Complications liées au biceps après ténotomie associée à la réparation arthroscopique de la coiffe des rotateurs : facteurs de risque et influence clinique

Abstract

Lots of studies investigated differences between tenotomy and tenodesis, while just a few specifically investigated the results of tenotomy in association with rotator cuff repari (RCR). Our aim is to report the rate of biceps related complications after long head of the biceps (LHB) tenotomy in association with RCR. A single-center prospective observational study was performed between 2015 and 2017 on consecutive patients who underwent RCR associated with LHB tenotomy. Patients were clinically evaluated preoperatively, at 6 months (also with ultrasound) and 1 year, and screened for postoperative popeye deformity, cramps and bicipital discomfort. Each complication was analyzed for the following risk factors: age, sex, BMI, dominant arm, manual work, tear kind, tendon healing. Finally, clinical outcome was compared between patients with at least one complication and without complications. Two hundred and seven patients were analyzed. Cramps, popeye deformity, and discomfort, were, respectively, present in 16 (7.7%), 38 (18.4%) and 52 (25.1%) cases at 6 months and 17 (8.2%), 18 (8.7%) and 24 (11.6%) cases at 1 year. Cramps were associated with lower age (1 year-increase OR = 0.88–95%CI, 0.81–0.96−), higher BMI (1 point-increase OR = 1.1–95% CI, 1.02–1.23−), single tendon tear (P = 0.0168), manual work (OR = 5.0–95%CI, 1.5–16.0−) at 6 months and manual work (OR = 2.9–95% CI, 1.1–8.3−) at 1 year. Objective popeye deformity was associated with male sex at 6 months (OR = 6.9–95%CI, 3.0–15.5−). Discomfort was associated with lower age (OR = 0.94–95%CI, 0.90–0.98−), manual work (OR = 2.3–95%CI, 1.2–4.3−), popeye deformity (OR = 2.3–95%CI, 1.1–4.9−) at 6 months and manual work (OR = 2.8–95% CI, 1.1–6.6−), single tendon tear (OR = 4.9–95%CI, 1.1–21.3−), popeye deformity (OR = 3.4–95% CI, 1.1–10.7−) at 1 year. Patients without complications showed a significant higher Constant score, pain and SSV (75.4 vs. 70.4, P = 0.00252 ; 0.9 vs. 1.9, P < 0.00001 ; 80.2 vs. 76.4 ; P = 0.00124) at 6 months, pain and SSV (0.6 vs. 2.0; P = 0.00044; 91.1 vs. 77.8; P = <.00001) at 1 year. Younger age, higher BMI, manual work and single tendon tears are risk factors associated with biceps related symptoms during the first year. Popeye occurs more frequently in males and is associated with discomfort. Nevertheless, the short-term clinical influence of biceps complications on shoulder outcome is very limited.