Purpose
To evaluate the surgical outcomes of a primary subpectoral biceps tenodesis for long
head of the biceps tendon (LHBT) pathology in a large cohort of prospectively, serially
collected, patients in a young active population that has known high physical demands
and requirements of their shoulder to perform their vocation.
Methods
A retrospective review of prospectively collected data from an active military personnel
with a diagnosis of a Type II SLAP tear or biceps tenosynovitis was performed. Outcomes
were evaluated at a minimum follow-up time of 18 months based on preoperative and
postoperative assessments of the Single Assessment Numeric Evaluation, Western Ontario
Rotator Cuff index, biceps position, and return to active duty. Inclusion criteria
were (1) SLAP tears on magnetic resonance arthrogram (classified into SLAP group),
and (2) no SLAP tear but examination findings of biceps tendonitis (placed in the
LHBT tendonitis group). Patients were excluded for full-thickness rotator cuff tears,
high-grade partial thickness tears requiring repair, acromioclavicular joint pathology,
and labral pathology outside of the SLAP lesion. Patients from both groups subsequently
were treated with open, subpectoral tenodesis.
Results
Over a 6-year period at a mean follow-up of 2.75 years (range 1.5-5.7 years), 125
active-duty military personnel with mean age of 42.6 years (range 26.3-56.5) were
enrolled. A total of 101 of 125 patients (81%) completed study requirements at a mean
of 2.75 years (range 1.5-5.7 years). In total, 40 patients were diagnosed with type
II SLAP tears (39.6%) and 61 with biceps tendonitis without SLAP tear (60.4%). Following
open, subpectoral tenodesis, there was a significant improvement in patient outcomes
(Western Ontario Rotator Cuff = 54% preoperative vs 89% postoperative, Single Assessment
Numeric Evaluation = 58 preoperative vs 89.5 postoperative, P < .01). In total, 82% of patients returned to full activity at a mean of 4.1 months.
The biceps muscle measured relative to the antecubital fossa of operative (mean 3.20 cm)
versus nonoperative (3.11 cm) was not clinically different (P = .57). There was an 8% complication rate, including 3 requiring revision, 2 superficial
infections, and 3 transient neurapraxias.
Conclusions
Primary subpectoral open biceps tenodesis for SLAP tears or pathology of the LHBT
provides significant improvement in shoulder outcomes with a reliable return to activity
level with low risk for complications.
Level of evidence
Level IV (Case series).
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Article Info
Publication History
Accepted:
June 21,
2019
Received:
February 12,
2019
Footnotes
The authors report the following potential conflicts of interest or sources of funding: S.A. has received payment for lectures including service on speakers bureaus from Arthrex. D.S. has received support for consultancy from Arthrex. M.P. has received support for consultancy from Arthrex and JRF Ortho; has patents issued under patent numbers 9226743, 20150164498, 20150150594, and 20110040339; and receives IP royalties from Arthrex and publishing royalties from SLACK Incorporated. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2019 Published by Elsevier on behalf of the Arthroscopy Association of North America
