate tendon length and strain, ease of tenodesis, and absence of knot tying.…”

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confidence: 99%

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A Simple, All-Arthroscopic, Knotless Suture Lasso Loop Technique for Suprapectoral Biceps Tenodesis

Saper

2017

Arthroscopy Techniques

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A variety of pathology of the long head of the biceps tendon can contribute to anterior shoulder pain in adults that can be managed with either arthroscopic tenotomy or tenodesis when conservative treatment fails. Biceps deformity or the Popeye sign is a major concern in patients after tenotomy. Biceps tenodesis can be performed in a variety of ways with different sized anchors and at different locations (suprapectoral or subpectoral). Several studies have shown that patient outcomes and complication rates are similar between all-arthroscopic suprapectoral biceps tenodesis and open subpectoral biceps tenodesis. We describe a simple, knotless, arthroscopic intra-articular biceps tenodesis technique using a 1.5-mm LabralTape lasso loop technique and a 2.9-mm PushLock anchor.S urgical intervention for pathology of the long head of the biceps has been well established in the literature. Although simple biceps tenotomy may yield good results, biceps tenodesis may offer increased patient satisfaction and a lower incidence of undesirable Popeye deformity and biceps cramping.

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Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodesis: A Comparison of Minimum Two Year Clinical Outcomes

Cited by 43 publications

References 0 publications

Open subpectoral biceps tenodesis in patients over 65 does not result in an increased rate of complications

Open subpectoral biceps tenodesis in patients over 65 does not result in an increased rate of complications

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

A Simple, All-Arthroscopic, Knotless Suture Lasso Loop Technique for Suprapectoral Biceps Tenodesis

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