Trends in the Treatment of Biceps Pathology: An Analysis of the American Board of Orthopaedic Surgery Database

Abstract

Background: Long head of biceps tendon pathology is a well-described source of pain in the anterior adult shoulder. Shoulder arthroscopic surgeons face this condition on a frequent basis because of the increasing aging population. Trends in treatment for this condition have varied over recent decades. An understanding of these trends may help orthopaedic surgeons counsel these patients. Purpose: To evaluate trends in treatment selection, patient population, and complications in recent part II examinees of the American Board of Orthopaedic Surgery (ABOS) board examination. Study Design: Cross-sectional study. Methods: Using a database maintained by the ABOS, we accessed and analyzed examinee data from 2008 to 2019 to evaluate trends in the following categories: examination year/subspecialty, region, patient age/sex, International Classification of Diseases code, Current Procedural Terminology code, and complications. These data points were analyzed for all board-eligible candidates from 2008 to 2019. Results: The annual number of proximal biceps tendon (PBT) procedures performed increased significantly from 597 cases in 2008 to 2203 cases in 2019 ( P < .001). Incidence of biceps tendon tenotomy significantly decreased between the years 2007 and 2018 ( P < .001). Both open and arthroscopic biceps tenodesis significantly increased between 2007 and 2018 ( P < .001). Most PBT cases were performed simultaneously with other procedures (17,283/17,861; 96.8%). The most common PBT procedure performed overall was open tenodesis of long tendon of biceps (∼60.8%). Complication rates for PBT procedures reported each year did not significantly change between 2007 and 2018 (7.5% vs 9.7%; P = .103). Conclusion: PBT procedures are being increasingly performed among recently trained orthopaedic surgeons. Proximal biceps tenotomy has significantly declined, whereas proximal biceps tenodesis, open or arthroscopic, has significantly increased, demonstrating a possible shift in the standard of care among new surgeons.

Physical Therapy Interventions for the Management of Biceps Tendinopathy: An International Delphi Study

“…Therefore, obtaining international expert consensus on a multimodal treatment approach further informs treatment recommendations, which could potentially be utilized prior to electing for surgical options. Surgery (biceps tenodesis) may be a safe option and may offer a satisfactory rate of return to sport in young athletes, 4 however, according to Frank et al 49,50 there is an increased risk of surgical revision in athletes under 20 years old with a history of throwing activity. Therefore, based on the results of this Delphi study conservative PT based management prior to individuals electing for more aggressive surgical intervention for the management of LHBT tendinopathy may be recommended based on these expert opinions.…”

Editorial Commentary: All-Suture Anchor for Shoulder Biceps Tenodesis Results in Excellent Outcomes

“…1,2 Unsurprisingly, the annual number of biceps tenodeses has significantly increased in recent years, whereas that of proximal biceps tenotomies has significantly declined. 3 As a result, discussion on the optimal technique for biceps tenodesis remains a topic of interest.…”