Risk Factors for Biceps Related Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon

Abstract

Objectives:Our objective was to evaluate complications after arthroscopic tenotomy of the long head of the biceps tendon (LHBT) and identify patient-related factors associated with postoperative cosmetic (Popeye) deformity, subjective weakness, and residual anterior shoulder pain.Methods:After obtaining IRB approval, the records of patients who underwent an arthroscopic LHBT tenotomy, between 2008 and 2015, at an integrated multi-center (14) and multi-surgeon (55) were retrospectively reviewed. Exclusion criteria included LHBT tenodesis, arthroplasty, neoplastic, or fracture surgery, age below 18, or indata. Demographic data, concomitant procedures, the appearance of the biceps tendon (presence or absence of hypertrophy) at time of arthroscopy, and postoperative complications were recorded. The development of each postoperative complication was compared by age, gender, hand dominance, workers’ compensation status, and intra-operative LHBT morphology.Results:192 patients met our inclusion criteria. The average age was 60.6 ± 9.5 years and 55% were male. Average follow-up was 10.6 ± 13.6 months. The most common concomitant procedures were subacromial decompression (82%), rotator cuff repair (72%), distal clavicle resection (26%), and glenohumeral debridement (18%). LHBT morphology based on arthroscopic images was as follows: normal (56%), mildly hypertrophic (24%), severely hypertrophic (20%). Postoperative complications cosmetic deformity (14%), subjective weakness (10.4%), persistent (residual) anterior shoulder pain (7.8%), conversion to tenodesis (3.6%), venous thromboembolism (1%). Seven (3.6%) patients underwent a revision surgery to convert the LHBT tenotomy to a tenodesis, most commonly for postoperative cosmetic deformity (6 patients, 86%). Male gender was significantly associated with the development of postoperative cosmetic deformity (Odds Ratio of 3.21, P<0.05). Biceps tenotomy on the dominant shoulder was significantly associated with postoperative subjective weakness (Odds Ratio 3.17, P<0.05). Patients with workers’ compensation injuries were more likely to have continued postoperative anterior shoulder pain (6.57, P<0.05). A full list of individual patient-related factors association with postoperative complications is presented in Table 1.Conclusion:In our series, in patients undergoing LHBT tenotomy, 14% developed a cosmetic deformity, 10% subjective reported weakness and 8% had persistent (residual) anterior shoulder pain. Male gender was associated with developing a cosmetic deformity, the dominant shoulder was associated with postoperative subjective weakness, and workers’ compensation status was associated with residual anterior shoulder pain. Older age and a hypertrophic biceps tendon demonstrated decreased odds of developing a postoperative cosmetic deformity but did not reach statistical significance. Surgeons who perform LHBT tenotomy should take these risk factors under consideration to minimize complications.Table 1Association of Patient-Related Characteristics with Postoperative Complications.Postoperative ComplicationPatient-Related CharacteristicDevelopment of Cosmetic DeformityReported Subjective WeaknessResidual Anterior Shoulder PainAverage AgeYes= 58 years oldYes= 59.6 years oldYes= 56.64No= 61 years oldNo= 60.7 years oldNo= 60.99P= 0.120P= 0.316P= 0.100GenderMale= 19%Male= 11%Male= 6.7%Female= 6.9%Female= 9.2%Female= 9.2%P= 0.013*P= 0.614P= 0.528Dominant ArmYes= 16.9%Yes= 14.2%Yes= 7.2%No=10%No= 5.0%No= 8.6%P= 0.171P= 0.038*P= 0.696Workers' CompensationYes= 28%Yes= 0%Yes= 42.8%No=13%No= 10.8%No= 6.5%P= 0.261P= 0.358P= 0.001*Biceps Tendon HypertrophyYes= 0%Yes= 0%Yes= 0%No= 19.4%No= 11.1%No= 8.3%P= 0.150P= 0.294P= 0.370* Indicates statistical significance