Biceps Tenodesis Research Articles

Comparison of clinical outcomes and return to sport between unicortical versus bicortical button fixation techniques for subpectoral biceps tenodesis.

There is limited clinical outcome data comparing fixation methods for tenodesis of the long head of the biceps tendon (LHBT), particularly button fixation. The purpose of this study was to compare clinical outcomes, patient-reported outcomes, and return to sport (RTS) between patients undergoing LHBT with bicortical versus unicortical button technique. The authors hypothesized these fixation methods would be similar for all outcomes. Patients who underwent LHBT using unicortical or bicortical button fixation with minimum 2-year follow-up were identified. Postoperative outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) questionnaire and visual analogue scale (VAS) pain score. A sports activity survey was collected to assess baseline sport participation and ability to return to pre-injury activities. Continuous variables were analyzed using the Mann-Whitney-U test. Categorical variables were analyzed using Chi-squared tests. Multivariable logistic and linear regression were performed to determine predictors of RTS and time to RTS. Sixty-four subjects (19 unicortical and 45 bicortical button fixation) were included (average follow-up 3.5 (range: 2.0-7.8) years). There were no significant differences found between button groups for VAS pain score (1.5 vs. 1.2; p = 0.876), VAS pain during sport score (1.6 vs. 1.1, p = 0.398), and ASES score (66 vs. 71; p = 0.294). There were no significant differences in rate of RTS (75.0 vs. 77.4%; p = 0.885) or average time to return to sport (11.7 ± 7.3 vs. 7.0 ± 4.0months; p = 0.081) between groups. There were no significant differences in clinical outcomes, pain, or return to sport between patients who underwent LHBT with unicortical or bicortical button fixation.

Establishing Clinical Significance for Patients Undergoing Arthroscopic Repair of Type II SLAP Lesions.

Type II superior labrum anterior to posterior (SLAP) lesions may be treated with either arthroscopic repair or biceps tenodesis. There are no previous reports of measures of clinically significant improvement after arthroscopic repair of SLAP lesions. To establish the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) for patients undergoing arthroscopic repair for type II SLAP lesions. Case series; Level of evidence, 4. A total of 69 arthroscopic repair procedures for isolated type II SLAP lesions were performed in a military population. The mean age was 28.1 ± 4.7 years, 97.1% were male, and the mean follow-up was 99.5 ± 19.7 months. The MCID, PASS, and SCB were calculated for each patient-reported outcome measure, consisting of the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain, using anchor- and distribution-based models. Factors associated with achieving a clinically relevant improvement were also determined. The MCID, PASS, and SCB for each measure were as follows: 7.7, 70, and 34 for the ASES score, respectively; 10.4, 80, and 45 for the SANE, respectively; and 1.0, 4, and 6 for the VAS pain, respectively. At least 85% of patients achieved the MCID for each measure; however, PASS rates were lower, with 50.7% for the SANE and 69.6% for both the ASES score and VAS pain. The ASES score had the highest percentage of patients achieving the SCB at 44.9%, followed by the SANE (26.1%) and VAS pain (10.1%). Greater forward flexion at final follow-up was associated with achieving the MCID and PASS for both the ASES score and SANE. Internal rotation stiffness at final follow-up was negatively associated with achieving the PASS for the VAS pain. Combat arms military occupational specialty was associated with a lesser likelihood of achieving the SCB for the ASES score. Clinical metrics of improvement were defined for the ASES score, SANE, and VAS pain using the MCID, PASS, and SCB for patients undergoing arthroscopic repair of type II SLAP lesions. Better final range of motion was positively associated with achieving improvement, while high-intensity military duty was negatively associated.

Biceps Tenodesis for the Treatment of Type II Superior Labral Anterior Posterior (SLAP) Tears in Overhead Athletes Under the Age of 35: A Case Series.

The best treatment for type II superior labral anterior posterior (SLAP) tears in overhead athletes is not well defined. The purpose of this study was to examine post-surgical outcomes in overhead athletes under the age of 35 who underwent primary biceps tenodesis for an isolated type II SLAP tear.We hypothesized that these patients would have high rates of return to play, as well as recovery of range of motion (ROM) and strength after surgery. Patients were between the ages of 18 and 35, had a primary isolated type II SLAP tear confirmed on magnetic resonance imaging (MRI), and were injured performing overhead activities.All patients underwent biceps tenodesis using an arthroscopic suprapectoral approach.Patients underwent standard postoperative rehabilitation lasting up to one year.Function and outcomes were measured at baseline, three months, six months, one year, and two years using range of motion, strength testing, and patient-reported outcomes (PROs) (Western Ontario Shoulder Instability Index (WOSI), Kerlan-Jobe Orthopedic Clinic Score (KJOC), American Shoulder and Elbow Surgeons Assessment Form (ASES), and Single Assessment Numeric Evaluation (SANE)). Five patients were included in the case series.There was consistent improvement at each time point on PROs: WOSI, p=0.01; KJOC, p=0.04; SANE, p=0.02; and ASES, p=0.03.Range of motion increased from baseline to each time point with a significant improvement in forward flexion (p=0.03).In strength testing, there were improvements in all exercises and a significant improvement in abducted external rotation between years 1 and 2 (p<0.01). This study demonstrated that biceps tenodesis in overhead athletes under the age of 35 provides improved outcomes, ROM, and strength.

Retrospective Evaluation of Clinical and Radiological Results of Patients Treated With Arthroscopic Transosseous Repair for Rotator Cuff Tear.

Surgical repair is recommended for symptomatic full-thickness rotator cuff tears to restore muscle function and alleviate pain. Advances in arthroscopic techniques and new implant designs have led to more reliable repair methods. The choice of technique is crucial for achieving favorable clinical outcomes. This study evaluates the short-term clinical and radiological outcomes of patients treated with the arthroscopic transosseous technique (ATO). Data from 43 patients who underwent full-thickness rotator cuff (RC) repair using the arthroscopic transosseous technique between February 2014 and April 2016 were prospectively collected and retrospectively reviewed. Included patients had medium-sized (1-3 cm) full-thickness supraspinatus tears extending to the infraspinatus and underwent tenotomy or biceps tenodesis. Functional outcomes were assessed using the Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and constant score at their final follow-up appointment. Radiological evaluation included postoperative MRI to assess re-tear development. The mean follow-up period was 26.52±8.14 months. Postoperative VAS, ASES, and constant scores significantly improved compared to preoperative values (3.14±1.20, 88.4±8.12, and 88.9±10.6, respectively). The ATO technique provides strong mechanical and biological repair, yielding good functional outcomes for full-thickness rotator cuff tears (RCTs). It is an effective method for early recovery of shoulder joint range of motion (ROM) and pain reduction.

Increased Postoperative Deltoid Signal seen after Suprapectoral Biceps Tenodesis: Potential Risk to the Anterior Branch of the Axillary Nerve

BackgroundArthroscopic suprapectoral biceps tenodesis is a common procedure for lesions of the long head of the biceps in the setting of anterior shoulder pain. However, the distal portal poses a theoretical risk to the terminal branches of the axillary nerve as the nerve travels from posterior to anterior to innervate the anterior deltoid. The purpose of this retrospective cohort study was to assess for axillary nerve branch injury, identified by deltoid signal change in postoperative magnetic resonance imaging (MRI) in patients who underwent an arthroscopic suprapectoral biceps tenodesis. MethodsPatients who underwent rotator cuff repair with a concomitant arthroscopic suprapectoral biceps tenodesis, had a postoperative MRI, and at least 1 year of follow-up were included. The incidence of increased deltoid signal consistent with injury to an anterior branch of the axillary nerve on proton density fat saturated sequences was collected. Age, sex, body mass index (BMI), and patient reported outcome measures (PROMs) including the American Shoulder and Elbow Surgeons Shoulder Score (ASES) score, Patient-Reported Outcomes Measurement Information System (PROMIS) pain, physical function (PF), and upper extremity (UE) scores, and Single Assessment Numeric Evaluation (SANE) score were compared in patients with and without increased deltoid signal on postoperative MRI. P<0.05 was used for significance. ResultsTwenty-four patients were eligible for inclusion (9 female, average age 59.0±10.1, BMI 27.6±6.7). Edema-like signal within the anterior deltoid musculature was observed in 9 patients on postoperative MRI. Two patients had a second follow-up MRI performed which demonstrated resolution of signal, and one patient required a second surgery for release of adhesions. Patients with increased deltoid signal had higher BMI (p=0.03). There was no difference in any other demographic or postoperative PROM between patients with increased signal and those without at any follow-up time point. No patient demonstrated persistent weakness or numbness in the axillary nerve distribution at final follow-up. DiscussionOver one third of patients in our cohort had MRI evidence of axillary nerve branch injury as seen on proton density fat saturated MRI sequences postoperatively. The distal arthroscopic portal for a suprapectoral biceps tenodesis may place anterior terminal branches of the axillary nerve at risk for injury. Additional investigation and strategies for avoidance of nerve injury in this area should be pursued.

Cost analysis of dermal allograft patch utilization in rotator cuff repair

PurposeTo perform an analysis of intra-operative costs associated with arthroscopic rotator cuff repair acellular dermal allograft patch augmentation and interposition. MethodsThis was a matched cohort retrospective cost identification analysis. We identified patients who underwent arthroscopic rotator cuff repair with acellular dermal allograft patch augmentation or interposition between 2014 to 2023 at a single academic center. These were matched based on age and tear size to a cohort of patients who underwent arthroscopic rotator cuff repair without a patch. Patients without preoperative MRI data were excluded. Via chart review, we collected demographics, medical comorbidities, tear characteristics, and intra-operative repair characteristics. Patch and control patients were compared with paired t tests. Differences in costs between patch and control patients were assessed using multivariable regression controlling for observable covariates. ResultsOne hundred and thirty-two (132) total patients were included: 66 patch patients and 66 control patients. The patch group demonstrated more tear retraction and utilized single row medial repair more frequently. Multivariable analysis revealed that there was a $4,930 total direct cost increase with the utilization of a patch (p<0.001) after controlling for age, BMI, ASA, CCI, gender, surgeon, tear width, number of anchors, occupation, biceps treatment, prior surgery, and repair construct. The multivariable analysis also revealed that a higher ASA was associated with a $1,440 increase in cost (p=0.012). Biceps tenotomy was associated with a $3,303 decrease in cost compared to tenodesis (p=0.001). Additionally, single row medial repair demonstrated a $1,745 decrease in total direct cost when compared to a double row repair construct (p=0.019). ConclusionThe addition of a patch increases the total direct cost by $4,930 when compared to arthroscopic RCR without a patch. Increased ASA, biceps tenodesis, and use of a double row repair construct were also associated with increased cost.

Subpectoral Biceps Tenodesis Using an All-Suture Anchor

Background: The long head of the biceps tendon (LHBT) has long been considered an intra-articular pain generator in the shoulder. While nonoperative treatment modalities can be acceptable for less severe presentations of LHBT pathology, surgical treatment options such as tenotomy and tenodesis remain controversial for recalcitrant cases. Open subpectoral biceps tenodesis allows for removal of all pathologic tissue from the bicipital groove, and all-suture anchor fixation utilizes a small caliber unicortical drill hole, which can potentially reduce the risk of a stress riser and iatrogenic fracture. Indications: In this study, we present a male patient with a history of left anterolateral shoulder pain worse overhead activities who has failed extensive physical therapy and other conservative measures. After extensive discussion regarding the treatment options, surgery in the form of shoulder arthroscopy, extensive debridement, rotator cuff repair, and open subpectoral biceps tenodesis was recommended and the patient had opted to proceed. For the purposes of this video, we focus on the open subpectoral biceps tenodesis portion of the procedure. Results: Open subpectoral biceps tenodesis can reduce pain with low complication and high satisfaction rates. Discussion: In this surgical technique study, we underline the importance position of the skin incision in axillary crease as well as skin tensioning when making the incision and retracting the conjoint tendon. We also highlight a locking lasso loop and double luggage tag fixation technique using a double-loaded all-suture anchor for the biceps tenodesis. We also provide technique commentary for appropriate restin tension of the LHBT. Finally, we review outcomes, postoperative management, rehabilitation protocol, and technique pearls and pitfalls. 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.

Compression of an Autograft Biceps Into an Augmentation Patch Does Not Cause Mechanical Damage to the Tenocyte

A compression plate has recently been reported as a point of care processor for adapting the long head of the biceps into an autograft patch for rotator cuff augmentation. The purpose of this study was to evaluate the effects of this graft preparation technique on histological evidence of tenocyte mechanical damage. A consecutive series of patients undergoing biceps tenodesis for shoulder pathology were evaluated. After supra-pectoral tenodesis, 27 mm of the long head of the biceps was secured for compression into the patch. The remaining length of residual tendon was longitudinally split, resulting in two equal lengths of remnant tendon from the same zone. One sample was sent to pathology with no preparation, and the other was prepared as a compressed biceps autograft patch according to the manufacturer's recommendations. Both grafts were sent to pathology for evaluation of tenocyte morphology. Records were reviewed to determine if compression resulted in mechanical damage to the tenocytes at the time of biceps augmentation. 55 shoulder procedures and 110 samples were sent for pathology analysis. 42 of the 55 (76%) specimens demonstrated morphologically normal tenocytes in both the compressed and non-compressed groups, and 7 (13%) cases showed evidence of tenocyte necrosis or mechanical damage in both groups. The difference abnormal tenocyte morphology between the compressed group and the native group was not statistically significant (p=0.625). Autograft biceps compression into a point of care patch did not result in mechanical damage to tenocyte morphology at the time of insertion for augmentation of rotator cuff pathology. Free proximal biceps tendon compression can result in a patch that does not mechanically damage the tenocyte. The patch can be used as a biologic autograft to enhance shoulder rotator cuff repair, as well as subscapularis repair in the setting of shoulder arthroplasty.

Clinical Outcome of an All Arthroscopic 'Whole Layer' Rotator Cuff Repair Technique with Simultaneous Biceps Tenodesis.

To retrospectively evaluate clinical outcomes, including function and pain, of patients after our all arthroscopic "whole layer" rotator cuff repair technique with simultaneous biceps tenodesis procedure; factors influencing results were also evaluated. Given the frequent association of rotator cuff tear with long head of biceps lesion and the need for effective combined treatment strategies, this study aims to evaluate the efficacy of our technique and compare it with established methods. We hypothesized that our technique would significantly improve function and reduce pain in patients with rotator cuff tears and biceps pathology. This is a retrospective study that included patients older than 20 years who underwent all arthroscopic "whole layer" rotator cuff repair technique with simultaneous biceps tenodesis procedures for concomitant rotator cuff tear and long head biceps pathology, from 2016 to 2020. Patients were evaluated preoperatively and at a minimum of 2 years of follow-up using the American Shoulder and Elbow Surgeons (ASES) and visual analogue scale (VAS) scores paired t-tests were used for analysis and statistical significance was set at p < 0.05(two-tailed). The satisfaction rate and complications were also evaluated. After an average follow-up of 2.3 years, 118 patients demonstrated significant improvement in both the ASES score (from 36.13 to 95.01, p < 0.001) and VAS score (from 6.81 to 0.89, p < 0.001). Ninety-four percent of the patients reported satisfaction with the surgical outcome. No complications related to Popeye deformity, biceps cramping pain, or ipsilateral shoulder reoperation were observed. Factors such as age, sex, body mass index (BMI), smoking status, alcohol consumption, hypertension, and diabetes did not influence the results. Patients showed significant improvement in both the ASES and VAS scores (p < 0.001). At a mean follow-up time of 2.3 years, the all arthroscopic "whole layer" rotator cuff repair technique with simultaneous biceps tenodesis is a therapeutic and efficient procedure. The procedure revealed a satisfactory functional outcome, reduced pain, and minimal complications and reoperations.

Greater Postoperative Biceps Tendon Migration Following Biceps Tenodesis Correlates with Lower Patient Reported Outcomes Scores

To assess the relationship between tendon migration, as measured by radiostereometric analysis (RSA), and patient-reported outcome measures (PROMs) following biceps tenodesis (BT); to determine the likelihood of achieving clinically significant outcomes (CSOs) following BT; and to identify factors that impact CSO achievement. Patients undergoing arthroscopic suprapectoral or open subpectoral BT at a single, high-volume academic medical center were prospectively enrolled. A tantalum bead sutured to the tenodesis construct was utilized as a radio-opaque marker. Biceps tendon migration was measured on calibrated radiographs at 12 weeks postoperatively. PROMs (Constant-Murley score [Constant], Single Assessment Numeric Evaluation [SANE], and Patient-Reported Outcomes Measurement Information Systemic-Upper Extremity [PROMIS-UE]) were collected preoperatively and at ≥2 years follow-up. Of 115 patients enrolled, 94 (82%) patients were included (median age=52 years and BMI=31.4 kg/m2). At a mean follow-up of 2.9 years, median Constant, SANE, and PROMIS-UE were 33 (interquartile range [IQR]=26-35), 90 (IQR=80-99), and 47 (IQR=42-58), respectively. Median tantalum bead migration was 6.5 mm (IQR 1.8-13.8). There was a significant correlation between migration and Constant (r2 = 0.222, beta= -0.554, 95% CI -1.027- [-0.081], P=0.022), SANE (r2 = 0.238, beta= -0.198, 95% CI -0.337 - [-0.058], P=0.006) and PROMIS-UE (r2 = 0.233, beta= -0.406, 95% CI -0.707 - [-0.104], P=0.009). In univariable analysis, higher BMI was associated with achievement of substantial clinical benefit (SCB, unadj-OR=1.078, 95%CI 1.007-1.161, P=0.038). Greater bead migration was negatively associated with achievement of minimal clinically important difference (MCID, unadj-OR=0.969, 95% CI 0.943-0.993, P=0.014) and patient acceptable symptomatic state (PASS, unadj-OR 0.965, 95% CI 0.937-0.989, P=0.008) on all 3 instruments. A 1 cm-increase in tenodesed biceps tendon migration was associated with a decrease in Constant, SANE, and PROMIS-UE of 6, 2, and 4 points, respectively, at a mean of 2.9 years after surgery. Most patients achieved clinically significant outcomes (CSOs) for these PROMs by latest follow-up, and greater biceps tendon construct migration was negatively associated with the likelihood of CSO achievement. IV, retrospective case series.

Clinical Outcomes After Mini-Open Subpectoral Biceps Tenodesis

Background Long head of the biceps tendon pathology is a common cause of shoulder pain. Current surgical treatment options for long head of the biceps tendon disorders include tenotomy and tenodesis. Younger and high-demand patients are usually treated with tenodesis since tenotomy is associated with increased biceps pain and cramping, cosmetic deformity and patient dissatisfaction. Previous studies have shown biomechanical advantages of subpectoral open approach over arthroscopic suprapectoral approach, with less biceps over tension and increased ultimate load to failure. Despite this, there is a lack of consensus in the literature regarding the management of biceps-related pathology. Methods We retrospectively reviewed all patients who underwent subpectoral biceps tenodesis with unicortical endo-button fixation between January 2015 and December 2019. Only patients who had a minimum of 24 months follow-up were included in the study. We reviewed patient demographics. The American Shoulder and Elbow Surgeons and Visual Analogue score were assessed and complications were recorded. Results A total of thirty-two patients were enrolled in this study. 15 were young patients and sports athletes with SLAP (Superior Labrum from Anterior to Posterior) lesions or isolated biceps instability and the remaining 17 were middle-age patients with degenerative biceps disease and concomitant pathology. The mean follow-up time was 36 months. SLAP lesions group average age was 24,3 and degenerative group average age was 53,8. The ASES score and the VAS score and were statically significative better in the isolated subpectoral tenodesis due to SLAP lesions 99,8 and 0,1 respectively in comparison with the degenerative group, 85,7 and 1,5 respectively. We recorded two complications. One case of superficial infection and one case of a patient that was concomitant submitted to arthroscopic rotator cuff tear repair with persisting shoulder pain. There was no case of failure of fixation or associated Popeye deformity. Conclusions Subpectoral biceps tenodesis with unicortical endo-button fixation is a viable treatment option for patients with symptomatic biceps disease. Anterior shoulder pain and biceps symptoms were resolved with this technique. Patients with coexistent rotator cuff lesion may have less favorable outcomes.

Improved patient reported outcomes with knotless double-row rotator cuff repair with and without lateral row biceps tenodesis at 2- and 5-years

BackgroundThe purpose of this study is to report outcomes of an arthroscopic knotless double-row (DR) rotator cuff repair (RCR) technique at 2- and 5- years postoperatively, and to compare clinical outcomes in patients undergoing knotless DR RCR with incorporated lateral row biceps tenodesis vs. those without lateral row biceps tenodesis. MethodsAll primary RCR surgeries were performed by a single surgeon at a single institution using a knotless transosseous equivalent (TOE) technique. The postoperative rehabilitation protocol was standardized for all patients. The primary outcomes collected included ASES Function, ASES Index, SANE, SST, VR-12 physical and mental, and VAS scores. ResultsThree hundred forty-two patients met inclusion criteria, of which 262 patients underwent isolated RCR and 61 underwent RCR with a concomitant lateral row biceps tenodesis, 15 underwent RCR with concomitant tenotomy and 4 had RCR with débridement of the biceps. Significant improvements in VAS, ASES, SANE, SST, and VR-12 scores were observed at all time points in all patient groups. No statistically significant differences in outcomes were noted in patients undergoing RCR with a lateral row tenodesis vs. those undergoing RCR alone. Similarly, no differences were seen when stratified by age, sex, BMI, Worker’s Compensation (WC) status, smoking, and diabetes mellitus (DM). Based on ASES, 81% of patients met minimum clinically important difference (MCID), and 64% met maximum outcome improvement (MOI) at 1-year postoperatively. ConclusionKnotless DR TOE arthroscopic RCR significantly improves patient-reported clinical outcomes at 1-, 2- and 5-year follow-ups. These results are reflected in clinical practice because 80% achieve MCID postoperatively. Patient-related factors, including BMI, age, sex, WC, and DM do not significantly affect patient-reported outcomes in the first 5 years after surgery. Smokers have worse baseline scores which persist at 2-year follow-up. Lastly, adding an arthroscopic lateral row biceps tenodesis in knotless DR TOE arthroscopic RCR provides similar clinical outcomes to knotless DR TOE arthroscopic RCR without biceps tenodesis.

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.

Repair of Isolated Subscapularis Tears With Concurrent Biceps Tenodesis Using a Single Anchor Results in Satisfactory Clinical Outcomes: Minimum 2-Year Follow-Up

PurposeThe aim of the present study was to investigate the clinical outcomes of patients treated with isolated subscapularis tear repair and biceps tenodesis using a single anchor. MethodsPatients diagnosed with subscapularis tear and underwent arthroscopic surgery by a single surgeon between February 2017 and January 2022 were retrospectively evaluated. Inclusion criteria were patients who underwent repair of isolated subscapularis tear along with tenodesis for LHBT pathologies such as superior labrum anterior posterior (SLAP) lesion, instability, partial tear or tenosynovitis, with a minimum follow-up of 24 months. Assessment included active and passive range of motion (ROM), single-assessment numeric evaluation (SANE), visual analog scale (VAS),Constant-Murley score (CMS), and specific subscapularis and biceps tests. Improvements were analyzed using Minimum Clinically Important Difference (MCID) values. ResultsA total of 20 patients were included. The mean age was 48.5±7 years, and the follow-up period was 43.1±12.7 months. Significant improvements were observed at the final follow-up in active forward flexion, active abduction, active internal rotation, as well as VAS, SANE, and CMS (p< 0.001). The MCID analysis showed that 100% of patients met the MCID for CMS, 90% for SANE, and 100% for VAS. ConclusionIn the presence of an isolated subscapularis tear associated with LHBT pathologies, favorableclinical outcomes could be achieved by performing both tear repair and biceps tenodesis with a double-loaded single anchor. A majority of patients (>90%) achieved the MCID for the CMS, SANE and VAS, indicating significant clinical improvement and satisfactory patient outcomes. Level of EvidenceLevel IV, Case series

Superior capsular reconstruction using the long head of biceps tendon: a biomechanical assessment of tenodesis location and angle of fixation

BackgroundMassive irreparable rotator cuff tears (MIRCT) treated with superior capsular reconstruction (SCR) using the long head of the biceps tendon have shown satisfactory early results. Different techniques and positions for biceps tenodesis have been described. This study aimed to evaluate the effect of tenodesis location and glenohumeral fixation angle for graft tensioning on the biomechanics of a SCR using a single strand biceps technique. MethodsEight cadaveric shoulders were mounted to a custom biomechanical simulator which employed static tone loads to the deltoid and rotator cuff muscles. All cadavers were first tested in the intact condition, and then in the simulated MIRCT condition by sectioning the tendinous insertions of the supraspinatus and upper border of the infraspinatus. SCR using the long head of the biceps tendon was then evaluated. Three biceps tenodesis locations relative to the greater tuberosity (anterior, middle, and posterior) and two glenohumeral fixation angles (0° and 30°) for graft tensioning were tested. An optical tracking system was used to quantify superior-inferior (SI) and anterior-posterior (AP) humeral head translation relative to the glenoid, while the functional abduction force was quantified using a load sensor. All tests were conducted at 0°, 30° and 60° of glenohumeral abduction in a randomized fashion. ResultsWhen assessing isolated superior humeral head migration, all biceps tenodesis locations were effective at decreasing superior migration, with no tenodesis location significantly better than the other (P=0.213). However, biceps grafts tensioned at 30° of glenohumeral abduction were significantly better at reducing proximal humeral migration as compared to graft tensioning at 0° abduction (P=0.008).Posterior humeral head translation observed in the MIRCT condition was significantly reduced when tensioning the biceps tendon at 30° of glenohumeral abduction compared to 0° for all tenodesis locations (P≤0.043). Tenodesis location also significantly influenced posterior humeral head translation (P=0.001), with middle and posterior positions restoring near normal humeral head position when fixed at 30° glenohumeral abduction. All SCR techniques using the biceps tendon improved the functional abduction force relative to the MIRCT condition, although no statistically significant differences were observed relative to the intact condition (P≥0.448). DiscussionSCR using the long head biceps tendon is biomechanically effective in reducing posterosuperior translation of the humeral head in the setting of a MIRCT. Graft tensioning and fixation at 30° of glenohumeral abduction combined with either a middle or posterior tenodesis location on the greater tuberosity most effectively restores near normal time-zero humeral head kinematics.

Anterior cable reconstruction using subpectoral biceps tenodesis with biceps transfer in rotator cuff tears: a surgical technique

Massive rotator cuff tears (MRCTs) constitute approximately 20% of all rotator cuff tears. Poor tissue quality or significant retraction can lead to failure of the repair. The anterior rotator cuff cable is essential in transmitting force to the proximal humerus and serves as the main load-bearing structure within the supraspinatus. Utilizing the long head of the biceps tendon (LHBT) for anterior cable reconstruction in the setting of rotator cuff tears, known as biceps augmentation, has the potential for improved biomechanical and healing properties. Importantly, the proximal LHBT remains attached to the superior glenoid labrum, serving as a viable collagen scaffold, a structural scaffold for the cable, and potentially as a conduit for living tenocytes to migrate into the hypovascular region of the rotator cuff, promoting repair healing. Similar methods utilize the transfer of the intact LHBT into the rotator cuff without a biceps tenodesis. While this accomplishes the aforementioned goals, it may create a source of biceps pain in these patients, and it changes the length-tension relationship of the LHBT distal to the transfer site. In this technical note, we detail an anterior cable reconstruction employing an autologous LHBT to reinforce a repaired MRCT with concurrent subpectoral tenodesis of the LHBT to achieve goals of 1) rotator cuff augmentation and grafting and, importantly, 2) securing the LHBT in a subpectoral position to mitigate pain and maintain supination strength while maintaining the anatomic length-tension relationship of the biceps. We feel this approach is superior in ensuring sufficient tendon is retained for an effective transfer and allows for a subpectoral tenodesis to prevent biceps symptoms.

Long-term patient-reported outcomes of open subpectoral biceps tenodesis with cortical button fixation.

Open subpectoral biceps tenodesis (OSBT) with cortical button fixation has been shown to deliver acceptable results in the short and intermediate term for long head of the biceps (LHB) pathology with the benefit of smaller bone tunnel diameter and a reduced risk of postoperative humeral shaft fracture. The primary purpose of this study was to determine whether OSBT with cortical button fixation results in significant improvements in patient reported outcomes (PROs) from pre-operative to long-term final follow-up. A retrospective analysis of patients who underwent OSBT with cortical button fixation at a single institution between the years of 2012 and 2014 was conducted and PROs were collected in the intermediate (> 2years follow-up) and long term (> 9years follow-up). PROs were measured pre-operatively, at intermediate follow-up, and at long-term follow-up using three validated questionnaires: American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Oxford Shoulder Score (OSS). Patients were additionally asked at final follow-up if they would undergo the same procedure again if they needed it. Twenty-nine (29) patients with a mean age of 51.16 ± 9.06years at the time of surgery were included in the study at final follow-up. Mean final follow-up time was 10.2 ± 0.5years (range: 9.2-11.1years). All PROs (ASES, OSS, and DASH) demonstrated statistically significant improvements from pre-operative to final follow-up with p < 0.01 for each. The proportions of patients exceeding established values for minimum clinically important difference (MCID) were 96.55%, 93.10%, and 75.86% for ASES, OSS, and DASH respectively. Only one patient had required re-operation as of final follow-up. None experienced humeral fractures post-operatively. A significant majority (89.66%; p < 0.01) of patients reported that they would undergo the same procedure again if they needed it. Fifty-three (53) patients were included in the study at intermediate follow-up with a mean follow-up time of 3.5 ± 1.4years (range: 2-5.3years). There were no statistically significant differences in any of the PRO measures from intermediate to long-term follow-up. This study reported a minimum 9-year follow-up of patients undergoing OSBT with cortical button fixation for the management of LHBT pathology in the setting of concomitant shoulder procedures. All patients had significantly improved functional outcomes assessed with ASES, OSS, and DASH and no obvious differences in median group scores were found between patients assessed at intermediate (mean 3.5years) and final (mean 10.2years) follow-up. No infections, fractures, or fixation failures were reported.

Systematic Review and Meta-Analysis Comparing Long Head Biceps Tendon Tenotomy versus Tenodesis with Concomitant Repiarable Rotator Cuff Tears

Abstract Background Both tenotomy and tenodesis have been widely used for the treatment of long head of biceps tendon (LHBT) lesions, but the optimal strategy remains considerably controversial. In this meta- analysis of published studies, we compared the results of the two procedures. Methods A literature search that compared tenotomy with tenodesis was performed using pubmed, MEDLINE, cochrane libaray and researchgate . A total of 6 studies reporting data on 659 subjects were included. Study quality was evaluated using Cochrane collaboration tool for assessing the risk of bias. Results Data synthesis showed higher ASES score, constant score, simple shoulder test mean, lower popeye sign and insignificant vas score in patients managed with tenodesis compared to tenotomy (ASES score, P &amp;lt;0.001; constant score, P &amp;lt; 0.001; simple shoulder test mean, P = 0.045, popeye sign, P = 0.010 ; vas score, P = 0.422 respectively). Conclusion The current evidence indicates that biceps tenodesis for LHBT lesions with concomitant reparable rotator cuff tears results in decreased rate of Popeye sign and improved Constant score also ASES score compared to biceps tenotomy.

Poster 148: Similar Outcomes Despite Differing Costs for Long-head Biceps Brachii Tendon Treatment: Open Tenodesis vs. Arthroscopic Tenodesis vs. Tenotomy

Objectives: Rotator Cuff Repair (RCR) is frequently associated with treatment of the long head of the biceps brachii tendon. This is because the biceps tendon is a common pain generator of the shoulder, and it is commonly diseased concurrently with the rotator cuff. Biceps tendinopathy is commonly treated with tenodesis (open or arthroscopic) or tenotomy. Previous studies have shown no differences in complication rates and patient-reported outcomes (PROs) at 2-year follow-up between arthroscopic tenodesis or open tenodesis. Other literature has shown open biceps tenodesis (OBT) to have similar costs and operative time compared to arthroscopic biceps tenodesis (ABT); however, time-driven activity-based costing was not used. The purpose of this study was to evaluate for differences in day of surgery (DOS) costs at one-year for OBT, ABT, and biceps tenotomy in the context of RCR. We hypothesized that cost would be similar between OBT and ABT and would be less for tenotomy. The primary outcome was DOS cost as measured by time-driven activity-based costing. Secondary aims included assessing PROs with the Single Assessment Numeric Evaluation (SANE) score, and the American Shoulder and Elbow Surgeons (ASES) score, as well as operative time, symptomatic retear rate, and reoperation rate at one year. Methods: A prospectively collected PRO database was retrospectively reviewed for patients who underwent surgical treatment of their biceps tendon in the setting of primary RCR between 2018 and 2022. Inclusion criteria consisted of patients who underwent supraspinatus or supraspinatus and infraspinatus tendon repair, as well as biceps tenodesis (arthroscopic or open) or tenotomy and had full PRO data at preoperative baseline and at one-year follow up. Patients were excluded if they were missing PRO data, missing cost and implant data, had a prior history of shoulder surgery, underwent revision rotator cuff repair, or had their subscapularis, teres minor, or isolated infraspinatus tendon repaired. A total of 266 patients met criteria. PROs collected included SANE and ASES scores at baseline and one-year follow-up. Patient demographics, injury and surgical characteristics, operative time, retear and reoperation rates, and day of surgery cost were evaluated. Time-driven activity-based costing was used to determine DOS costs. Statistical analyses conducted included descriptive statistics, Fisher exact tests, and analysis of variance. Results: Of the 266 patients that met criteria, approximately half were female (n = 131, 49.3%). Mean patient age at time of surgery was 60.4 years old and mean body mass index was 30.15. Chronic tears were present in 55.6% of patients. 113 patients underwent OBT, 75 underwent ABT, and 78 underwent biceps tenotomy. The average values for ASES and SANE scores at baseline versus 1-year follow-up were 46.9 versus 84.3 and 40.2 versus 84.0, respectively. The age of patients who underwent tenotomy (64.2 years old) was significantly older than the ABT (58.7 years old) and OBT (58.8 years old) groups (p &lt; 0.001). Additionally, more women underwent biceps tenotomy versus tenodesis compared to men (37.4% of women vs. 21.5% of men). Mean operative time was significantly different between the groups with tenotomy being the fastest (ABT 128.0 minutes, OBT 139.9 minutes, tenotomy 121.6 minutes, p &lt; 0.001). DOS costs as well as biceps tendon fixation costs were highest for OBT compared to ABT and biceps tenotomy (DOS $3,963.64 vs. $3,426.67 vs. $3,095.34, p &lt; 0.001, respectively; Biceps fixation $505.25 vs. $237.94 vs. $5.15, p &lt; 0.001, respectively). Additionally, overall implant costs (including RCR) were highest for OBT, despite the number of anchors used not differing between the groups (p = 0.132). There was no difference in the number of tendons repaired by bicep treatment type (p = 0.203). Changes in 1-year ASES and SANE scores were not different between the group (p = 0.221 and p = 0.159, respectively). There were also no differences between groups in rotator cuff symptomatic retears or reoperations (p = 0.731 and p = 0.391, respectively). Conclusions: This study found DOS costs were lowest for biceps tenotomy and highest for OBT with a difference of more than $850. Operative time from shortest for biceps tenotomy, while OBT was associated with an 18 minute longer operative time. Despite the differences in cost and operative time, there were no differences in PROs, symptomatic rotator cuff retear rates, or reoperation rates at one-year follow-up. These results may indicate that all three treatment types can provide patients with similar outcomes; however, lower operative times and costs can be provided by tenotomy or ABT compared to OBT. Surgeons can use these results to help guide technique selection when treating patients with biceps pathology. [Figure: see text]