The rate and reporting of fracture after biceps tenodesis: A systematic review

Huddleston, Hailey P.; Kurtzman, Joey S.; Gedailovich, Samuel; Koehler, Steven M.; Aibinder, William R.

doi:10.1016/j.jor.2021.11.014

Cited by 5 publications

(10 citation statements)

References 89 publications

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“…12 In the literature, rates of proximal humeral fracture after subpectoral bicep tenodesis has been reported at an incidence of 7.9 per 10,000 cases and overall rate around 0.5% to 1.4%. 3,20,21 Additionally, Parisien et al found that the risk for proximal humeral fracture was increased in open tenodesis when compared to an arthroscopic approach. 21 Our study aimed to examine humeral morphology at the subpectoral region and determine regions for safe drilling of cortical tunnels to avoid the incidence of stress risers.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 One important, however disastrous complication is proximal humeral shaft fractures at the tenodesis site. 3,4…”

Section: Introductionmentioning

confidence: 99%

“…13 A systematic review on the fracture rate in biceps tenodesis was unable to determine the effect of surgical approach on the fracture rate due to a lack of granular data. 3…”

Section: Introductionmentioning

confidence: 99%

“…2 As with all procedures, biceps tenodesis carries the risk of complications with an incidence found to be 12.9% with common complications including adhesive capsulitis, dislocation, wound infection, delayed healing, neurovascular injury, and anterior shoulder pain. 3,4 One important, however disastrous complication is proximal humeral shaft fractures at the tenodesis site. 3,4 Proximal humerus fractures, while a rare complication, has been well-documented in the literature from case reports and as part of larger studies.…”

Section: Introductionmentioning

confidence: 99%

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Subpectoral proximal humeral anatomy: Guidance to decrease risk of fracture following subpectoral biceps tenodesis

et al. 2023

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Background Biceps tenodesis is used for a variety of shoulder and biceps pathologies. Humeral fracture is a significant complication of this procedure. This cadaveric anatomy study sought to determine the cortical thickness of the humeral proximal shaft to identify the optimal technique to decrease unicortical drilling and reduce the risk of fracture. Methods A computed tomography (CT) of eight cadaveric humeral specimens was obtained with a metallic marker placed at the site of subpectoral tenodesis. These scans were examined to define the cortical thickness of the subpectoral region of the humerus and determine angular safe zones for reaming. Results At the standard point of a subpectoral tenodesis, a mean angle relative to the coronal plane of 29.2° medially and 21.6° laterally from the deepest portion of the bicipital groove avoided unicortical drilling with a 7 mm reamer. These values varied slightly 1 cm proximal and distal to this level. The thickest regions of cortex in the subpectoral humerus correspond to the ridges of the bicipital groove. Discussion To avoid unicortical tunnels, surgeons should limit deviation from the perpendicular approach to no more than 23° relative to the coronal plane medially and 11° relative to the coronal plane laterally.

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Section: Discussionmentioning

confidence: 99%

“…3,4 One important, however disastrous complication is proximal humeral shaft fractures at the tenodesis site. 3,4…”

Section: Introductionmentioning

confidence: 99%

“…13 A systematic review on the fracture rate in biceps tenodesis was unable to determine the effect of surgical approach on the fracture rate due to a lack of granular data. 3…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Subpectoral proximal humeral anatomy: Guidance to decrease risk of fracture following subpectoral biceps tenodesis

et al. 2023

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“…However, they announced that open subpectoral tenodesis may be associated with an increased risk of complications because of its requirement to expose more tissue. For open subrapectoral tenodesis, some complications have been reported, such as neurovascular injury ( 11 , 12 ), fractures ( 13 – 16 ), and deep infection ( 17 , 18 ); but the complications above can be mitigated by adopting an arthroscopic approach ( 19 – 21 ).…”

Section: Introductionmentioning

confidence: 99%

The high resistance loop (H-loop) technique used for all-inside arthroscopic knotless suprapectoral biceps tenodesis: A case series

Zhou

Cui

et al. 2022

Front. Surg.

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IntroductionSuprapectoral tenodesis is a common technique for the treatment of long head biceps tendon lesions. However, so far, there is no gold standard treatment in all-inside arthroscopy. The purpose of the present study was to introduce and evaluate the functional outcomes of an innovative, all-inside arthroscopic high resistance loop (H-loop, high resistance to tissue cutout and 360° grasping of the tendon) technique for long head of biceps (LHB) tenodesis.MethodFrom September 2020 to March 2022, a series of cases of 32 consecutive patients (28 rotator cuff tear with LHBT pathology and 4 superior labrum anterior-posterior (SLAP) tears which including 2 type II and 2 type IV) who received LHB tenodesis using all-inside arthroscopic high resistance loop technique were included in this study. The American Shoulder and Elbow Surgeon Score (ASES), Visual Analog Scale (VAS), Simple Shoulder Test Score (SST), Constant–Murley scores, and University of California at Los Angeles Scoring System (UCLA) were used to evaluate the clinical outcomes of patients in preoperative and final follow-up. Meanwhile, postoperative complications were also observed.Result32 patients (14 women and 18 men, average age was 55.7 years) underwent all-inside arthroscopic knotless suprapectoral biceps tenodesis using the H-Loop stitch technique. The mean time of follow-up was 16.2 ± 2.6 months. The ASES, VAS, Constant–Murley, SST, and UCLA scores improved from 51.5 ± 15.8, 5.5 ± 1.6, 57.8 ± 14.7, 5.0 ± 2.8, and 16.1 ± 3.8 preoperatively, to 89.1 ± 7.5, 1.0 ± 0.8, 87.3 ± 5.5, 10.4 ± 1.5, and 31.3 ± 2.6 in the last follow-up, respectively (p < 0.001). During the follow-up, no patients in this study experienced postoperative complications such as infection of the wound, injury of nerves, and hardware failure; no patients required revision after their operation. In addition, none of the patients had cramping or a “Popeye” deformity during follow-up.ConclusionThis article presents an innovative, all-arthroscopic H-loop technique for LHB tenodesis. This technique for LHB tenodesis showed favorable functional and cosmetic outcomes, as well as high satisfaction rates. Due to its simplicity of operation and satisfactory preliminary clinical outcomes, H-loop technique is perhaps another option to choose in all-inside arthroscopic LHB tenodesis.

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Return to Sports and Clinical Results After All-Arthroscopic Biceps Tenodesis Using a 2.7-mm Knotless PEEK Suture Anchor

Bischofreiter,

Gattringer,

Gruber

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: The long head of the biceps tendon (LHBT) is a well-known source of pain in the shoulder, especially in active patients. Purpose: To evaluate the outcomes and return-to-sports rate after all-arthroscopic suprapectoral tenodesis of the LHBT using a small knotless anchor. Study Design: Case series; Level of evidence, 4. Methods: In this retrospective study, 27 patients—who underwent all-arthroscopic tenodesis of the LHBT using a 2.7-mm knotless polyether ether ketone anchor—were evaluated. Sports activities, the return-to-sports rate, and other sports-related parameters (eg, pain during sports, level of sports) were examined. Sports-related data, the Constant score with isometric force (at 90° of abduction in the scapular plane), the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST) score, the visual analog scale (VAS) score for satisfaction, range of motion, and the presence of a Popeye deformity were assessed at a mean follow-up of 15.3 ± 8.7 months. The data were initially analyzed using descriptive statistics. Results: The postoperative ASES, Constant, and SST scores were 81.61, 85.74 and 8.85, respectively. Of the 27 patients, 4 patients (14.8%) showed a Popeye deformity. Preoperatively, 25 patients (92.6%) participated regularly in some type of sports activity. All 25 patients (100.0%) were able to return to sports activities after surgery. 24 (96.0%) returned to the same level preoperatively, with 88.0% (22/25) within 6 months. Patient satisfaction with the outcome was high (VAS score: 2.15 ± 2.78). Neither bicipital groove pain nor cramping was reported. There were no signs of osteolytic bone around the anchor or a fracture of the humeral bone. Conclusion: Our clinical results after using a 2.7-mm knotless anchor for LHBT tenodesis as well as the return-to-sports rate were satisfying. Using an anchor this size can lower the risk of cortical bone damage and therefore the risk of fractures of the humeral head while still enabling patients to perform at a high level.

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The rate and reporting of fracture after biceps tenodesis: A systematic review

Cited by 5 publications

References 89 publications

Subpectoral proximal humeral anatomy: Guidance to decrease risk of fracture following subpectoral biceps tenodesis

Subpectoral proximal humeral anatomy: Guidance to decrease risk of fracture following subpectoral biceps tenodesis

The high resistance loop (H-loop) technique used for all-inside arthroscopic knotless suprapectoral biceps tenodesis: A case series

Return to Sports and Clinical Results After All-Arthroscopic Biceps Tenodesis Using a 2.7-mm Knotless PEEK Suture Anchor

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