Summary

Patients with LHBT pathology that is left untreated during RCR are more likely to have poorer PROMs and postoperative external rotation than those without LHBT pathology

Abstract

Background

The theoretical benefit of addressing the Long Head of Biceps Tendon (LHBT) in addition to arthroscopic rotator cuff repair (RCR) has been mixed with many studies finding no significant difference in outcomes among patients receiving RCR with or without concomitant LHBT procedure. Therefore, our study looked to investigate outcomes amongst patients following RCR without concomitant LHBT intervention. We hypothesized that in this cohort, patients with untreated LHBT pathology identified intraoperatively would have higher rates of failure and lower patient-reported outcomes compared to patients without LHBT pathology noted intraoperatively.

Methods

We conducted a retrospective review of all patients who underwent arthroscopic RCR without concomitant biceps tenotomy or tenodesis between 2009 and 2023 at a single academic institution with cases excluded if the surgery was a revision procedure, or if the patient lacked follow-up data. All cases and intra-operative evaluations of LHBT pathology were performed by a fellowship-trained orthopaedic shoulder specialist (senior author AL). 228 total patients were identified, and 174 patients were deemed eligible. Of these, 24 patients were identified as having LHBT pathology noted intra-operatively. Propensity score analysis was done to match patients in a 4:1 ratio, with patients matched for sex, age, BMI, and date of surgery. This resulted in 96 matched patients with intra-operative LHBT pathology noted and 120 patients included in the final analysis. Failure was defined as any return of symptomatic LHBT pathology and/or return to the operating room for LHBT procedure on the ipsilateral shoulder. Student t-test was utilized for continuous variables and chi-square test or Fisher’s exact test was used for categorical variables. Mean clinically important differences (MCID) thresholds were used to assess patient-reported outcomes (PROs).

Results

For all patients, the mean age was 52.2 ± 14.8 years with average follow up of 16.8 ± 21.4 months. The most common intraoperative biceps pathology included type II SLAP tear (41%) and type V SLAP tear (20.8%). Zero (0%) patients with or without LHBT pathology noted intra-operatively were noted to have failed. Patients with LHBT pathology noted intra-operatively had significantly decreased postoperative range-of-motion in external rotation compared to patients without LHBT pathology noted intra-operatively (p = 0.013). Difference of preoperative and postoperative PROs showed significantly lower rates of achieving MCID for patients with biceps pathology compared to controls (0% vs. 57.1%, p = 0.019). Difference between preoperative and postoperative SSV and VAS were similar between groups.

Conclusion

Patients undergoing primary arthroscopic rotator cuff repair with LHBT pathology who did not have concomitant biceps intervention showed comparable rates of postoperative complications, improvements in both SSV and VAS, and failure as defined by either need for reoperation for LHBT procedure or inadequate pain relief after surgery. However, these patients had decreased improvements in PROs and external rotation after surgery compared to patients without LHBT pathology noted intra-operatively. Thus, this study suggests that patients with LHBT pathology that is left untreated during RCR are more likely to have poorer PROMs and postoperative external rotation than those without LHBT pathology.