An Expedited Sling Immobilization Protocol After Isolated Biceps Tenodesis Results in Clinical and Patient-Reported Postoperative Outcomes Equivalent to a Standard Rehabilitation Protocol

Abstract

PurposeTo characterize clinical and patient-reported outcomes for patients after isolated biceps tenodesis (BT) who underwent either standard or expedited sling immobilization protocols following surgery. MethodsThis retrospective cohort study comparing patients who were assigned to use a sling for either four- to six-weeks (standard) or zero- to two-weeks (expedited) following an isolated BT. Primary endpoint included rate of re-rupture, surgical revision, loss of fixation, and Popeye deformity. Secondary endpoints included shoulder range of motion (ROM) as well as pre- and post-operative patient reported outcomes (PROs) of pain and function. Missing data was managed via multiple imputation with chained equations. Complication prevalence 95% confidence intervals were calculated using the Clopper Pearson method and a series of hierarchical mixed effects linear regressions were performed to assess differences between sling interventions in PROs and ROM. ResultsThe average age of the standard cohort (n=66) was 49 years ( ± 14) and the average age of the expedited cohort (n=69) was 47 years (± 14). The expedited and standardized cohorts demonstrated 0.4 and 0.3 complications per 10,000 exposure days, respectively, with no significant difference between groups [1.4 (95% CI: 0.2, 10.0), p = 0.727]. There was no demonstrated difference in forward flexion, abduction, or external range of motion. The expedited group had less improvement in Visual Analogue Scale (VAS) for pain scores that was not clinically significant and there were no differences in PROs of function. ConclusionsNo statistically significant difference in the rate of re-rupture, surgical revision, loss-of-fixation, or Popeye deformity was noted between protocols after isolated BT. Furthermore, there were no clinically significant differences in ROM or PROs identified between protocols after isolated BT. This study suggests that patients who have undergone isolated BT may safely discontinue sling use within two weeks after surgery.