Arthroscopic Biceps Tenodesis Research Articles

Correlation between the Long Head of the Biceps Microscopic Degeneration and Extent of Apoptotic Process.

Objectives: The purpose of this study was to determine the correlation between microscopic degeneration in the long head of the biceps tendon (LHBT) and the apoptotic process. Methods: This study included 26 consecutive patients who had undergone arthroscopic biceps tenodesis or tenotomy for symptomatic LHBT with or without concomitant rotator cuff tears (RCTs). Histological examination of the specimens under a light microscope was conducted after staining with hematoxylin, eosin, and the Alcian blue. Histopathological changes were assessed using the original Bonar score and the modified Bonar score and then correlated with the expression of the subsequent apoptosis markers: activated caspase-3 (casp3), tumor protein p53 (p53), and B-cell lymphoma 2 (BCL-2). Results: The mean original Bonar score was 8.65 (range 5-11), while the modified Bonar score was 7.61. There was no correlation between the original Bonar score and the age of the patients, but a positive correlation was found between the modified Bonar score and the age of the patients (p = 0.0022). There was no correlation between the age of patients and the expression indexes of BCL-2 and casp3. However, the expression of the p53 index showed a positive correlation with patient aging (p = 0.0441). Furthermore, there was no correlation observed between the expression of apoptotic indexes and both the original and modified Bonar scale. Conclusions: In LHB tendinopathy, the expression of apoptosis does not seem to directly correlate with the extent of degeneration, particularly in the late stages of tendinopathy. However, the transformations observed in collagen and ground substance were significantly associated with age, as well as tendinous tissue degeneration quantified according to modified Bonar score. The age of patients was also linked with the expression of the p53 index, as an increased apoptosis in the studied population.

Arthroscopic Suprapectoral Biceps Tenodesis: A Knotless, Onlay, All-Suture Anchor Technique

Anterior shoulder pain is a common complaint often caused by pathology of the long head of the biceps such as biceps tendinitis, partial biceps tears, biceps instability, and SLAP lesions. Surgical treatment of biceps pathology includes tenotomy versus tenodesis, with tenodesis being favored in young, active patients owing to less cramping pain and superior outcomes in terms of shoulder function and cosmesis. Various surgical techniques for tenodesis of the long head of the biceps exist, with varying indications. Subpectoral biceps tenodesis is primarily indicated for zone 2 to 3 tendon pathology and revision biceps tenodesis. Secondary indications include overhead athletes, chronic biceps tendinopathy, and rotator cuff repair. Proximal arthroscopic biceps tenodesis performed “high in the groove” has been shown to preserve biceps length and reduce Popeye deformity compared with tenotomy. Knotless techniques are becoming popular; they provide low-profile fixation that limits knot abrasion and is not reliant on knot security for fixation. We present a variation of suprapectoral biceps tenodesis using knotless fixation in an onlay technique.

No clinical difference in outcomes between inlay and onlay arthroscopic biceps tenodesis techniques during rotator cuff repair

BackgroundBoth inlay and onlay arthroscopic biceps tenodesis (ABT) are common procedures performed during rotator cuff repair. The inlay method involves creating a bone socket in the bicipital groove to secure the long head of the biceps tendon (LHBT) using an interference screw. The onlay method utilizes a suture anchor to secure the LHBT on the surface of the bicipital groove. Little is known on the long-term differences in patient reported outcomes (PROs) between these two techniques. The primary purpose of this study was to compare PROs of inlay versus onlay ABT with a minimum follow-up of two years. Secondary aims were to evaluate the impact of rotator cuff tear size on outcomes and compare rates of complications between the two techniques. MethodsA retrospective chart review was performed to identify patients who had an ABT during a full-thickness rotator cuff repair. Any symptom specific to the biceps were noted, including pain and cramping, Popeye deformity, or revision surgery. Complication rates were compared between groups. The VAS pain score, ASES, SANE, and VR-12 scores were compared at two years. The impact of rotator cuff tear size was analyzed by categorizing into small/medium or large/massive based on operative reports and arthroscopic images. ResultsThere were 165 patients identified (106 in the inlay group and 59 in the onlay group). No revision surgeries were performed secondary to the biceps tendon in either group. Eleven patients (10%) in the inlay group complained of biceps pain or cramping compared to 2 patients (3%) in the onlay group (p = .11). One Popeye deformity was noted in each group (p = .67). No significant differences were found between groups for VAS (p=.41), ASES functional (p = .61), ASES Index (p = .91), SANE (p = .09), VR-12 PCS (p = .77), or VR-12 MCS (p = .09). Rotator cuff tear size within the groups also did not demonstrate statistical significance. ConclusionNo clinical differences or complications were found at minimum two-year follow-up between inlay and onlay arthroscopic biceps tenodesis in patients undergoing rotator cuff repair when controlling for tear size. The clinical relevance suggests either technique is effective and can be based on surgeon preference.

Superior labrum anterior to posterior (SLAP) repair is associated with increased rate of subsequent rotator cuff diagnoses and revision surgery: a propensity-matched comparison

Surgical management of superior labral anterior to posterior (SLAP) tears remains controversial. Current management utilizes 2 well-established procedures: biceps tenodesis and SLAP repair. This study evaluates the complications associated with arthroscopic SLAP repair vs. an open or arthroscopic biceps tenodesis to further elucidate optimal surgical management. In this retrospective cohort study, the TriNetX database was utilized to evaluate patients who underwent repair of SLAP lesions (International Classification of Diseases, Tenth Revision code: S43.43) from May 15, 2003, to May 15, 2023. Three patient cohorts were evaluated: those who underwent arthroscopic SLAP repair (Current Procedural Terminology [CPT] code: 29807), those who underwent arthroscopic biceps tenodesis (CPT code: 29828), and those who underwent open tenodesis of the biceps (CPT code: 23430). Cohorts were propensity matched for type 2 diabetes, nicotine dependence, alcohol-related disorders, body mass index, and demographic factors such as age at event, ethnicity, race, and sex. The outcomes evaluated were disruption of surgical wound, deep vein thrombosis, mononeuropathy of upper limb, shoulder contusion, humeral fracture, sepsis, deceased, acute postoperative pain, revision, shoulder stiffness, and rotator cuff strain. All outcomes were evaluated within 1 year postprocedure. A total of 11,081 arthroscopic SLAP repairs, 9960 arthroscopic biceps tenodesis, and 9420 open biceps tenodesis were matched. Compared with patients who underwent arthroscopic biceps tenodesis, those who underwent arthroscopic SLAP repair were 1.8 times more likely to undergo revision (2.9% vs. 1.6%, P<.0001). Compared with those who underwent open biceps tenodesis, patients who had SLAP repair performed were 1.4 times more likely to undergo revision (3.1% vs. 2.3%, P=.013) and 1.6 times more likely to have a subsequent rotator cuff strain diagnosis (5.1% vs. 3.2%, P=.0002). Compared with patients who underwent SLAP repair, those who underwent arthroscopic biceps tenodesis exhibited 1.3 times more instances of acute postoperative pain (5.2% vs. 4.0%, P=.011). Similarly, open biceps tenodesis exhibited 1.8 times more instances of acute postoperative pain (6.9% vs. 3.8%, P<.0001) and 1.3 times more shoulder stiffness (11.8% vs. 9.0%, P<.0001). In the last 20 years, patients who underwent SLAP repair were associated with higher risk of revision surgery and subsequent rotator cuff strain diagnosis. Conversely, patients who underwent biceps tenodesis were associated with higher rates of acute postoperative pain and shoulder stiffness.

The Association of Tobacco Smoking and Level of Apoptosis in the Long Head of the Biceps Chronic Tendinopathy—An Immunohistochemical Study

Background: The substances present in cigarette smoke have a negative impact on cellular integrity and metabolism, can reduce blood flow to tissues, and can disrupt collagen synthesis. Ultimately this can lead to cell death, which clinically may result in impaired tendon healing and the onset of chronic tendinopathy. Within the shoulder, the exact association between the extent of apoptosis in the long head of the biceps (LHB) tendon and harmful factors like cigarette smoke remains unclear. Objectives: The purpose of this study was to investigate the connection between smoking, the degree of apoptosis in LHB tendinopathy, and the long-term outcomes of surgical treatment. Design: Observational, retrospective study. Methods: This study included 22 consecutive patients who had undergone arthroscopic biceps tenodesis or tenotomy for symptomatic LHB tendinopathy with or without concomitant rotator cuff tears (RCT). The intra-articular LHB tendon remnants were histologically examined by measuring the level of expression of apoptotic cell markers such as BCL2, cleaved caspase 3, and p53. Pre- and postoperative clinical outcomes were analyzed by collecting patient report outcome measures such as the American Shoulder and Elbow Surgeons (ASES) score and the Visual Analogue Scale (VAS) for pain. Results: The smokers group had a mean pack-year history of 13.12 (SD = 9.94), mean number of cigarettes per day of 14.77 (SD = 4.64), and a mean smoking duration of 16.38 (SD = 10.1) years. Among the smoking indexes, the number of cigarettes per day showed a positive correlation with Snyder classification (p = 0.0459, rho = 0.3682). Non-smokers and smokers did not show a statistically significant difference in the expression indexes of BCL2, cleaved caspase 3, or p53 (p = 0.4216, p = 0.5449, p = 0.5613, respectively). However, the cleaved caspase 3 expression index showed a negative correlation with the severity of rotator cuff lesions in the total population (p = 0.0193, rho = −0.4651). Conclusions: While apoptotic processes in the LHB tendon were observed, no significant association was found between tobacco smoking, the extent of apoptosis, and clinical outcomes. However, the expression of the apoptotic marker cleaved caspase 3 correlated with the severity of rotator cuff pathology. Furthermore, active smoker status was associated with worse clinical outcomes in terms of pain following LHB tenodesis or tenotomy.

One-Step Release Technique for Tendon Extraction During Biceps Tenodesis

All biceps tenodesis techniques involving extra-articular tendon preparation consist of 2 distinct steps for tenotomy and tendon grasping. These 2 maneuvers are performed by different instruments. A single-step tendon release technique is described for both arthroscopic and open shoulder surgery. This technique finds application in arthroscopic proximal suprapectoral tenodesis, open treatment of proximal humerus fractures, and suprapectoral mini-open tenodesis. Herein, we describe an arthroscopic biceps tenodesis technique that combines the actions of cutting and gripping the tendon in a single step.

Arthroscopic biceps tenodesis using press-fit bony plug: a case series study.

To assess the feasibility, operative time, clinical outcomes, possible complications, and failure rates of all-through arthroscopic biceps tenodesis using press-fit bony plug technique. This prospective case series study involved 30 skeletally mature patients with long head of biceps pathology (tendinitis after failure of conservative treatment, subluxation, dislocation, or tendon tears). All patients were followed up for 24months at least. Twenty-nine patients regained full shoulder and elbow range of motion; one case suffered from reflex sympathetic dystrophy. There was a significant improvement in the constant, ASES, and VAS scores when comparing the pre-operative and post-operative values. The average biceps strength was 96% compared to the opposite healthy side. No cases were complicated by neuro-vascular deficits or failure of the tenodesis. Press-fit biceps tenodesis is safe and accessible with low economic demands. We recommend this technique to be used more often when addressing patients with long head of biceps pathologies. Registration number: N-1562023. Registration date: June 2022 "Retrospectively registered".

Arthroscopic suprapectoral biceps tenodesis provided earlier shoulder function restoration compared with open subpectoral biceps tenodesis during the recovery phase

This study compared the clinical outcomes of open subpectoral biceps tenodesis and arthroscopic suprapectoral biceps tenodesis for symptomatic biceps tenosynovitis. Although both techniques have pros and cons, no studies have compared clinical and functional outcomes during the recovery phase. Previous studies show that suprapectoral tenodesis has a higher probability of Popeye deformity and postoperative bicipital pain and stiffness, whereas subpectoral tenodesis has a higher risk of nerve complications and wound infections. This study aimed for clinical comparison between arthroscopic suprapectoral biceps tenodesis and open subpectoral biceps tenodesis. This study is a retrospective review of institutional records of patients with biceps tendinitis who underwent open or arthroscopic biceps tenodesis. Surgical indications included biceps tenosynovitis, biceps partial tear, and biceps pulley lesion. Patients with prior shoulder surgery, preoperative shoulder stiffness, or full-thickness tear of rotator cuff were excluded. Tenodesis was considered when the pain recurs within 3 months despite conservative treatment including at least 2 triamcinolone injections on the biceps tendon sheath. Visual analog scale (VAS) score for pain, presence of the night pain, American Shoulder and Elbow Surgeons (ASES) score, Constant score, and range of motion were assessed preoperatively at 3, 6, 12, and 24 months postoperatively and the last follow-up. A total of 72 patients (33 with arthroscopic suprapectoral biceps tenodeses and 39 with open subpectoral biceps tenodeses) were included in analysis. At postoperative 6 months, lower VAS score (0.4±0.8 vs. 1.7±1.9, P<.001), and the presence of the night pain (2 [6%] vs. 14 [36%], P=.002), ASES score (89.6±9.2 vs. 81.4±14.6, P=.006), and Constant score (89.4±5.6 vs. 82.0±12.5, P=.003) compared with the subpectoral group. The mean number of postoperative steroid injections for pain control in the subpectoral group (0.51±0.80) was significantly higher than that in the suprapectoral group (0.18±0.40) (P=.031). However, postoperative clinical outcomes were restored similar between the 2 groups at 12 months and the last follow-up. Arthroscopic suprapectoral biceps tenodesis performed statistically better than the subpectoral biceps tenodesis for the VAS, ASES, night pain, and Constant score at postoperative 6 months. However, only night pain and the Constant score showed differences that exceeded minimum clinically important difference during the recovery phase. At postoperative 12 and 24 months, biceps tenodesis provided satisfactory clinical outcomes and pain relief regardless of the fixation technique and suture anchor location.

A Radiostereometric Analysis of Tendon Migration After Arthroscopic and Mini-Open Biceps Tenodesis: Interference Screw Versus Single Suture Anchor Fixation.

Studies suggest that similar clinical results are achieved via arthroscopic and open biceps tenodesis (BT) techniques. To quantify the postoperative migration of the BT construct between arthroscopic suprapectoral BT (ASPBT) and open subpectoral BT (OSPBT) techniques via interference screw (IS) or single-suture suture anchor (SSSA) fixation using radiostereometric analysis. Cohort study; Level of evidence, 2. Distal migration of the biceps tendon after OSPBT with a polyetheretherketone IS, OSPBT with 1 SSSA, ASPBT with polyetheretherketone IS, and ASPBT with 2 SSSAs was measured prospectively. Patients with symptomatic biceps tendinopathy and preoperative patient-reported outcome measures (PROMs) including Constant-Murley subjective, Single Assessment Numeric Evaluation, or Patient-Reported Outcomes Measurement Information System-Upper Extremity scores were included. A tantalum bead was sutured on the proximal end of the long head of the biceps tendon before fixation of tendon tissue. Anteroposterior radiographs were performed immediately postoperatively, at 1 week, and at 3 months. Bead migration was measured, and preoperative PROMs were compared with those at latest follow-up. Of 115 patients, 94 (82%) were available for final follow-up. IS fixation yielded the least tendon migration with no difference between the open and arthroscopic approaches (4.31 vs 5.04 mm; P = .70). Fixation with 1 suture anchor demonstrated significantly greater migration than that achieved with an IS at both 1 week (6.47 vs 0.1 mm, 6.47 vs 1.75 mm, P < .001;) and 3 months (14.76 vs 4.31 mm, 14.76 vs 5.04 mm, P < .001) postoperatively. Two-suture anchor fixation yielded significantly greater migration than IS fixation at 1 week (7.02 vs 0.1 mm, P < .001; 7.02 vs 1.75 mm, P = .003) but not 3 months postoperatively (8.06 vs 4.31 mm, P = .10; 8.06 vs 5.04 mm, P = .07). Four patients with suture anchor fixation (3 patients in the OSPBT 1 SSSA group, 9.4%, and 1 patient in the ASPBT 2 SSSAs group, 3.8%) developed a Popeye deformity, whereas no Popeye deformities occurred in the IS groups. Mean 3-month bead migration in patients with and without a Popeye deformity was 60.8 and 11.2 mm, respectively (P < .0001). PROMs did not differ among groups at final follow-up. Interference screw fixation yielded the least tendon migration whether achieved arthroscopically or open. The available data indicated that fixation with 1 SSSA but not 2 SSSAs resulted in significantly greater migration than that achieved with an IS. Despite variations in tendon migration, PROMs were similar among all groups. When SSSAs are used, tendon migration may be minimized by using ≥2 anchors.

Novel all-arthroscopic biceps tenodesis technique incorporated into rotator cuff repair—two hundred cases with minimum 2-year follow-up

Biceps tendon pathology is a common source of pain in the shoulder. It is frequently seen in conjunction with symptomatic rotator cuff tears. Biceps tendon management during arthroscopic rotator cuff repairs can be achieved via tenodesis with various techniques or tenotomy. Tenodesis of the biceps generally results in less deformity and reduced exertion-related cramping. However, most techniques require the addition of some type of hardware to provide fixation for the biceps tendon, which adds cost, time, and complexity. This study presents a technique for an all-arthroscopic bicep tenodesis performed in conjunction with a double-row rotator cuff repair, requiring no additional hardware. This study is a retrospective review of data that were prospectively collected for 200 consecutive patients for whom the procedure was performed. Patients were seen postoperatively at 2 weeks, 6 weeks, 4 months, and 6 months and in addition massive rotator cuff repairs were seen at 8 months. Additionally all patients were contacted at a minimum 2-year follow-up to access for the presence deformity, the American Shoulder and Elbow Surgeons (ASES) score, and SANE score. Descriptive statistics and comparisons to known minimal clinical important differences (MCIDs) for the patient recorded outcome measures were recorded. Two hundred patients were included in the study and 152 responded to the telephone interviews. The mean age of the patients at the time of surgery was 65.3 year old (standard deviation ± 9.1, range of 46-84), and the mean postoperative phone interview was 3.2 years postsurgery (standard deviation of ± 1.0, range of 2-5 years). The average ASES score improved from 52.6 to 94.6, which is 3 times greater than the minimal clinical important difference. The average postoperative SANE score was 94. Seven procedures out of the 200 were labeled as failures due to 1 patient's nonsatisfaction with the procedure and 3 for a Popeye deformity and 3 that had a revision RCR. The described method of an arthroscopic biceps tenodesis performed with a rotator cuff repair uses no extra hardware, requires minimal additional operative time, and is clinically effective. At a minimum 2-year follow-up, the all-arthroscopic biceps tenodesis in conjunction with a double-row rotator cuff repair resulted in a marked improvement in their ASES score with a 3.5% failure rate. The all-arthroscopic bicep tenodesis performed in conjunction with a double-row rotator cuff repair demonstrated improved clinical outcome, without requiring any additional hardware to tenodese the biceps, at a minimum 2-year follow-up.

Poster 172: Subpectoral open versus Arthroscopic Biceps Tenodesis with concomitant Arthroscopic Rotator Cuff Repair does not impact ability to achieve Minimal Clinically Important Difference with use of Patient Reported Outcome Measurement System

Objectives: Disagreement exists within the current literature as to whether performing an arthroscopic vs. open subpectoral bicep tenodesis with concomitant arthroscopic rotator cuff repair (ARCR) leads to significantly different outcomes. Therefore, the objective of this study is to use a matched cohort of patients who undergo arthroscopic versus subpectoral biceps repair with concomitant ARCR and assess if there is a significant difference in (Patient-Reported Outcomes Measurement Information System) PROMIS outcomes and the ability to achieve a minimal clinically important difference (MCID). Methods: Data from the electronic medical record, including operative reports, were retrospectively collected for patients who underwent ARCR performed by one of six fellowship-trained board-certified orthopedic surgeons at a single institution. Current Procedural Terminology (CPT) for open or arthroscopic biceps tenodesis with concomitant arthroscopic rotator cuff repair was used to identify patients who underwent this procedure concomitant with ARCR between 01/01/2016 to 12/31/2019.Preoperative PROMIS physical function (PF), pain interference (PI), and depression (Dep) scores were obtained at the closest date prior to arthroscopic rotator cuff repair, and postoperative scores were collected at every clinical visit thereafter. The final PROMIS score used for data analysis was determined by the patients’ PROMIS scores between 90 and 180 days. A delta PROMIS value was determined by taking the difference between the final PROMIS score and the preoperative score. Unadjusted bivariate analysis was performed to assess the differences in PROMIS outcomes between the two cohorts. The MCID was determined as one-half of the standard deviation of a given PROMIS value, which is consistent with the current orthopedic literature. Results: A total of 297 patients were identified underwent rotator cuff repair with concomitant biceps tenodesis. A total of 151 subjects underwent arthroscopic biceps tenodesis with concomitant ARCR, while 147 underwent open subpectoral bicep tenodesis. The average time to follow up was 132.2 days for the arthroscopic cohort and 136.3 days for the subpectoral open group.Bivariate analysis demonstrated no significant difference between the two cohorts for insurance, race, ethnicity, last PROMIS input day, mechanism of injury, ASA class, or Charleston Comorbidity Index (CCI). There was a significant difference for patients who required contaminant subscapularis repair (p &lt; 0.001) and revision surgery (p &lt; 0.001).Unadjusted t-test analysis showed that patients in the arthroscopic biceps tenodesis cohort had significantly higher postoperative PROMIS PF and lower PROMIS PI and Dep scores. (P = 0.001, P = 0.001, and P = 0.007, respectively) when compared to their preoperative PROMIS values. The subpectoral open biceps tenodesis cohort did not show a significant difference in the postoperative PROMIS Dep score when compared to its preoperative score (P = 0.18), but it did show a significant improvement for postoperative PROMIS PF and PI (P = 0.001 and P = 0.04, respectively). No significant difference was determined between the arthroscopic bicep and subpectoral bicep tenodesis cohorts for delta PROMIS PF, PI, and Dep (P = 0.50, P = 0.51, and P = 0.10, respectively). A chi-square analysis found no significant difference between the achievement of MCID for PROMIS PF, PI, and Dep (P = 0.64, P = 0.72, and P = 0.95, respectively). Finally, no significant difference was determined between the time it took to achieve a minimal clinically important difference for PROMIS PF, PI, or Dep for patients who underwent arthroscopic rotator cuff repair with concomitant arthroscopic biceps tenodesis when compared to subpectoral open biceps tenodesis. Conclusions: The objective of this study was to assess differences in PROMIS outcomes for patients who undergo ARCR with concomitant arthroscopic or open subpectoral bicep tenodesis. The main findings of our study highlighted that patients with arthroscopic biceps tenodesis showed significant improvement at six months for PROMIS PF, PI, and Dep, whereas those who underwent an open subpectoral approach showed significant improvement in PF and PI but not Dep. Our findings suggest there may be a slight benefit for patients who undergo arthroscopic tenodesis when compared a subpectoral open approach. However, no significant differences were found between the two cohorts for PROMIS or the time to reach MCID. Therefore, suggesting the modality of bicep tenodesis with concomitant ARCR does not impact patient outcomes at 6-month follow-up. [Table: see text][Table: see text][Table: see text]

Poster 178: Outcomes of SLAP Repair vs. Biceps Tenodesis of SLAP Lesions in Females: A Retrospective Review

Objectives: When surgically managing superior labrum from anterior to posterior (SLAP) tears, there is no consensus on whether SLAP repair or biceps tenodesis yields superior long term outcomes. Additionally, no previous studies have specifically examined outcomes of these procedures in female patients, despite evidence of sex-based differences in recovery following orthopedic surgery. The purpose of this study was to retrospectively compare outcomes after SLAP repair and biceps tenodesis in females. Prior to the start of the study, it was predicted that outcomes between patients who undergo SLAP repair and biceps tenodesis as a treatment will not significantly differ. Methods: Female patients who underwent arthroscopic SLAP repair or biceps tenodesis for treatment of an SLAP lesion between 1/1/2014 and 9/1/2019 at a single institution were retrospectively reviewed. Patients were queried using CPT codes for arthroscopic SLAP repair or biceps tenodesis: for those identified, electronic medical records were reviewed to confirm they met inclusion criteria. Exclusion criteria included: age less than 18 years old at the time of surgery, revision surgery, and concomitant rotator cuff repair at the time of surgery. Patients were contacted at a minimum of two-years post- surgery and asked to complete the standardized American Shoulder and Elbow Surgeons (ASES) score, single assessment numerical evaluation (SANE) survey, and visual analog scale (VAS) for pain. Patients were also given a custom survey assessing return to activity and level of activity following the operation. Patient demographics collected included age at time of surgery, BMI, laterality, and procedure type. Differences in post-operative function between the procedures were assessed using T-tests or Mann- Whitney U tests for numerical data and Chi-Square testing for categorical data. Results: The study included 118 patients. 61 (51.7%) underwent arthroscopic SLAP repair, and 57 (48.3%) underwent open or arthroscopic biceps tenodesis. Comparing demographic data for SLAP repair versus biceps tenodesis groups, mean age was 35.2±8.93 years versus 45.5±10.2 years (p&lt;0.001), mean BMI was 27.5 versus 29.2 (p=0.095), the rates of left shoulder repairs was 30 (50.8%) versus 14 (26.4%), and the rates of right shoulder repairs was 29 (49.2%) versus 39 (73.6%) (p=0.014). Concomitant pathologies were recorded in 68.9% of SLAP repairs and in 88.0% of biceps tenodesis (p=0.030). Concomitant procedures (including bursectomy, capsular release, and acromioplasty) were performed in 74.6% of SLAP repairs and in 92.0% of biceps tenodesis (p=0.033). The two groups showed no differences in two-year ASES scores (81.5 in SLAP repair vs 83.3 in biceps tenodesis, p=0.461), SANE scores (75.6 in SLAP repair vs 79.7 in biceps tenodesis, p=0.344) and VAS scores (20.2 in SLAP repair vs 21.1 in biceps tenodesis, p=0.645). Furthermore, rates of participation in sports prior to surgery was similar (55.4% in SLAP repair vs 42.6% in biceps tenodesis , p=0.251); of those who reported participation prior to surgery, rates of return to participation in sport following surgery was also similar (77.4% in SLAP repair vs 78.3% in biceps tenodesis, p=1.000). Conclusions: This is the first study to evaluate the outcomes of SLAP repair and biceps tenodesis for SLAP lesions in female patients. Female patients who underwent surgical treatment of SLAP lesions with SLAP repair or biceps tenodesis show comparable minimum two-year results with respect to level of function, self-reported pain, and ability to return to sports after these procedures. The incidence of concomitant pathologies and concomitant procedures at the time of SLAP repair and biceps tenodesis differed between the two groups, possibly related to group age disparity. Further research is necessary to define precise treatment indications for this pathology in this specific patient population.

Poster 192: Depressive and Anxiety Disorders Increase Risk for Continued Biceps Pain Following Arthroscopic Biceps Tenodesis

Objectives: Arthroscopic suprapectoral biceps tenodesis (ASPBT) may result in postoperative biceps pain. Previous studies have revealed associations between demographic or intraoperative factors and shoulder pain, but with conflicting results. No study has exclusively investigated predictors of biceps pain following ASPBT. The purpose of this study was to evaluate factors associated with postoperative biceps pain following ASPBT while also determining the clinical impact of postoperative biceps pain. We hypothesized that younger age and pre-existing diagnoses of chronic pain syndromes would be associated with increased postoperative biceps pain. Methods: A retrospective study comprised of patients that underwent ASPBT was completed. Groups were categorized by the presence (BP+) or absence (BP-) of postoperative biceps pain. Differences between continuous variables were tested with two-sample t-tests and differences between categorical variables were tested with the chi-squared or Fisher’s exact test. Variables collected at different postoperative timepoints were first analyzed using a linear mixed model or generalized linear mixed model with fixed effects for group, timepoint, the group*timepoint interaction, and a random subject effect. Post-hoc comparisons were analyzed and p-values were adjusted for multiple testing with the Benjamini-Hochberg procedure. Results: A total of 461 (47 BP+, 414 BP-) patients met criteria for analysis. A lower mean age was observed in the BP+ group (p&lt;0.01). Diagnoses of major depressive disorder (MDD) (p=0.03) and any anxiety disorder (p&lt;0.01) were more prevalent in the BP+ group. Prescription medication with selective serotonin reuptake inhibitors or selective norepinephrine reuptake inhibitors (p&lt;0.01) and atypical antidepressants (p=0.01) was more prevalent in the BP+ group. Subacromial decompression (SAD) was performed less frequently in the BP+ group (p&lt;0.01). Conclusions: Younger age, diagnosis of MDD or any anxiety disorder, as well as the use of psychotropic medications were predictive of postoperative biceps pain following ASPBT. The study also observed lower odds of developing postoperative biceps pain in patients undergoing concomitant SAD. Postoperative biceps pain after ASPBT resulted in prolonged recovery, inferior PROs, and a higher incidence of repeat surgical procedures. The decision to perform ASPBT in younger patients, patients diagnosed with MDD or anxiety, and patients taking psychotropic medications should be carefully considered given the correlation to postoperative biceps pain and inferior outcomes. [Table: see text][Table: see text]

Arthroscopic Biceps Tenodesis: Midterm Clinical Results of a New Anchor Suture Technique in Patients with Single-Row Rotator Cuff Repair

Arthroscopic Biceps Tenodesis: Midterm Clinical Results of a New Anchor Suture Technique in Patients with Single-Row Rotator Cuff Repair

Does the timing of tenotomy during biceps tenodesis affect the incidence of Popeye deformity and clinical outcome? An analysis of short-term follow-up of 2 techniques.

There are multiple techniques that attempt to maintain anatomic length-tension relationship during biceps tenodesis. However, no direct comparison has been performed with respect to the timing of biceps tenotomy during biceps tenodesis. This study aims to assess the incidence of Popeye deformity and clinical outcomes of 2 all-arthroscopic techniques for biceps tenodesis based on timing of the biceps tenotomy. A consecutive series of patients undergoing arthroscopic biceps tenodesis with concomitant rotator cuff tears were enrolled from 2019 to 2021. Biceps tenodesis performed after tenotomy formed the first cohort (group 1). The other cohort had biceps tenodesis performed prior to biceps tenotomy (group 2). Postoperative anterior arm pain, biceps muscle spasms, and patient perceptions of the appearance of the bicep muscle were assessed. In addition, patient-reported outcomes (PROs) were collected at 3 months and minimum 6 months postoperatively. A total of 71 patients were eligible for participation and 62 patients (53% female, age 58.7±9.0 years) were enrolled (n=33 in group 1, and n=29 in group 2). There were no differences between groups with respect to gender, age, and laterality of biceps tenodesis, as well as type and size of rotator cuff repair. At 3-month follow-up, Veterans RAND 12-Item Health Survey (VR-12) physical health summary scores were significantly improved in group 2 (44.8±9.7) compared with group 1 (34.1±3.4) (P=.03). In addition, patients in group 2 experienced significantly less pain in their anterior arm than patients in group 1 (19% vs. 33%, P=.02). There were no differences in biceps muscle spasm (3.4% vs. 5.2%, P=.21) and no other differences in PROs between groups. Final follow-up averaged 11.6±3.3 months in group 1 and 11.8±5.5 months in group 2. There were no significant differences in patient-perceived biceps Popeye deformity between group 1 (12.1%) and group 2 (0%) (P=.652). Furthermore, there were no differences in American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, EuroQol-5 Dimension, Patient-Reported Outcomes Measurement Information System Global Health (PROMIS 10) physical health, PROMIS 10 depression, VR-12 physical health summary, and Single Assessment Numeric Evaluation scores between the 2 technique groups. Patients with tenotomy performed after tenodesis had better VR-12 physical health summary scores and less arm pain than patients with tenotomy performed before tenodesis at 3-month follow-up. However, there were no differences in any outcome at final follow-up of nearly 1-year. In addition, there were no differences in perceived Popeye deformity between groups at any time period.

Biomechanical Analysis of Lark-Loop, Lasso-Loop and Krackow Suture Technique in Tenodesis.

Strong tendon grasping is vital to the success of a tenodesis operation. The purpose of this study was to evaluate the initial tendon-fixation strength of the Lark-Loop technique in arthroscopic suprapectoral biceps tenodesis and compare it with others commonly used techniques. Thirty-three porcine superficial flexor digitorum tendons were harvested from a local slaughterhouse and randomly divided into three groups to perform three tendon fixation techniques (Lasso-Loop stich group, Lark-Loop stich group or Krackow stich group; 11 tendons each group) with a No. 2 suture, respectively. Each tendon was pre-tensioned in 5°N for 2min and then cyclically loaded 5 to 30°N for 500 cycles to assess displacement. After cyclic loading, the tendon was loaded to ultimate tendon-suture configuration failure at the rate of 1 mm/s. Finally, the mode of failure and the construct stiffness of the tendon were recorded and calculated. After cyclical loading, the displacement of the Lark-Loop group was equivalent to the Krakow group (P > 0.9999) but significantly smaller than the Lasso-Loop group (P = 0.0009). The ultimate load to failure for the Lark-Loop was equivalent to the Krakow technique group (P = 0.1463) but significantly greater than the Lasso-Loop group (P < 0.0001). The stiffness for the Lark-Loop was equivalent to the Krakow group (P = 0.4718) but significantly greater than the Lasso-Loop technique group (P < 0.0001). In the Lark-Loop and Krackow group, all the tendons failed by suture breakage, while all the tendons failed by suture cutting through the tendon in the Lasso-Loop technique group. Lark-Loop suture technique has biomechanical properties comparable to Krackow and superior to the Lasso-Loop in terms of suture displacement, ultimate load to failure, and stiffness. Therefore, the Lark-Loop suture fixation technique may be beneficial for arthroscopic biceps tenodesis.

Bi-Cortical transhumeral drilling for biceps tenodesis – Is it safe?

BackgroundBiceps tenodesis is an effective procedure performed to treat shoulder pain originating from the long head biceps tendon. In arthroscopic biceps tenodesis unicortical drilling of the humerus is more commonly practiced as it is considered safe to the vital structures lying posterior to the proximal humerus. Many surgeons are wary of the bi-cortical approach as it poses a risk to these vital structures. The aim of this study was to establish whether bi-cortical drilling in proximal humerus is safe or not. Our second purpose was to find a safe zone (if any) for bi-cortical drilling if bi-cortical drilling is safe. MethodsThis study is a descriptive study conducted on cadaveric shoulders. Bilateral shoulders and arms of ten fresh-frozen cadavers (mean age 77.7 y) were dissected. Four landmarks in the dissected humerus were identified. They were superior margin of the bicipital groove, center of the bicipital groove, upper and lower border of pectoralis major insertion. Bi-cortical trans-humeral pinning was done in the humerus at all these points so that the pin exited through the posterior cortex of the humerus. The shortest distance between the pin and the nearest vital structure namely axillary nerve, radial nerve, articular surface of the humeral head, and cephalic vein was calculated from each fixed landmark. ResultsWe established that bi-cortical drilling in proximal humerus was safe. The safe zone established for bi-cortical biceps tenodesis is at the middle of bicipital groove, which is 18.00 ± 4.02 mm inferior to the groove’s upper border. The boundaries of the safe zone lie 9.39 mm superiorly and 9.40 mm inferiorly to the middle of the bicipital groove. ConclusionThe center of the established safe zone for bi-cortical trans-humeral pinning was 18 mm inferior to the bicipital groove’s upper border.

All Arthroscopic Suprapectoral Biceps Tenodesis

Background: Biceps tendinopathy can have significant clinical manifestations in active patients. Failure to achieve resolution of symptoms through nonsurgical modalities oftentimes results in surgical intervention. The 2 most common surgical treatment options for tendinopathy of the long head of the biceps tendon (LHBT) are tenotomy and tenodesis. Both modalities have shown efficacy within the literature; however, tenodesis of the LHBT has many advantages to tenotomy. Indications: Subgroove tenodesis eliminates the potential pain generation within the bicipital groove. Despite recent proof of clinical equivalence in open versus arthroscopic tenodesis, there has been increasing interest in all-arthroscopic biceps tenodesis techniques in hopes of minimizing surgical exposure, decreasing the rate of potential neurovascular compromise, and decreasing the time to recovery. Technique: We present an all-arthroscopic technique for a subgroove biceps tenodesis using a unicortical tensionable button. The proximal biceps anchor is held in place at its insertion site with a spinal needle to prevent retraction. The lateral portal is redirected into the subdeltoid space. A novel suprapectoral biceps portal, called the Willingboro portal, is placed percutaneously 2 cm above the pectoralis tendon. Onlay fixation of the LHBT is performed proximal to the pectoralis major muscle insertion using a unicortical button. Postoperative protocol is similar to other fixation constructs. Results: Numerous arthroscopic biceps tenodesis techniques have been described with good success; however, an all-arthroscopic suprapectoral tenodesis is attractive to many reasons. The unicortical button construct shows similar load to failure strength as the bicortical button construct, both of which are greater than all other constructs described in the literature. Discussion/Conclusion: Arthroscopic subgroove biceps tenodesis using a unicortical button technique is a viable option that avoids the complications associated with an open axillary incision as well as persistent groove pain. Anchoring the biceps tendon prior to tenotomy allows for preservation of tendon length, limiting the complications associated with tendon retraction with anticipated improvement in patient-reported outcomes. The unicortical button is known to have a similar strength profile as the bicortical button technique, which is greater than other techniques described in the literature. Future studies should be aimed at assessing long-term patient-reported outcomes. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Poster 143: Variation in Postoperative Tendon Migration Does Not Result in Significant Differences in Patient Reported Outcomes in Patients Undergoing Arthroscopic or Open Biceps Tenodesis Using All-Suture Suture Anchor and Interference Screw

Objectives:It is unknown whether the degree of biceps tendon migration influences patient outcomes following biceps tenodesis (BT). We aimed to assess the relationship between in vivo tendon migration and patient reported outcomes (PROs) following arthroscopic and open BT using suture anchor (SA) and interference screw (IS) constructs.Methods:One hundred twenty patients undergoing arthroscopic and open BT with SA or IS fixation at a single academic center were prospectively enrolled. Postoperative biceps tendon migration was measured via RSA, using a tantalum bead as a radio-opaque marker for tendon migration, with radiographs at 3- and 12-weeks postoperatively. PROs (Constant, SANE and PROMIS) were collected preoperatively, and at 6 months, 1 year, and 2 years. A Bonferroni correction was made for multiple comparisons.Results:Preoperative PRO completion was as follows: 20 (16.7%) ASES, 64 (53.3%) Constant, 96 (80.0%) SANE, and 108 (90.0%) PROMIS-UE. Patients with an open SA had a younger median age (48.4, IQR 38-55.4, P=0.014) and fewer dominant-sided surgeries (8/33 patients or 24.2%, P=0.003). PRO scores did not differ by groups for any questionnaire at all timepoints. There were no significant differences in likelihood of achieving MCID for ASES (P>0.99), Constant (P=0.87), SANE (P=0.68), or PROMIS-UE (P>0.99) between groups. In univariable analysis, no patient- or surgery-related factors served as significant predictors of achieving MCID at 6 months. Notably, neither RSA bead migration>3cm (Constant: OR= -0.54, 95%CI -2.53-1.45, P=0.60; SANE: collinear; PROMIS-UE: collinear) nor Popeye deformities (Collinear for all PROs) were negatively associated with likelihood of achieving MCID.Conclusions:Patient-reported outcomes are similar for patients undergoing arthroscopic BT via IS and SA, and open BT via IS and SA. No significant predictors of achieving MCID at 6 months were identified, including migration of the RSA bead. Biceps tendon migration was not significantly correlated with patient reported outcomes.Table 1.Demographics and PROs in Patients with biceps tenodesisFigure 1.Scatter plot of 6-Month change in Constant and Tantalum bead migration (R⁁2=0.03,P=0.38)Figure 2.Scatter plot of 6-Month change in SANE and Tantalum bead migration (R⁁2 = 0.004, P=0.78)Figure 3.Scatter plot of 6-Month change in PROMIS UE and Tantalum bead migration (R⁁2 = 0.01, P=0.42)

Outcomes of Biceps Tenotomy Versus Tenodesis During Arthroscopic Rotator Cuff Repair: An Analysis of Patients From a Large Multicenter Database.

Background:Studies to date evaluating biceps tenotomy versus tenodesis in the setting of concomitant rotator cuff repair (RCR) have demonstrated relatively equivalent pain and functional outcomes.Hypothesis:It was hypothesized that a significant difference could be demonstrated for pain and functional outcome scores comparing biceps tenotomy versus tenodesis in the setting of RCR if the study was adequately powered.Study Design:Cohort study; Level of evidence, 3.Methods:The Arthrex Surgical Outcomes System database was queried for patients who underwent arthroscopic biceps tenotomy or tenodesis and concomitant RCR between 2013 and 2021; included patients had a minimum of 2 years of follow-up. Outcomes between treatment types were assessed using the American Shoulder and Elbow Surgeons Shoulder (ASES), Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and Veterans RAND 12-Item Health Survey (VR-12) scores preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Results were stratified by age at surgery (3 groups: <55, 55-65, >65 years) and sex.Results:Overall, 1936 primary RCRs were included for analysis (1537 biceps tenodesis and 399 biceps tenotomy patients). Patients who underwent tenotomy were older and more likely to be female. A greater proportion of female patients aged <55 years and 55 to 65 years received a biceps tenotomy compared with tenodesis (P = .012 and .026, respectively). All scores were comparable between the treatment types preoperatively and at 3 months, 6 months, and 1 year postoperatively. At 2-year follow-up, patients who received a biceps tenodesis had statistically more favorable ASES, SANE, VAS pain, and VR-12 scores (P ≤ .031); however, the differences did not exceed the minimal clinically important difference (MCID) for these measures.Conclusion:Our findings indicate that surgeons are more likely to perform a biceps tenotomy in female and older patients. Biceps tenodesis provided improved pain and functional scores compared with tenotomy at 2-year follow-up; however, the benefit did not exceed previously reported MCID for the outcome scores. Both procedures provided improvement in outcomes; thus, the choice of procedure should be a shared decision between the surgeon and patient.