Summary

Arthroscopic suprapectoral biceps tenodesis requires more surgical time than open subpectoral biceps tenodesis; however, clinical and functional outcomes are not different.

Abstract

Purpose

Biceps pathology typically includes pain in the anterior shoulder that is reproduced with provocative maneuvers. However, optimal treatment of patient with this diagnosis is not clear and can include tenotomy or various forms of tenodesis. As tenotomy can lead to cosmetic deformity and anterior humeral discomfort from spasms, many surgeons perform tenodesis. Technique for tenodesis includes intra-articular soft tissue fixation or osseous fixation, suprapectoral osseous fixation, and subpectoral osseous fixation. Focusing on the later two, it is unclear if there is a clinical or surgical benefit of performing an open subpectoral biceps tenodesis (OBT) versus arthroscopic suprapectoral biceps tenodesis (ABT). We therefore designed this randomized clinical trial to assess these two techniques.

Methods

Patients diagnosed with biceps tendinopathy meeting the inclusion and exclusion criteria were randomized into the arthroscopic and mini-open biceps tenodesis groups. Prior to surgery, patients were asked a series of questions regarding their anterior shoulder pain and underwent a subsequent shoulder exam. Follow-up was completed at 3 months, 6 months, and 1 year time points, during which the shoulder exam and patient questionnaires were also completed.

Results

A total of 38 patients were enrolled with a mean age of 43.5 ± 10.5 years and a mean BMI of 28.3 ± 5.4. All patients had arthroscopic evidence of biceps pathology and underwent either an ABT (18) or an OBT (20). All patients underwent a concomitant arthroscopic subacromial decompression. The surgical time for the ABT group, 17.2 ± 3.7 minutes, was significantly greater than the OBT group, 11.7 ± 6.1 (p < 0.05). One patient was converted from the ABT group to the OBT group due to sheering of a severely attenuated tendon, eliminating the ability to perform an ABT. One patient in the OBT group required a revision tenodesis. No significant difference (p > 0.05) was found in strength or anterior shoulder pain at 3 months, 6 months, and 1 year. Additionally, no significant difference (p > 0.05) was found in clinical outcome scores (ASES, Constant subjective, WORC, KJOC) between the two groups.

Conclusion

This randomized clinical trial suggests there is no clinical difference between the two techniques. Additionally, while the arthroscopic procedure requires more surgical time, the revision rates are not different. Besides the cosmetic concern for an additional scar, we recommend decisions to be made based on surgeon preference and experience.