Biceps Tenotomy Vs Tenodesis in Patients Younger Than 50, Systematic Review

Purpose: The objective of this meta-analysis was to offer an up-to-date comparison of clinical outcomes of tenotomy and tenodesis in the surgical treatment of LHB tendinopathy in patients under the age of 50. Methods: A literature search was conducted in EMBASE, PubMed/Medline and the Cochrane database from January 2010 to Dec 2020. All studies that compared the clinical results of LHB tenotomy and tenodesis were included. Results: The Meta- analysis data were from nine studies that comprised 669 participants who had LHB tenotomy or tenodesis with or without other shoulder surgeries (mainly rotator cuff repairs). There were no clinically significant changes in the Constant score, the American Shoulder and Elbow Society Score, shoulder pain, elbow flexion strength loss, or forearm supination strength when tenodesis and tenotomy were compared in randomized studies. Patients who have tenodesis were less likely to develop a Popeye deformity. Conclusion: In a meta-analysis, patients who had a tenotomy were more likely to have a Popeye deformity. There is no evidencebased benefit of LHB tenodesis over tenotomy in terms of shoulder function, shoulder discomfort, or biceps-related strength, according to a large number of studies. It's unknown whether LHB tenodesis is beneficial to some patient populations, such as children. Keywords: Biceps, Tenotomy, Tenodesis, Rotator cuff, Meta-analysis

Biceps Brachii Alterations Following the Latarjet Procedure: A Prospective Multicenter Study

Purpose: To prospectively investigate the postoperative forearm supination and elbow flexion strength of both upper extremities and popeye deformity in patients who underwent a mini-open Latarjet procedure for anterior shoulder instability. Methods: Patients who underwent a mini-open Latarjet procedure at two specialized shoulder centers were prospectively evaluated preoperatively (T0) and at least 6 months (T1) after surgery. Subjects were tested for elbow flexion and forearm supination strength of both upper extremities using an isometric dynamometer and customized torque dynamometer. Clinical outcome was assessed by the Constant Score (CS), American Shoulder and Elbow Score (ASES) and Simple Shoulder test (SST). Popeye deformity was defined as a distalization of the greatest circumference of the biceps muscle belly towards the lateral epicondyle of the elbow. Results: A total of 20 patients with a mean age of 27 ± 6 years were included in the study. At a mean follow-up of 10 ± 3 months, the elbow flexion strength was restored to the preoperative state (p = 0.240). Forearm supination strength significantly decreased at final follow-up, to 88 % in the surgical arm (p = 0.015) vs. 90 % in the non-surgical arm (p = 0.023). There was no statistical difference when comparing both arms concerning elbow flexion strength (p = 0.510) and forearm supination strength (p = 0.495). No significant popeye deformity was observed in both arms (p = 0.111 vs. p = 0.508). Clinical outcome scores improved significantly from 73 ± 18 to 82 ± 13 (p = 0.014) for CS and 76 ± 22 to 89 ± 12 (p = 0.008) for ASES score preoperatively to final follow-up. No difference in the SST was documented (p = 0.10). Conclusion: The Latarjet procedure showed to preserve elbow flexion strength and provided comparable forearm supination strength compared to the uninjured arm with reliable clinical outcome in this study population. However, a decrease of forearm supination strength in both arms was persistent at a mean of 10 months postoperatively. No popeye deformity was noted in the postoperative examinations. Level of evidence: Case series, Level III.

Clinical outcome comparison of suprapectoral and subpectoral tenodesis of the long head of the biceps with concomitant rotator cuff repair: A systematic review

Background Simultaneous repairs of rotator cuff and biceps tenodesis can be managed by tenodesis of long head of biceps tendon to a subpectoral or suprapectoral area. This review investigated long head of biceps tendon tenodesis with concomitant rotator cuff repair and evaluated the clinical outcomes and incidences of complications based on tenodesis location. Methods Medline, Cochrane, and Embase databases were searched for published, randomized or nonrandomized controlled studies and prospective or retrospective case series with the phrases “suprapectoral,” “subpectoral,” “tenodesis,” and “long head of biceps tendon”. Those with a clinical evidence Level IV or higher were included. Non-English manuscripts, review articles, commentaries, letters, case reports, and sole long head of biceps tendon tenodesis articles were excluded. Results From 481 studies, 13 were chosen. In total, 1194 subpectoral and 2520 suprapectoral tenodesis cases were investigated. Postoperative Constant-Murley and American Shoulder and Elbow Surgeons mean scores showed similar good results. In terms of complication incidences, while transient nerve injuries were more commonly seen in patients with subpectoral tenodesis, persistent bicipital pain and Popeye deformity are mostly seen in patients with suprapectoral tenodesis. Discussion Biceps tenodesis to suprapectoral or subpectoral area with concomitant rotator cuff repair demonstrated similar outcomes. Popeye deformity and persistent bicipital pain were higher in suprapectoral area and transient neuropraxia was found to be higher in subpectoral area. Level of evidence: IV.

Biceps Tenodesis Versus Tenotomy with Fast Rehabilitation Protocol—A Functional Perspective in Chronic Tendinopathy

The study aimed to evaluate the results after arthroscopic tenodesis and tenotomy of the biceps tendon (LHBT), coupled in tenotomy modality with a personalized postoperative rehabilitation protocol. The study included patients who underwent arthroscopic biceps tenotomy or tenodesis due to chronic biceps tendinopathy. Postoperatively, a standard rehabilitation program was prescribed to the tenodesis group and personalized was introduced in the tenotomy group, respectively. The outcomes were assessed using the American Shoulder and Elbow Surgeons scale (ASES), clinical tests that are dedicated to biceps tendinopathy, the occurrence of a Popeye deformity, night pain, and return to previous sporting activities. A cohort of 67 patients was enrolled in the final follow-up examination (mean 27 months) of which 40 patients underwent tenotomy (60%), and 27 patients (40%) underwent tenodesis. The mean ASES score improved from 48.1 to 87.8 in the tenotomy group and from 44 to 72.7 in the tenodesis group during the follow-up (p < 0.0001). The tenotomy group had better mean postoperative ASES scores than the tenodesis group (p < 0.0001). Positive clinical tests for biceps pathology were noticed more often in patients after LHB tenodesis (p = 0.0541). The Popeye deformity occurred more often in the tenotomy group; however, no patient complained of the visual appearance of the arm contour (p = 0.0128). Moreover, the frequency of night pain decreased in the tenotomy group (p = 0.0059). Return to previous sporting activities was more frequent in the tenotomy group (p = 0.0090). Arthroscopic biceps tenotomy is a reproducible, simple procedure, and augmented by a rapid rehabilitation protocol that provides promising clinical outcomes, reduces shoulder pain, and allows the patient to return to previous sporting activities, even in population older than 50 years.

Arthroscopic Biceps Tenodesis Outcomes: A Comparison of Inlay and Onlay Techniques

Background: Arthroscopic biceps tenodesis (ABT) high in the groove can be achieved using an inlay or an onlay technique. However, there is little information comparing outcomes between the 2. Purpose: To compare postoperative healing and functional outcomes of ABT high in the groove performed using either an onlay or an inlay technique. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was performed on patients undergoing ABT at the articular margin (high in the groove) at a single center over a 2-year period. An inlay technique using an interference screw was performed during the first year, followed by an onlay technique using a knotless suture anchor during the second. Tendon healing, elbow flexion strength, functional outcome, and complications were evaluated at a postoperative minimum of 1 year. Results: A total of 37 patients with inlay and 53 with onlay ABTs were available for follow-up. There was no difference in range of motion, functional outcome scores, or elbow flexion strength between the groups. A postoperative popeye deformity was noted in 27% of patients in the inlay group as compared with 9.4% of the onlay group ( P = .028). Four patients (10.8%) in the inlay group required revision surgery (2 of which were biceps tenodesis related) as compared with 0% in the onlay group ( P = .015). Conclusion: An onlay technique using a knotless suture anchor for ABT at the top of the articular margin is an acceptable alternative to an inlay technique using an interference screw. The onlay technique was associated with lower rates of postoperative popeye deformity and revision surgery as compared with the inlay technique.

Outcomes and Complications After Primary Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis for Superior Labral Anterior-Posterior Tears or Biceps Abnormalities: A Systematic Review and Meta-analysis

Background: Biceps tenodesis is a surgical treatment for both superior labral anterior-posterior (SLAP) tears and long head of the biceps tendon (LHBT) abnormalities. Biceps tenodesis can be performed either above or below the pectoralis major tendon with arthroscopic or open techniques. Purpose: To analyze the outcomes and complications comparing primary arthroscopic suprapectoral versus open subpectoral biceps tenodesis for either SLAP tears or LHBT disorders. Study Design: Systematic review; Level of evidence, 4. Methods: A search strategy based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) protocol was used to include 18 articles (471 patients) from a total of 974 articles identified. Overall exclusion criteria included the following: non–English language, non–full text, biceps tenodesis with concomitant rotator cuff repair, review articles, meta-analyses, and case reports. Data were extracted and analyzed according to procedure type and tenodesis location: arthroscopic suprapectoral biceps tenodesis (295 patients) versus open subpectoral bicepts tenodesis (176 patients). Results: For arthroscopic suprapectoral biceps tenodesis, the weighted mean American Shoulder and Elbow Surgeons (ASES) score was 90.0 (97 patients) and the weighted mean Constant score was 88.7 (108 patients); for open subpectoral biceps tenodesis, the mean ASES score was 91.1 (199 patients) and mean Constant score was 84.7 (65 patients). Among the 176 patients who underwent arthroscopic biceps tenodesis, there was an overall complication rate of 9.1%. Among the 295 patients who underwent open biceps tenodesis, there was an overall complication rate of 13.5%. Both residual pain (5.7% vs 4.7%, respectively) and Popeye deformity (1.7% vs 1.0%, respectively) rates were similar between the groups. Open subpectoral biceps tenodesis had higher reoperation (3.0% vs 0.0%, respectively), wound complication (1.0% vs 0.0%, respectively), and nerve injury (0.7% vs 0.0%, respectively) rates postoperatively. A meta-analysis of 3 studies demonstrated that both methods had similar ASES scores ( P = .36) as well as all-cause complication rates (odds ratio, 0.76 [95% CI, 0.13-4.48]; P = .26). Conclusion: Patients undergoing arthroscopic suprapectoral biceps tenodesis for either SLAP tears or LHBT abnormalities had similar outcome scores and complication rates compared with those undergoing open subpectoral biceps tenodesis. Additionally, both residual pain and Popeye deformity rates were similar between the 2 groups.

Risk Factors and Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon

Background: Controversy exits regarding performing a tenotomy versus a tenodesis of the long head of the biceps tendon (LHBT). Purpose: To evaluate the complications after arthroscopic tenotomy of the LHBT and characterize the incidence of cosmetic deformity, cramping, subjective weakness, and continued anterior shoulder pain (ASP). Additionally, to identify patient-related factors that may predispose a patient to these complications. Study Design: Case-control study; Level of evidence, 3. Methods: Records of patients who underwent an arthroscopic LHBT tenotomy at an integrated health care system under the care of 55 surgeons were retrospectively reviewed. Exclusion criteria included LHBT tenodesis, arthroplasty, neoplastic, or fracture surgery; age younger than 18 years; incomplete documentation of physical examination; or incomplete operative reports. Characteristic data, concomitant procedures, LHBT morphology, and postoperative complications were recorded. Patients with and without postoperative complications—including cosmetic deformity, subjective weakness, continued ASP, and cramping—were analyzed by age, sex, dominant arm, body mass index (BMI), smoking status, workers’ compensation status, and intraoperative LHBT morphology to identify risk factors for developing these postoperative complications. Results: A total of 192 patients who underwent LHBT tenotomy were included in the final analysis. Tenotomy was performed with concomitant shoulder procedures in all but 1 individual. The mean ± SD patient age was 60.6 ± 9.5 years, and 55% were male. The overall complication rate was 37%. The most common postoperative complications include cosmetic (Popeye) deformity (14.1%), subjective weakness (10.4%), cramping (10.4%), and continued postoperative ASP over the bicipital groove (7.8%). Every 10-year increase in age was associated with 0.52 (95% CI, 0.28-0.94) times the odds of continued ASP and 0.59 (95% CI, 0.36-0.98) times the odds of cramping pain. Male patients had 3.9 (95% CI, 1.4-10.8) times the odds of cosmetic (Popeye) deformity. Patients who had active workers’ compensation claims had 12.5 (95% CI, 2.4-63.4) times the odds of having continued postoperative ASP. Tenotomy on the dominant arm, BMI, and active smoking status demonstrated no statistically significant association with postoperative complications. Conclusion: Patients experiencing complications after tenotomy were significantly younger and more likely to be male and to have a workers’ compensation injury. LHBT tenotomy may best be indicated for elderly patients, female patients, and those without active workers’ compensation claims.