Subpectoral Biceps Tenodesis with endobutton fixation in the young population - which technique works best?

Abstract

Injuries of the long head of the biceps (LHB) tendon are a prevalent source of anterior shoulder pain and are commonly treated with tenodesis. Not only a stable fixation of the LHB but also anatomical restoration of the length-tension relationship plays a central role to provide satisfying functional and cosmetic outcomes, especially in young patients. Here we report the clinical outcomes of two different subpectoral tenodesis techniques using unicortical button fixation. Patients under the age of 50 that were treated between April 2015 and January 2020 with one of the following two subpectoral tenodesis techniques were retrospectively selected and enrolled for a follow-up examination at least 2 years after surgery: Subpectoral in situ tenodesis followed by resection of the intraarticular portion leaving a residual tendon stump in the bicipital groove (group I) vs. tenotomy first followed by resection of the stump and subpectoral tenodesis (group II). Patients that underwent concomitant rotator cuff repair, subsequent shoulder surgery or contralateral biceps surgery were excluded. Clinical outcome was evaluated using the LHB Score, Constant-Murley Score (CMS) and measurements of isometric elbow flexion and forearm supination strength. Sonographic evaluation included assessment of the integrity of the LHB and tenodesis, signs of inflammation within the sulcus or around the tendon and measurements of the distalization of the myotendinous junction (MTJ) of the LHB compared to the non-operated side. Thirty-four patients in group I (24 males, mean age at the time of surgery 40.3 years, mean follow-up 57.2 months) and 24 patients in group II (19 males, mean age 39.8 years, mean follow-up 51.9 months) were evaluated. Total CMS as well as the respective subcategories did not reveal significant differences between groups. Overall LHB score was on average 10 points higher in group I (mean 94 points) compared with group II (mean 84 points) (p=0.016). In the LHB score subcategories, group I showed significantly better results regarding patient-dependent cosmesis (group I mean: 15 points; group II mean: 12 points; p=0.005) and examiner-dependent cosmesis (group I mean: 14 points; group II mean: 10 points; p=0.001). This was substantiated by a significantly higher distalization of the MTJ in group II (group I mean: 3.0 cm; group II mean: 3.8 cm; p=0.030). This study shows that subpectoral in situ tenodesis of the LHB followed by arthroscopic resection of the intraarticular portion provides higher LHB scores and better cosmetic outcome compared with proximal intraarticular tenotomy followed by subpectoral tenodesis.