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Arthroscopic Proximal Biceps Versus Subpectoral Tenodesis: Short-Term Differences and Long-Term Follow-Up

  • Stephen C. Weber
Chapter

Abstract

Recent publications have suggested that proximal biceps tenodesis creates higher reoperation rates and complications related to retention of the biceps in the bicipital groove. Few studies have presented comparative data between the two techniques. Presented here is the first study contrasting the long-term outcome of arthroscopic proximal biceps tenodesis versus mini-open subpectoral repair. Ninety-two patients were followed for a mean 10.4 years in the proximal group. Fifty-three were soft tissue tenodesis, the remainder proximal suture anchor repairs. This was in contrast to 44 patients treated with mini-open subpectoral repair with mean follow-up of 6.71 years. The biceps was tenotomized arthroscopically. It was then sutured to the rotator cuff tendon using permanent sutures in the soft tissue group, and in the remainder, the suture used was from an arthroscopically placed suture anchor incorporated in the repair. In open, distal group, the bicipital groove was exposed through a subpectoral approach, and the tendon is then fixed in place using a screw and spiked washer. UCLA scores improved in the proximal group from a mean of 18.93 to a mean of 30.12 and in the distal group from 17.61 to 32.37. Following proximal tenodesis, two patients had mild deformity, but all patients rated their arms as cosmetically normal, and no patient complained of upper arm cramping. There were no complications related to the procedure in either group. Operative times were significantly shorter for proximal tenodesis (p < 0.0001), but perioperative narcotics and recovery room stays were not significantly different between the two procedures. The shorter operating times and absence of cost of an interference screw resulted in a cost savings of $1647.37 with proximal tenodesis. All patients who obtained a good result at short-term follow-up continued to maintain a good result at final follow-up. Reoperation involving conversion to distal tenodesis was not required in any proximal tenodesis patient. Arthroscopic proximal biceps tenodesis appears to be a reliable technique to manage the pathologic biceps tendon. The operative time and cost were significantly less than with a subpectoral approach, especially if interference screws were used. The subpectoral approach however did not appear to have significant increase in morbidity in short or long term. Concerns about pain related to the retention of the biceps within the bicipital groove appear unfounded even at long-term follow-up.

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Copyright information

© ISAKOS 2019

Authors and Affiliations

  • Stephen C. Weber
    • 1
  1. 1.Department of OrthopedicsThe Johns Hopkins School of MedicineBaltimoreUSA

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