Purpose
To assess failure rates and patient reported outcomes following revision of failed
proximal long head of the biceps (LHB) tenodesis.
Methods
Patients from an active-military population who underwent revision proximal (suprapectoral)
to distal (subpectoral) LHB tenodesis were prospectively enrolled. Patients were included
if they were between the ages of 16 and 60 years presenting after a previous biceps
tenodesis with mechanical failure and clinical failure, defined as Single Assessment
Numeric Evaluation (SANE) or American Shoulder and Elbow Surgeons (ASES) <70. Exclusion
criteria were concomitant rotator cuff repair or debridement, full-thickness rotator
cuff tear, extensive labral tears, or any evidence of glenohumeral arthritis. Pre-
and postoperative SANE and ASES were documented and analyzed.
Results
From 2004 to 2010, a total of 12 patients (all male) with a mean age of 39.9 years
(range, 30-54 years) were assessed at a mean follow-up time of 29 months (range, 24-38
months). Nine patients presented with a failed tenodesis construct located at the
top of the bicipital groove and 9 patients had LHB tendons originally affixed with
an interference screw. Diagnostic arthroscopy revealed that the majority of patients
(10/12) had excessive scarring at the site of previous fixation. Mean preoperative
assessments of SANE (70.4) and ASES (59.9) improved postoperatively to SANE (90.3;
P < .01) and ASES (89.8; P < .01). No patients were lost due to follow-up, and there were no reported complications
or failures. All patients returned to full active duty and were able to perform all
required physical tests before returning to their vocation.
Conclusions
Patients presenting with symptoms following a proximal LHB tenodesis can be successfully
converted to a distal (subpectoral) LHB tenodesis with favorable outcomes. Although
in a small sample, there was excessive scarring and synovitis in a majority, which
improved significantly when treated with a revision subpectoral tenodesis with minimal
complication risk and no reported failures.
Level of Evidence
IV (Therapeutic case series)
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Article info
Publication history
Published online: July 25, 2020
Accepted:
July 16,
2020
Received:
December 16,
2019
See commentary on page 2982Footnotes
The authors report the following potential conflicts of interest or sources of funding: P.J.M. receives royalties from MedBridge and Springer Publishing and holds stock in GameReady and VuMedi. M.T.P. reports consultant for Arthrex and JRF Ortho; receives grant funding from Arthrex; has patents numbers (issued): 9226743, 20150164498, 20150150594, 20110040339; receives royalties from Arthrex (IP royalties) and SLACK (publishing royalties) and an honorarium from Arthrosurface. He is an editorial or governing board member for Arthroscopy, Knee, Orthopedics, and SLACK and is a board or committee member for Arthroscopic Association of North America, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, the San Diego Shoulder Institute, and the Society of Military Orthopaedic Surgeons. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Investigation performed at the Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Identification
Copyright
© 2020 Published by Elsevier on behalf of the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Biceps Tenodesis Location May Not Matter: Go High…Go Low…Go Wherever You Want to Go!ArthroscopyVol. 36Issue 12
- PreviewTenodesis of the long head of the biceps tendon has long been a source of dialogue, discussion, debate, and dogma. In general, the shoulder literature has been exhaustive regarding various biceps tenodesis techniques and outcomes, and studies have shown positive clinical outcomes of tenodesis, regardless of location, along the proximal humerus. Fewer studies have evaluated the outcomes of revision tenodesis; however, those that have looked at this have generally found that a revision to a subpectoral tenodesis site is usually quite successful.
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