Biceps Tenodesis versus Tenotomy at the Time of Manipulation and Lysis of Adhesions for Adhesive Capsulitis

Abstract

Objectives: Although rare in the treatment of adhesive capsulitis, arthroscopic lysis of adhesions and manipulation under anesthesia (LOA/MUA) may be necessary if the patient fails conservative therapy. Patients at the time of surgery often have biceps tendon, superior labrum anterior to posterior (SLAP) pathology, or other pathology requiring concurrent treatment. Common treatments for these can include biceps tenodesis or tenotomy. Some surgeons believe that concomitant repairs at the time of LOA/MUA can cause increased stiffness post-operatively due to need for immobilization or protection, possibly leading to poorer outcomes and potentially needing further interventions such as repeat injections or repeat LOA/MUA. The goal of this study was to compare patients who underwent LOA/MUA with biceps tenodesis to those who underwent LOA/MUA with biceps tenotomy. We hypothesized that biceps tenodesis at the time of LOA/MUA did not lead to an increased risk for further intervention in the form of post-operative injections for pain or stiffness or repeat LOA/MUA compared to biceps tenotomy. Methods: A retrospective review of consecutive LOA/MUA for adhesive capsulitis performed by 5 surgeons at a single center from 2010-2016 was performed. All included patients were required to have a minimum of 1 year of follow-up, and be a minimum 2 years post-procedure. Exclusion criteria included prior biceps tenodesis, surgery within six months prior to LOA/MUA, prior infection, prior shoulder fracture or fracture fixation, and concomitant rotator cuff repair. Patients without any biceps surgery (tenotomy or tenodesis) were also excluded. The primary outcome measure was a postoperative injection in the ipsilateral shoulder for recurrent adhesive capsulitis, pain or residual stiffness. The secondary outcome measure was a repeat LOA/MUA. Statistical analysis was completed in SPSS using a chi-square analysis for categorical variables and a student’s t-test for continuous variables. Results: Fifty-five patients were included in the study. Thirty-three patients underwent biceps tenotomy, and 22 patients underwent biceps tenodesis at the time of arthroscopic LOA/MUA. The average age in the tenotomy group was 53 years and 47 years in the tenodesis group (p = 0.383). There was no significant difference in the percentage of males in the tenodesis group (59%) versus tenotomy (48%) (p = 0.440). Average body mass index (BMI) was not significantly different between the two groups (p = 0.329). No patients from either group underwent repeat LOA/MUA. Of those patients who received a biceps tenotomy, 39% had an injection for pain or stiffness post-operatively compared to 18% for biceps tenodesis, which was not significant (p=0.17). Table 1 summarizes the outcomes in both groups. Conclusion: Patients who underwent biceps tenodesis with concurrent arthroscopic LOA/MUA for adhesive capsulitis did not have a higher rate of postoperative injections or repeat LOA/MUA compared to patients who underwent biceps tenotomy at the time of LOA/MUA. [Table: see text]