Open Subpectoral Biceps Tenodesis for Isolated Biceps Reflection Pulley Lesions: Minimum 2-year Outcomes in a Young Patient Population

Abstract

Objectives:Biceps Reflection Pulley (BRP) lesion is a common generator of anterior shoulder pain and cause of biceps tendon instability. The purposes of this study were (1) to investigate if patients younger than 50 years had improved functional outcomes following open subpectoral biceps tenodesis (BT) for treatment of an isolated BRP lesion with a minimum follow-up of 2-years, and (2) to determine whether a correlation exists between patient age and outcomes scores. It was hypothesized that subpectoral BT would result in reduced pain, improved functional outcomes, and a high return-to-activity rate and that there would be no association between patient age and outcomes scores.Methods:This was an IRB-approved study with retrospective review of prospectively-collected data. All patients who had arthroscopically confirmed isolated BRP lesion treated with open subpectoral biceps tenodesis were at least 2 years out from surgery were included in the study. Patients with additional surgery on the index shoulder were excluded from the study. ASES (pain and function), QuickDASH, and SF-12 scores were collected pre- and postoperatively. Postoperative satisfaction (10-point scale) was also collected. The pre- and postoperative scores of each patient were compared with a Wilcoxon-test, and association between patient age and outcomes scores were investigated with a Spearman correlation test. Further, patient return-to-activity was evaluated by questionnaire. Failure was defined as revision surgery of the biceps tenodesis.Results:14 shoulders in 14 patients (6 male, 8 female) with a mean age of 37 ± 8.9 years met the inclusion criteria. Minimum 2-year outcomes data were available for 13 (93%) shoulders. The mean follow-up time was 3.6 ± 1.3 years. There were significant improvements postoperatively for all outcome scores (p<0.05, see table 1) and no patients underwent revision surgery of the biceps tenodesis. There was no correlation between age and outcomes scores (p>0.05). Overall, median patient satisfaction was 9 out of 10 (range 3-10). Of 14 patients who answered the “return-to-activity” questions, 5 patients () reported return to activity with no modification; 9 patients reported return to activity with modifications. The 5 patients who returned to activity with no modification had significantly less time from initial injury/onset of symptoms until surgery in comparison to the 9 patients who modified their activity (p <0.05, see table 1).Conclusion:At minimum 2-year follow-up, patients with symptomatic isolated BRP lesions can expect excellent clinical outcomes, high satisfaction, and a high return-to-activity rate with little postoperative pain if treated with an open subpectoral BT close to the time of their initial injury/onset of symptoms. No differences in outcomes were observed upon patient age.Table 1:Pre- and postoperative outcomes scores and p-values. Values are expressed as median (range) unless otherwise indicated.TestPreoperativePostoperativep-value ASES Total 62 (33-80)97 (28-100)0.017 ASES Func 29 (13-38)45 (18-50)0.005 ASES pain 35 (15-50)50 (10-50)0.034 QuickDash 39(11-70)7(0-54)0.002 SF-12 PCS 43 (22-58)56 (39-59)0.003 Satisfaction -9 (3-10)- Return to activity – Patients (Percent) Time until surgery (days) -5 (36%) no modifications 215 (49-414)9 (64%) w/ modications 1375 (79-7472)P = 0.028