Summary

Long head biceps tenodesis as adjuvant procedure to rotator cuff repair is safe procedure, however it does not add any functional benefit to rotator cuff repair and should not be perform without indication as it may improve post operative pain up to 3 month and has no statistical clinically insignificant improvement in the functional outcome up to one year post the procedure.

Abstract

Background

Arthroscopic rotator cuff repair (RCR) with biceps tenodesis become a common combined procedure in shoulder surgeries. The long head of the biceps (LHB) tendon is often associated with rotator cuff pathology and impingement. Adding an LHB procedure to RCR may improve patient-reported outcomes, but data is limited. Studies have shown similar outcomes between isolated RCR and RCR with biceps tenotomy and tenodesis.

Methods

This is a prospective cohort study aimed to compare the functional outcome of patients who underwent RCR with LHB tenodesis to RCR without LHB tenodesis for patients with complete small to large rotator cuff tears in King Abdullah Medical City in Makkah from January 2017 until March 2023 using a validated and reproducible published scoring system which are ASES and UCLA scoring questionnaire at 3, 6,9 12-month period post-surgery.

Results

Cohort of 102 patients, 66 had rotator cuff repair with biceps tenodesis and 36 without biceps tenodesis had satisfied inclusion criteria were obtained for data collection and analysis with 12 months of follow-up data. The mean age (SD) was 54.5 (9.8) years. More than half were females (53.9%), 72.5% had the operation on the right side, 28.4% had hypertension and 32.4% had diabetes mellitus. Of the total, 66 (64.7%) had Arthroscopic rotator cuff repairs with a biceps procedure and 36 (35.3%) had Arthroscopic rotator cuff repairs without a biceps procedure. Mean BMI was 30.36 (5.1%). The mean (SD) of RCR with versus without biceps tenodesis for ASES score43.2 (17.1) versus 42.8 (16.8), P value 0.90, for UCLA score mean (SD) 18.1 (5.8) versus 18.7 (6.8), P value 0.67. at the baseline 3-month period. When using paired t-test to compare the groups. The arthroscopic rotator cuff repairs RCR with biceps procedure group demonstrated no statistically significant greater mean enhancement in all 2 outcome measures: ASES (mean, 41.32 vs 39.96; P= .000; 95% CI, 36.59, 44.32), and UCLA (mean, 12.35 vs 11.59; P = .000; 95% CI, 10.77, 12.96) at 1-year follow-up compared with patients who had an isolated RCR. This was further confirmed by using the ANOVA test to compare functional outcomes at each specific time. There is an overall significant increase in ASES over time in both groups with a mean difference of 40.97 between the 12 months and three months in the RCR with Biceps tenodesis group (p<0.001) and a mean difference of 40.5 in the RCR without Biceps tenodesis group (p<0.001). There was no difference in ASES over time between the two groups (Biceps tenodesis and NO Biceps tenodesis), (p>0.05), which confirms that both groups performed equally. Both groups had no postoperative complications reported.

Conclusion

Patients who underwent RCR and Subacromial Decompression with LHB tenodesis had no significant difference in functional outcomes using ASES and UCLA scoring system at 3, 6, 9, and 12 months compared to RCR without biceps tenodesis.