Subpectoral Tenodesis Research Articles

Complete Proximal Long Head Biceps Tendon Rupture in an Elite 17-year-Old Softball Pitcher: A Case Report.

This case report describes the successful treatment of a year-round teenage softball pitcher who sustained a proximal biceps tendon rupture who underwent successful subpectoral tenodesis. To our knowledge, this is the only reported case of such an injury occurring in an underhand throwing teenage athlete. This case highlights an unusual instance of a sport-related injury in an adolescent softball pitcher, suggesting that the softball pitch in elite athletes may put similar stress on the shoulder to overhead throwing athletes over time and further demonstrating that patients may continue to have success at elite levels of competition after tenodesis.

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.

Long head of the biceps tendon plays a role in stress absorption and humeral head restriction during the late cocking and deceleration phases of overhead throwing: a finite element study

BackgroundEmerging evidence suggests that the long head of the biceps (LHBT) may play a role in stabilizing the glenohumeral joint, and this has led to controversy around the efficacy of biceps tenotomy for superior labral anterior and posterior (SLAP) lesions. Therefore, the aim of this finite element analysis (FEA) study was to determine the stress absorption and humeral head translation restriction effects of the LHBT within the glenohumeral joint during the late cocking and deceleration phases of overhead throwing with a view to resolving the controversy around tenotomy. MethodsEight FEA models were created using computed tomography and magnetic resonance imaging data from normal glenohumeral joints. The models represented four LHBT conditions: uninjured, subpectoral tenodesis, tenotomy, and type II SLAP lesions. The late cocking and deceleration phases of the overhead throwing were simulated for each model. The impacts of the four LHBT conditions on glenohumeral joint stress absorption and humeral head displacement restriction were studied based on 1) stress and related distributions on the cartilage, labrum, capsule, and LHBT and 2) humeral head translation variation. ResultsThe FEA analysis showed that the magnitude of the contact stress on the articular cartilage, labrum, and capsule was the lowest in the uninjured models, followed by the subpectoral tenodesis, tenotomy, and type II SLAP lesion models. Humeral head translation was the most restricted in the subpectoral tenodesis models, followed by the tenotomy and type II SLAP lesion models. ConclusionFinite element analysis demonstrated that the LHBT plays a significant role in stress absorption and displacement restriction in the late cocking and deceleration phases of overhead throwing. Subpectoral tenodesis of the LHBT exhibited lesser amount of stress and humeral head translation than those of tenotomy, thereby making it a better option for patients who engage in overhead throwing.

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.

Histological features of the structure of the long head of biceps brachii tendon in patients with concomitant injuries of the rotator cuff

Background. The long head of biceps brachii tendon plays an important role in shoulder pain. Surgical tactics remain controversial. There are two approaches: tenotomy of the long head of biceps brachii tendon and tenodesis. Both have positive and negative sides. There is also no consensus on the effective position for performing tenodesis.The aim. To assess the histological structure of various parts of the long head of biceps brachii tendon, which may be the causes for persistent pain syndrome.Materials and methods. In this study, we examined the histological structure of the long head of biceps brachii tendon in 12 patients aged 18–59 years having chronic anterior shoulder pain with concomitant damage to the supraspinatus and subscapularis tendons. In all cases, magnetic resonance imaging (MRI) revealed changes that made it impossible to perform intraarticular tenodesis. Patients were divided into two groups according to the World Health Organization classification: young (18–44 years) and middle-aged (45–59 years). All patients underwent arthroscopy with subpectoral tenodesis and correction of concomitant pathology. The obtained macropreparations are divided into three zones: the proximal zone, the intertubercular zone and the zone below the intertubercular groove. All macropreparations were sent for histological examination.It was revealed that the most common changes occur in the area of the intertubercular groove in all categories, however, in the middle-aged group, the signs of inflammation and degeneration are equally evident in this zone and in the proximal part of the tendon.Conclusions. Young and middle-aged patients with damage to the tendons of the supraspinatus and subscapularis muscles and signs of chronic tendinitis of the long head of biceps brachii tendon tendon and pronounced structural changes according to MRI should undergo a subpectoral tenodesis procedure; it is also necessary to take into account the anatomical features of the tendon and possible surgical risks.

Biceps Rerouting Regardless of a Biceps-Labral Lesion During Rotator Cuff Repair Results in Lower Retear Rates and Comparable Clinical Outcomes to Subpectoral Biceps Tenodesis

PurposeTo evaluate the radiographic and clinical outcomes when rerouting a pathologic biceps during arthroscopic rotator cuff repair, by comparing it with concomitant subpectoral biceps tenodesis. MethodsThis retrospective, historical cohort study was conducted with patients who underwent an arthroscopic repair of a full-thickness rotator cuff tear, with intraoperative confirmation of biceps pathology including partial tears, subluxation, pulley lesions, or type II superior labrum anterior to posterior (SLAP) lesions. Until May 2018, such patients were treated with concomitant subpectoral tenodesis (group SPBT). Afterward, biceps rerouting was done regardless of biceps pathology (group BR) without biceps or SLAP repair. Radiographic parameters, including fatty degeneration, acromiohumeral distance, Sugaya classification, and retears, were evaluated using preoperative and one-year postoperative MRI. Clinical evaluation with a minimum two-year follow-up included pain visual analogue scale, American Shoulder and Elbow Surgeons, Simple Shoulder Test, and Constant-Murley scores. Whether individual patients exceeded these scores' minimal clinically important difference was also determined. ResultsA total of 64 patients (group SPBT, 32; group BR, 32) were included in the final analysis. The duration of clinical follow-up was 36.2 ± 9.3 months in group SPBT and 29.4 ± 6.9 months in the BR group (P=0.002). Compared to group SPBT, group BR demonstrated a significantly lower retear rate (SPBT vs. BR: 34.4% vs. 12.5%, P=0.039). In the BR group, 8/32 (25%) patients demonstrated a postoperative LHBT tear. The four cuff retears in group BR only took place within these patients. Other postoperative radiographic and clinical outcomes were comparable between the groups. Within each group, significant postoperative improvements were demonstrated (P<0.05 for all clinical scores). ConclusionEven in the presence of a pathologic LHBT and/or a type II SLAP lesion, augmenting the rotator cuff repair with BR significantly reduced retear rates while achieving clinical scores comparable to SPBT in a minimum two-year follow-up.

Surgical Treatment of Patients with Damage to the Ligaments Holding the Long Head of the Biceps (Pulley Lesion) in Combination with Contracture of the Shoulder Joint

Background. Damage to the ligaments holding the long head of the biceps, or Pulley Lesion injuries, are often accompanied by contracture of the shoulder joint.&#x0D; Objective. The objective of the study was to compare the treatment outcomes of patients with Pulley Lesion injuries and secondary adhesive capsulitis.&#x0D; Material and Methods. The study included 82 patients with contracture of the shoulder joint and damage to the ligaments holding the long head of the biceps. The patients were divided into 2 groups depending on the extent of surgical intervention: group 1 underwent subpectoral tenodesis and selective capsulotomy of the shoulder joint; group 2 underwent subpectoral tenodesis without selective capsulotomy of the shoulder joint. The function of the shoulder joint was assessed using the Constant Shoulder Score and VAS scales before surgery, at 3 and 6 months after the surgery.&#x0D; Results. At 3 months follow-up, the average functional result according to the Constant Shoulder Score was somewhat worse in group 2 (14.5±5.2 points) than in group 1 (8.5±6.4 points), p = 0.031. At 6 months follow-up, the average functional result according to the Constant Shoulder Score was 5.1±5.6 points in group 1 and 10.1±4.1 points in group 2 (p = 0.024). At 3 months follow-up, the average VAS score was worse in group 2 than in group 1 and reached 2.81±0.7 points. At 6 months follow-up, the average VAS score in group 2 was also worse than in group 1 (p = 0.051).&#x0D; Conclusions. Performing selective capsulotomy and subpectoral tenodesis in patients with secondary adhesive capsulitis and damage to the ligaments holding the long head of the biceps (Pulley Lesion injuries) allows us to achieve better functional results both according to the Constant Shoulder Score and the VAS scale at 3 and 6 months after the surgery.

Revision Subpectoral Biceps Tenodesis Demonstrates a High Patient Satisfaction and Good Functional Outcomes

To clinically evaluate a subset of patients who underwent a revision subpectoral biceps tenodesis for a clinically failed proximal biceps tenodesis. This is a retrospective case series of patients with at least 2-year follow-up who had undergone a revision biceps tenodesis after clinical failure of a proximal biceps tenodesis between January 2008 and February 2020 by a single surgeon. Patients who underwent concomitant procedures, such as revision cuff repair, were excluded. Patients with a minimum of 2 years duration status postrevision subpectoral tenodesis were contacted for informed consent and outcome data, which included Simple Shoulder Test, American Shoulder and Elbow Surgeons score, visual analog scale for pain, and subjective reporting of arm weakness and satisfaction. Fourteen patients were initially identified as meeting inclusion criteria with a minimum 2-year follow-up achieved for 11 of 14patients (78.5% follow-up). The mean follow-up time was 8.1 years (range, 2.7-14.8 years). After the primary biceps tenodesis, a mean of 8.0 ± 9.6 months passed before the revision subpectoral biceps tenodesis was performed. The average postoperative active forward elevation and adducted external rotation were 159 ± 7° and 47 ± 17°, respectively. The mean ± standard deviation (range) follow-up American Shoulder and Elbow Surgeons score was 79 ± 23 (30-100), Simple Shoulder Test was 11 ± 2 (7-12), and visual analog scale for pain was 2.6 ± 2.8 (0-9). All 11 patients reported being satisfied with their operation and would elect to have the operation again. Revision subpectoral biceps tenodesis is a viable procedure for addressing patients with persistent pain following initial proximal biceps tenodesis. Although some persistent pain is common, revision subpectoral biceps tenodesis demonstrates a high patient satisfaction and good functional outcomes. Level IV, therapeutic case series.

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.

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

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

Subpectoral proximal humeral anatomy: Guidance to decrease risk of fracture following subpectoral biceps tenodesis.

Biceps tenodesis is used for a variety of shoulder and biceps pathologies. Humeral fracture is a significant complication of this procedure. This cadaveric anatomy study sought to determine the cortical thickness of the humeral proximal shaft to identify the optimal technique to decrease unicortical drilling and reduce the risk of fracture. A computed tomography (CT) of eight cadaveric humeral specimens was obtained with a metallic marker placed at the site of subpectoral tenodesis. These scans were examined to define the cortical thickness of the subpectoral region of the humerus and determine angular safe zones for reaming. At the standard point of a subpectoral tenodesis, a mean angle relative to the coronal plane of 29.2° medially and 21.6° laterally from the deepest portion of the bicipital groove avoided unicortical drilling with a 7 mm reamer. These values varied slightly 1 cm proximal and distal to this level. The thickest regions of cortex in the subpectoral humerus correspond to the ridges of the bicipital groove. To avoid unicortical tunnels, surgeons should limit deviation from the perpendicular approach to no more than 23° relative to the coronal plane medially and 11° relative to the coronal plane laterally.

Open Subpectoral Tenodesis for Isolated Traumatic Long Head of Biceps Tendon Rupture Provides Excellent Functional Outcomes in Active Male Patients.

For many years the long head of biceps tendon (LHBT) rupture has been described and is commonly identified by weakness, cramping, and the so-called "Popeye" sign. Traditionally, this was treated non-operatively, likely reflecting patient factors and the technical difficulty in reattaching a degenerative and shortened tendon. In contrast, traumatic distal biceps rupture is now commonly repaired despite historically being managed non-operatively. The advent of a convenient and reproducible surgical technique led to an increase in the rate of fixation, thereby improving the cramping and weakness associated with non-operative treatment. Given recent surgical advances within this field, many techniques are now present for LHBT pathology. We describe results from a cohort of patients suffering traumatic LHBT rupture who sought a surgical solution to improve their symptoms. Over four years, 18 male patients underwent surgical intervention for isolated traumatic LHBT rupture. The technique used involved an open subpectoral tenodesis with fixation of the LHBT into the bicipital groove. Postoperative immobilization using a sling was recommended for six weeks prior to a progressive rehabilitation program. Patients were assessed with pre- and postoperative visual analog scores (VAS) for pain and American Shoulder and Elbow Society (ASES) scores. The mean patient age at the time of surgery was 49 years (range: 26-65 years). The mean time to surgery was nine weeks (range: 2-24 weeks). All patients showed an improvement following surgery with a mean pre-op ASES score of 33 (range: 10-60) compared to a post-op score of 92.6 (range: 85-100). All patients were able to return to work and sport, with all but one returning to the same functional demand level of work. The mean pre-op pain VASwas 6.3 (out of 10) compared to 0.2 post-op. All patients had a requirement for analgesia pre-operatively and none had postoperatively. No surgical complications were observed. No correlation was observed between the time to surgery and the outcome. LHBT rupture is often treated non-operatively as few studies within the literature describe the surgical technique and outcomes from surgical intervention. When treated non-operatively, patients complain of pain, cramping, and cosmetic deformity known as the "Popeye" sign. Following a traumatic rupture of the LHBT, we have demonstrated excellent outcomes using a standard approach and common fixation technique that has the potential to improve the functional outcome for symptomatic patients. Open subpectoral biceps tenodesis is associated with excellent outcomes in symptomatic patients following isolated LHBT rupture.

Rare case of intra-articular biceps incarceration following traumatic massive rotator cuff tear

Rare case of intra-articular biceps incarceration following traumatic massive rotator cuff tear

Paper 26: Update On Performance And Return To Sport After Biceps Tenodesis In Professional Baseball Players

Objectives:The purpose of this study was to determine the return to sport (RTS) rate and performance upon RTS in professional baseball players who underwent biceps tenodesis. A secondary purpose was to compare the postoperative performance of the group of players who underwent biceps tenodesis to a group of matched controls.Methods:All professional baseball pitchers who underwent biceps tenodesis between 2014 and 2017 were included. Players with concomitant rotator cuff repair were excluded. Demographic and performance data (preoperative and postoperative) were recorded for each player. Performance metrics were then compared between the biceps tenodesis and matched control (no history of biceps tenodesis) groups.Results:14 players (average age 27±4 years; 12 pitchers, 2 position outfielders) were included. Most (79%) were open subpectoral tenodeses while two were arthroscopic biceps transfers, and one was an arthroscopic suprapectoral tenodesis. Fixation methods included cortical button (42%), interference screw (25%), suture anchor (25%) and drill holes (8%). Most players (79%) underwent concomitant procedures (43% underwent SLAP repairs). Among the 14 players, 2 were unable to RTS, 5 RTS but to a lower level, and 7 RTS at the same or a higher level. Thus, overall, while 86% (12/14) were able to RTS, 50% (7/14) RTS at the same or a higher level and 50% were either unable to return or returned to a lower level. Among pitchers, 100% (12/12) were able to RTS, but only 50% (6/12) were able to return to the same or a higher level. For those players who did return to play, it took 245±84 days, and their performance following RTP was unchanged and did not differ from matched controls.Conclusions:While 86% of professional baseball players returned to sport following biceps tenodesis, only 50% returned to the same or higher level. No decline in performance was noted in players who successfully returned. Open subpectoral tenodesis is the most common tenodesis technique performed on professional baseball playersUPLOAD-https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/c7753b55-d658-4847-a8e7-7b70c6cad84f/1/Table_1.docx UPLOAD-https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/961efbc8-aedb-4cfe-b18f-6b8c07d93ec7/1/Table_2.docx UPLOAD-https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/36fbb55a-f22f-468e-a8a3-e7a29979b4b8/1/Table_3.docx None

Improvement in long head of biceps function and lower rate of biceps deformities after subpectoral tenodesis with cortical button and interference screw vs. arthroscopic tenotomy: a 4-year follow-up.

BackgroundThis study aimed to evaluate clinical, cosmetic, and strength midterm outcomes in arthroscopic biceps tenotomy and subpectoral biceps tenodesis using bicortical endobutton and interference screw.MethodsIn this retrospective study, inclusion criteria were long head of the biceps (LHB) pathologies treated either with tenotomy or an additional tenodesis. Postoperative assessment included Long Head of Biceps Score (LHBS), age-adjusted Constant-Murley Score, and Subjective Shoulder Value. Elbow flexion and forearm supination strength were measured. The presence of Popeye sign, cramps, and tenderness over the bicipital grove was evaluated. Statistical analysis of continuous variables without normal distribution was performed using Mann-Whitney U test. Grouped analysis was performed using 2-way analysis of variance. Binominal data were analyzed using chi-square test.ResultsA total of 73 patients with a mean age of 63.1 ± 9.6 years and a mean follow-up of 4.2 ± 0.5 years were included. Tenotomy was performed in 34 and tenodesis in 39 patients. Tenodesis group displayed a significantly higher LHB score (P = .0006), but no significant differences were detected for the age-adjusted Constant-Murley Score and Subjective Shoulder Value. Tenodesis group showed a significantly lower rate of Popeye deformities (P = .0007) and tenderness over the bicipital groove (P = .004). Patients from the tenotomy group with biceps deformity showed a significantly higher mean contralateral supination strength (P = .002) but no significant difference in contralateral elbow flexion compared with patients without biceps deformity. There was one (1.4%) complication in the tenotomy group (postoperative shoulder stiffness).ConclusionBoth techniques resulted in comparable outcome scores on preselected patients, with tenodesis leading to better LHB function. Tenodesis did not improve elbow flexion and forearm supination strength beyond the tenotomy; however, it reduced the frequency of biceps deformities and tenderness over the bicipital groove. Patients with a strong contralateral forearm supination strength could be at risk of developing a biceps deformity after tenotomy.

SLAP Repair Versus Subpectoral Biceps Tenodesis for Isolated SLAP Type 2 Lesions in Overhead Athletes Younger Than 35 Years: Comparison of Minimum 2-Year Outcomes.

Background:It remains unclear if young overhead athletes with isolated superior labrum anterior-posterior (SLAP) type 2 lesions benefit more from SLAP repair or subpectoral biceps tenodesis.Purpose:To evaluate clinical outcomes and return to sport in overhead athletes with symptomatic SLAP type 2 lesions who underwent either biceps tenodesis or SLAP repair.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective analysis of prospectively collected data was performed in patients who underwent subpectoral biceps tenodesis (n = 14) or SLAP repair (n = 24) for the treatment of isolated type 2 SLAP lesions. All patients were aged <35 years at time of surgery, participated in overhead sports, and were at least 2 years out from surgery. Clinical outcomes were assessed with the American Shoulder and Elbow Surgeons (ASES) score; Single Assessment Numerical Evaluation (SANE) score; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score; and the 12-Item Short Form (SF-12) physical component score. Return to sport and patient satisfaction were documented. Clinical failures requiring revision surgery and complications were reported.Results:Preoperative baseline scores in both the tenodesis and SLAP repair groups were similar. There were no significant differences between the groups on any postoperative outcome measure: For biceps tenodesis versus SLAP repair, the ASES score was 92.7 ± 10.4 versus 89.1 ± 16.7, the SANE score was 86.2 ± 13.7 versus 83.0 ± 24.1, the QuickDASH score was 10.0 ± 12.7 versus 9.0 ± 14.3, and SF-12 was 51.2 ± 7.5 versus 52.8 ± 7.7. No group difference in return-to-sports rate (85% vs 79%; P = .640) was noted. More patients in the tenodesis group (80%) reported modifying their sporting/recreational activity postoperatively because of weakness compared with patients in the SLAP repair group (15%; P = .022). One patient in each group progressed to surgery for persistent postoperative stiffness, and 1 patient in the tenodesis group had a postoperative complication related to the index surgery.Conclusion:Both subpectoral biceps tenodesis and SLAP repair provided excellent clinical results for the treatment of isolated SLAP type 2 lesions, with a high rate of return to overhead sports and a low failure rate, in a young and high-demanding patient cohort. More patients reported modifying their sporting/recreational activity because of weakness after subpectoral tenodesis.

Evaluation of Rotator Cuff Repair With and Without Concomitant Biceps Intervention: A Retrospective Review of Patient Outcomes

Background: Biceps tendon pathology is common in patients with rotator cuff tears. Leaving biceps pathology untreated in rotator cuff repairs (RCRs) may lead to suboptimal outcomes. Purpose/Hypothesis: The purpose was to compare clinical outcomes between patients who underwent isolated RCR versus patients who underwent RCR with concomitant biceps treatment. It was hypothesized that there would be no difference in clinical outcomes between groups. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 244 patients who underwent RCR in 2016 were included. Patient characteristics, presence of concomitant biceps pathology, pre- and postoperative American Shoulder and Elbow Surgeons (ASES) scores, rotator cuff failure, revision surgery, and complications were recorded. Results: There were no significant differences between patients who underwent isolated RCR (n = 143) and those who underwent RCR with biceps treatment (n = 101) at 2 years postoperatively in ASES scores (RCR, 81.5; RCR+biceps treatment, 79.5; P = .532), cuff failure rate (5.6% vs 4.0%; P = .760), revision RCR rate (3.5% vs 2.0%; P = .703), or complication rate (11.9% vs 5.0%; P = .102). Furthermore, when comparing concomitant biceps tenotomy (n = 30) versus concomitant biceps tenodesis (n = 71), there were no differences in ASES scores (P = .149), cuff failure rate (P > .999), revision RCR rate (P > .999), or complication rate (P > .999) postoperatively. Finally, when comparing arthroscopic biceps tenodesis (n = 50) versus subpectoral biceps tenodesis (n = 21), there were no differences in ASES scores (P > .592), cuff failure rate (P > .999), revision RCR rate (P = .507), or complication rate (P > .999) 2 years postoperatively. Conclusion: Addressing biceps pathology when performing RCR resulted in similar rates of cuff failure, revision RCR, and complications, as well as a similar improvement in patient-reported outcomes when compared with isolated RCR at 2 years postoperatively. Furthermore, when comparing tenotomy versus tenodesis and arthroscopic versus subpectoral tenodesis, comparable outcomes with regard to rate of rotator cuff repair failure, revision RCR, complications, and patient-reported outcomes were found.

Update on Performance and Return to Sport After Biceps Tenodesis in Professional Baseball Players.

Background:Bicipital disorders are common among overhead athletes, especially professional baseball players. The ideal treatment for bicipital problems in professional baseball players is unknown.Purpose/Hypothesis:The purpose was to determine the return-to-sport (RTS) rate and performance after RTS in professional baseball players who underwent biceps tenodesis. It was hypothesized that there will be a high RTS rate in this population, with no difference between the biceps tenodesis and control groups in the RTS rate or performance.Study Design:Case series; Level of evidence, 4.Methods:All professional Major League Baseball players who underwent biceps tenodesis between 2014 and 2017 were included. Players with concomitant rotator cuff repair were excluded. Demographic and performance data (preoperative and postoperative) were recorded for each player. Performance metrics were then compared between players with biceps tenodesis and matched controls (no history of biceps tenodesis).Results:Included were 14 players (mean age, 27 ± 4 years; 12 pitchers, 2 position outfielders). Most surgeries (79%) were open subpectoral tenodeses, 2 were arthroscopic biceps transfers, and 1 was an arthroscopic suprapectoral tenodesis. Fixation methods included cortical button (42%), interference screw (25%), suture anchor (25%), and drill holes (8%). Most players (79%) underwent concomitant procedures (43% underwent superior labral anterior-posterior repairs). While 86% (12/14) were able to RTS, 50% (7/14) returned at the same or a higher level, and 50% of the whole study were either unable to return or returned to a lower level. Among pitchers, 100% (12/12) were able to RTS, but only 50% (6/12) were able to return to the same or a higher level. For those players who did RTS, it took 245 ± 84 days, and their performance after RTS was unchanged and did not differ from that of matched controls.Conclusion:Open subpectoral tenodesis was the most common tenodesis technique performed on professional baseball players. While 86% of players returned to sport after biceps tenodesis, only 50% returned to the same or higher level. No decline in performance was noted in players who returned successfully.

Effectiveness comparison of arthroscopic intertubercular groove and open subpectoral tenodesis for long head of biceps tendon tendinopathy

To compare the effectiveness of arthroscopic intertubercular groove and open subpectoral tenodesis in treatment of long head of biceps tendon (LHBT) tendinopathy. A clinical data of 80 patients with LHBT tendinopathy who were admitted between June 2013 and May 2017 and met the selection criteria was retrospectively analyzed. After cutting LHBT under arthroscopy, the arthroscopic intertubercular groove tenodesis was performed in 40 cases (group A) and open subpectoral tenodesis was performed in 40 cases (group B). There was no significant difference in the gender, age, side of the affected shoulder joint, disease duration, and preoperative pain visual analogue scale (VAS) score, Constant score, American Society of Shoulder and Elbow Surgery (ASES) score, Disability of Arm, Shoulder, and Hand (DASH) score, LHBT score (LHBS) between the two groups ( P>0.05). The operation time and the scores of shoulder joint pain and function at 12 months after operation were compared between the two groups. The operation time was (3.6±2.5) minutes in group A and (8.5±2.3) minutes in group B, showing a significant difference ( t=18.584, P=0.000). The incisions of the two groups healed by first intention, and there was no complication such as infection or thrombosis. All patients were followed up. The follow-up time was 24-30 months (mean, 26.0 months) in group A and 24-31 months (mean, 26.0 months) in group B. Both Speed test and Yergason test were negative at 3 months after operation. MRI showed that there was no obvious effusion around the LHTB and no dislocation of LHTB. At 12 months after operation, the VAS score, Constant score, ASES score, DASH score, and LHBS score of the two groups all improved when compared with preoperative ones ( P<0.05), and there was no significant difference in the differences before and after operation between the two groups ( P>0.05). No Popeye sign appeared during the follow-up. The arthroscopic intertubercular groove and open subpectoral tenodesis can effectively relieve shoulder pain and improve function, but the former has shorter operation time and less trauma.

Update On Performance And Return To Sport After Biceps Tenodesis In Professional Baseball Players (226)

Objectives:Determine the return to sport (RTS) rate and performance upon RTS in professional baseball players who underwent biceps tenodesis.Methods:All professional baseball pitchers who underwent biceps tenodesis between 2014 and 2017 were included. Players with concomitant rotator cuff repair were excluded. Demographic and performance data (preoperative and postoperative) were recorded for each player. Performance metrics were then compared between the biceps tenodesis and matched control (no history of biceps tenodeses) groups.Results:14 players (average age 27±4 years; 12 pitchers, 2 position outfielders) were included. Most (79%) were open subpectoral tenodeses while one was an arthroscopic biceps transfer and one was arthroscopic suprapectoral. Fixation methods included cortical button (42%), interference screw (25%), suture anchor (25%) and drill holes (8%). Most players (79%) underwent concomitant procedures (43% underwent SLAP repair). Among the 14 players, 2 were unable to RTS, 5 RTS but to a lower level, and 7 RTS at the same or a higher level. Thus, overall, while 86% (12/14) were able to RTS, 50% (7/14) were able to return to the same or a better level and 50% were either unable to return or returned to a lower level. Among pitchers specifically, 100% (12/12) were able to return to play, but only 50% (6/12) were able to return to the same or a higher level. For those players who did return to play, it took 245±84 days, their performance was unchanged and did not differ from matched controls.Conclusions:While 86% of professional baseball players returned to sport following biceps tenodesis, only 50% returned at the same or higher level. No decline in performance was noted in players who successfully returned. Open subpectoral tenodesis is the most common tenodesis technique performed on professional baseball players.