Suprapectoral Biceps Tenodesis. Clinical Outcomes
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Published:
Aug 31, 2022
Keywords:
Biceps, suprapectoral tenodesis, tenodesis, SLAP, proximal biceps, LHB
Main Article Content
Abstract
Objective: To evaluate and compare outcomes in a case series of SLAP injuries and complete tears of the long head of the biceps treated with suprapectoral tenodesis using a mini-open approach.
Materials and Methods: Patients aged over 18, treated between 2019 and 2020, with a minimum 1-year follow-up were included. The demographic characteristics, indication for surgery, return to activities considered usual by the patient, and complications were recorded. The American Shoulder and Elbow Surgeons (ASES) score for the shoulder was used, and the active range of motion of the affected shoulder was measured. In addition, the patients were asked if they were able to return to their daily activities. We recorded the diagnosis that led the patients to surgery and whether they had undergone a traumatic event coinciding with the onset of symptoms.
Results: 8 patients were evaluated, the median age was 42.5, and the follow-up was 17 months (IQR 13.5 – 21.5). Six patients (75.0%) had a type II SLAP injury, and two (25.0%) had a complete LHB tear. Six patients (75.0%) associated the symptoms with a traumatic event. The final range of motion of the shoulder (median) was: flexion 180° (IQR 170°-180), internal rotation 65° (IQR 60° - 75°), and external rotation 70° (IQR65° - 87.5°).
Conclusion: Suprapectoral tenodesis with a prior arthroscopic tenotomy for SLAP II cases or in cases of complete tears of the long head of the biceps is a safe technique for achieving functional outcomes.
Materials and Methods: Patients aged over 18, treated between 2019 and 2020, with a minimum 1-year follow-up were included. The demographic characteristics, indication for surgery, return to activities considered usual by the patient, and complications were recorded. The American Shoulder and Elbow Surgeons (ASES) score for the shoulder was used, and the active range of motion of the affected shoulder was measured. In addition, the patients were asked if they were able to return to their daily activities. We recorded the diagnosis that led the patients to surgery and whether they had undergone a traumatic event coinciding with the onset of symptoms.
Results: 8 patients were evaluated, the median age was 42.5, and the follow-up was 17 months (IQR 13.5 – 21.5). Six patients (75.0%) had a type II SLAP injury, and two (25.0%) had a complete LHB tear. Six patients (75.0%) associated the symptoms with a traumatic event. The final range of motion of the shoulder (median) was: flexion 180° (IQR 170°-180), internal rotation 65° (IQR 60° - 75°), and external rotation 70° (IQR65° - 87.5°).
Conclusion: Suprapectoral tenodesis with a prior arthroscopic tenotomy for SLAP II cases or in cases of complete tears of the long head of the biceps is a safe technique for achieving functional outcomes.
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How to Cite
Patiño, J. M., & Cabrera, E. S. (2022). Suprapectoral Biceps Tenodesis. Clinical Outcomes. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(4), 488-497. https://doi.org/10.15417/issn.1852-7434.2022.87.4.1526
Section
Clinical Research
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References
1. Lo IKY, Burkhart SS. Arthroscopic biceps tenodesis using a bioabsorbable interference screw. Arthroscopy
2004;20(1):85-95. https://doi.org/10.1016/j.arthro.2003.11.017
2. Mazzocca AD, Rios CG, Romeo AA, Arciero RA. Subpectoral biceps tenodesis with interference screw fixation.
Arthroscopy 2005;21(7):896. https://doi.org/10.1016/j.arthro.2005.04.002
3. Gottschalk MB, Karas SG, Ghattas TN, Burdette R. Subpectoral biceps tenodesis for the treatment of type II and IV superior labral anterior and posterior lesions. Am J Sports Med 2014;42(9):2128-35. https://doi.org/10.1177/0363546514540273
4. Froimson AI, O I. Keyhole tenodesis of biceps origin at the shoulder. Clin Orthop Relat Res 1975;(112):245-9.
PMID: 1192640
5. Sethi PM, Vadasdi K, Greene RT, Vitale MA, Duong M, Miller SR. Safety of open suprapectoral and subpectoral
biceps tenodesis: an anatomic assessment of risk for neurologic injury. J Shoulder Elbow Surg 2015;24(1):138-42.
https://doi.org/10.1016/j.jse.2014.06.038
6. Prabhu J, Faqi MK, Awad RK, Alkhalifa F. Modified open suprapectoral EndoButton tension slide tenodesis
technique of long head of biceps with restored tendon tension-length. Open Orthop J 2017;11:281-90.
https://doi.org/10.2174/1874325001711010281
7. Saltzman BM, Leroux TS, Cotter EJ, Basques B, Griffin J, Frank RM, et al. Trends in open and arthroscopic long
head of biceps tenodesis. HSS J 2020;16(1):2-8. https://doi.org/10.1007/s11420-018-9645-1
8. Feng S, Song Y, Li H, Chen J, Chen J, Chen S. Outcomes for arthroscopic repair of combined Bankart/SLAP lesions in the treatment of anterior shoulder instability: A systematic review and meta-analysis. Orthop J Sports Med 2019;7(10):2325967119877804. https://doi.org/10.1177/2325967119877804
9. Gombera MM, Kahlenberg CA, Nair R, Saltzman MD, Terry MA. All-arthroscopic suprapectoral versus open
subpectoral tenodesis of the long head of the biceps brachii. Am J Sports Med 2015;43(5):1077-83.
https://doi.org/10.1177/0363546515570024
10. Johannsen AM, Macalena JA, Carson EW, Tompkins M. Anatomic and radiographic comparison of arthroscopic
suprapectoral and open subpectoral biceps tenodesis sites. Am J Sports Med 2013;41(12):2919-24.
https://doi.org/10.1177/0363546513503812
11. Patiño JM. SLAP en pacientes no deportistas. Resultados funcionales con un mínimo de dos años de seguimiento y factores de riesgo para retorno a las actividades. Artroscopia 2021;28(2):134-9. Disponible en:
https://www.revistaartroscopia.com.ar/index.php/revista/article/view/180
12. Green JM, Getelman MH, Snyder SJ, Burns JP. All-arthroscopic suprapectoral versus open subpectoral tenodesis of the long head of the biceps brachii without the use of interference screws. Arthroscopy 2017;33(1):19-25. https://doi.org/10.1016/j.arthro.2016.07.007
13. Ek ET, Shi LL, Tompson JD, Freehill MT, Warner JJ. Surgical treatment of isolated type II superior labrum anteriorposterior (SLAP) lesions: Repair versus biceps tenodesis. J Shoulder Elbow Surg 2014;23(7):1059-65.
https://doi.org/10.1016/j.jse.2013.09.030
14. Denard PJ, Lädermann A, Parsley BK, Burkhart SS. Arthroscopic biceps tenodesis compared with repair of isolated type II SLAP lesions in patients older than 35 years. Orthopedics 2014;37(3):e292-7. https://doi.org/10.3928/01477447-20140225-63
15. Hurley ET, Lorentz NA, Colasanti CA, Campbell KA, Alaia MJ, et al. Open subpectoral biceps tenodesis may be an alternative to arthroscopic repair for SLAP tears in patients under 30. Arthroscopy 2022;38(2):307-12.
https://doi.org/10.1016/j.arthro.2021.07.028
16. Werner BC, Evans CL, Holzgrefe RE, Tuman JM, Hart JM, et al. Arthroscopic suprapectoral and open subpectoral biceps tenodesis: a comparison of minimum 2-year clinical outcomes. Am J Sports Med 2014;42(11):2583-90. https://doi.org/10.1177/0363546514547226
17. Jarrett CD, McClelland WB Jr, Xerogeanes JW. Minimally invasive proximal biceps tenodesis: an anatomical study for optimal placement and safe surgical technique. J Shoulder Elbow Surg 2011;20(3):477-80.
https://doi.org/10.1016/j.jse.2010.08.002
18. Pogorzelski J, Horan MP, Hussain ZB, Vap A, Fritz EM, Millett PJ. Subpectoral biceps tenodesis for treatment of
isolated type II SLAP lesions in a young and active population. Arthroscopy 2018;34(2):371-6.
https://doi.org/10.1016/j.arthro.2017.07.021
19. Provencher MT, McCormick F, Peebles LA, Beaulieu-Jones BR, Dekker TJ, LeClere LE, et al. Outcomes of
primary biceps subpectoral tenodesis in an active population: A prospective evaluation of 101 patients. Arthroscopy 2019;35(12):3205-10. https://doi.org/10.1016/j.arthro.2019.06.035
20. Hsu AR, Ghodadra NS, Provencher MT, Lewis PB, Bach BR. Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results. J Shoulder Elbow Surg 2011;20(2):326-32. https://doi.org/10.1016/j.jse.2010.08.019
21. The B, Brutty M, Wang A, Campbell PT, Halliday MJC. Long-term functional results and isokinetic strength
evaluation after arthroscopic tenotomy of the long head of biceps tendon. Int J Shoulder Surg 2014;8(3):76-80.
https://doi.org/10.4103/0973-6042.140114
2004;20(1):85-95. https://doi.org/10.1016/j.arthro.2003.11.017
2. Mazzocca AD, Rios CG, Romeo AA, Arciero RA. Subpectoral biceps tenodesis with interference screw fixation.
Arthroscopy 2005;21(7):896. https://doi.org/10.1016/j.arthro.2005.04.002
3. Gottschalk MB, Karas SG, Ghattas TN, Burdette R. Subpectoral biceps tenodesis for the treatment of type II and IV superior labral anterior and posterior lesions. Am J Sports Med 2014;42(9):2128-35. https://doi.org/10.1177/0363546514540273
4. Froimson AI, O I. Keyhole tenodesis of biceps origin at the shoulder. Clin Orthop Relat Res 1975;(112):245-9.
PMID: 1192640
5. Sethi PM, Vadasdi K, Greene RT, Vitale MA, Duong M, Miller SR. Safety of open suprapectoral and subpectoral
biceps tenodesis: an anatomic assessment of risk for neurologic injury. J Shoulder Elbow Surg 2015;24(1):138-42.
https://doi.org/10.1016/j.jse.2014.06.038
6. Prabhu J, Faqi MK, Awad RK, Alkhalifa F. Modified open suprapectoral EndoButton tension slide tenodesis
technique of long head of biceps with restored tendon tension-length. Open Orthop J 2017;11:281-90.
https://doi.org/10.2174/1874325001711010281
7. Saltzman BM, Leroux TS, Cotter EJ, Basques B, Griffin J, Frank RM, et al. Trends in open and arthroscopic long
head of biceps tenodesis. HSS J 2020;16(1):2-8. https://doi.org/10.1007/s11420-018-9645-1
8. Feng S, Song Y, Li H, Chen J, Chen J, Chen S. Outcomes for arthroscopic repair of combined Bankart/SLAP lesions in the treatment of anterior shoulder instability: A systematic review and meta-analysis. Orthop J Sports Med 2019;7(10):2325967119877804. https://doi.org/10.1177/2325967119877804
9. Gombera MM, Kahlenberg CA, Nair R, Saltzman MD, Terry MA. All-arthroscopic suprapectoral versus open
subpectoral tenodesis of the long head of the biceps brachii. Am J Sports Med 2015;43(5):1077-83.
https://doi.org/10.1177/0363546515570024
10. Johannsen AM, Macalena JA, Carson EW, Tompkins M. Anatomic and radiographic comparison of arthroscopic
suprapectoral and open subpectoral biceps tenodesis sites. Am J Sports Med 2013;41(12):2919-24.
https://doi.org/10.1177/0363546513503812
11. Patiño JM. SLAP en pacientes no deportistas. Resultados funcionales con un mínimo de dos años de seguimiento y factores de riesgo para retorno a las actividades. Artroscopia 2021;28(2):134-9. Disponible en:
https://www.revistaartroscopia.com.ar/index.php/revista/article/view/180
12. Green JM, Getelman MH, Snyder SJ, Burns JP. All-arthroscopic suprapectoral versus open subpectoral tenodesis of the long head of the biceps brachii without the use of interference screws. Arthroscopy 2017;33(1):19-25. https://doi.org/10.1016/j.arthro.2016.07.007
13. Ek ET, Shi LL, Tompson JD, Freehill MT, Warner JJ. Surgical treatment of isolated type II superior labrum anteriorposterior (SLAP) lesions: Repair versus biceps tenodesis. J Shoulder Elbow Surg 2014;23(7):1059-65.
https://doi.org/10.1016/j.jse.2013.09.030
14. Denard PJ, Lädermann A, Parsley BK, Burkhart SS. Arthroscopic biceps tenodesis compared with repair of isolated type II SLAP lesions in patients older than 35 years. Orthopedics 2014;37(3):e292-7. https://doi.org/10.3928/01477447-20140225-63
15. Hurley ET, Lorentz NA, Colasanti CA, Campbell KA, Alaia MJ, et al. Open subpectoral biceps tenodesis may be an alternative to arthroscopic repair for SLAP tears in patients under 30. Arthroscopy 2022;38(2):307-12.
https://doi.org/10.1016/j.arthro.2021.07.028
16. Werner BC, Evans CL, Holzgrefe RE, Tuman JM, Hart JM, et al. Arthroscopic suprapectoral and open subpectoral biceps tenodesis: a comparison of minimum 2-year clinical outcomes. Am J Sports Med 2014;42(11):2583-90. https://doi.org/10.1177/0363546514547226
17. Jarrett CD, McClelland WB Jr, Xerogeanes JW. Minimally invasive proximal biceps tenodesis: an anatomical study for optimal placement and safe surgical technique. J Shoulder Elbow Surg 2011;20(3):477-80.
https://doi.org/10.1016/j.jse.2010.08.002
18. Pogorzelski J, Horan MP, Hussain ZB, Vap A, Fritz EM, Millett PJ. Subpectoral biceps tenodesis for treatment of
isolated type II SLAP lesions in a young and active population. Arthroscopy 2018;34(2):371-6.
https://doi.org/10.1016/j.arthro.2017.07.021
19. Provencher MT, McCormick F, Peebles LA, Beaulieu-Jones BR, Dekker TJ, LeClere LE, et al. Outcomes of
primary biceps subpectoral tenodesis in an active population: A prospective evaluation of 101 patients. Arthroscopy 2019;35(12):3205-10. https://doi.org/10.1016/j.arthro.2019.06.035
20. Hsu AR, Ghodadra NS, Provencher MT, Lewis PB, Bach BR. Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results. J Shoulder Elbow Surg 2011;20(2):326-32. https://doi.org/10.1016/j.jse.2010.08.019
21. The B, Brutty M, Wang A, Campbell PT, Halliday MJC. Long-term functional results and isokinetic strength
evaluation after arthroscopic tenotomy of the long head of biceps tendon. Int J Shoulder Surg 2014;8(3):76-80.
https://doi.org/10.4103/0973-6042.140114