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Siddiq BS, Dean MC, Gillinov SM, Lee JS, Dowley KS, Cherian NJ, Martin SD. Biceps tenotomy vs. tenodesis: an ACS-NSQIP analysis of postoperative outcomes and utilization trends. JSES Int 2024; 8:828-836. [PMID: 39035668 PMCID: PMC11258841 DOI: 10.1016/j.jseint.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background While studies have assessed comparative rates of restoration of shoulder function and alleviation of symptoms, comparative systemic postoperative complication rates between biceps tenotomy and tenodesis have yet to be assessed. The purpose of the present study was to use a national administrative database to perform a comprehensive investigation into 30-day complication rates after biceps tenotomy versus tenodesis, thus providing valuable insights for informed decision-making by clinicians and patients regarding the optimal surgical approach for pathologies of the long head of the biceps tendon. Methods The National Surgical Quality Improvement Program database was queried to analyze postoperative complication rates and metrics associated with biceps tenotomy and tenodesis. Patient data spanning from 2012 to 2021 was extracted, with relevant variables assessed to identify and compare these two surgical approaches. Adjusted and unadjusted analyses were utilized to analyze patient demographics, comorbidities, operative times, lengths of stay, readmissions, adverse events, and yearly surgical volume, along with trends in usage, across cohorts. Results Of 11,527 total patients, 264 (2.29%), 6826 (59.22%), and 4437 (38.49%) underwent tenotomy, tenodesis with open repair, and tenodesis with arthroscopic repair, respectively. Tenotomy operative times ([mean ± SD]: 66.25 ± 44.76 minutes) were shorter than those for open tenodesis (78.83 ± 41.82) and arthroscopic tenodesis (75.98 ± 40.16). Conversely, tenotomy patients had longer hospital days (0.88 ± 4.86 days) relative to open tenodesis (.08 ± 1.55) and arthroscopic tenodesis (.12 ± 2.70). Multivariable logistic regression controlling for demographics and comorbidities demonstrated that patients undergoing tenodesis were less likely to be readmitted (adjusted odds ratio [AOR]: 0.42, 95% confidence interval [CI]: 0.17-0.98, P = .050) or sustain serious adverse events (AOR: 0.27, 95% CI: 0.13-0.57, P < .001), but equally likely to sustain minor adverse events (AOR: 0.87, CI: 0.21-3.68, P = .850), compared with patients undergoing tenotomy. Lastly, comparing utilization rates from 2012 to 2021 revealed a significant decrease in the proportion of tenotomy (from 6.2% to 1.0%) compared to open tenodesis (from 41.0% to 57.3%) and arthroscopic tenodesis (52.8% to 41.64%; P trend = .001). Conclusion To our knowledge, this is the first large national database study investigating postoperative complication rates between the various surgical treatments for pathologies of the long head of the biceps tendon. Our results suggest that tenodesis yields fewer serious adverse events and lower readmission rates than tenotomy. We also found a shorter operative time for tenotomy. These findings support the increased utilization of tenodesis relative to tenotomy in recent years.
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Affiliation(s)
- Bilal S. Siddiq
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Michael C. Dean
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen M. Gillinov
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan S. Lee
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kieran S. Dowley
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Nathan J. Cherian
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, University of Nebraska, Omaha, NE, USA
| | - Scott D. Martin
- Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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Katthagen JC, Wermers J, Paus C, Michel PA, Köhler A, Schliemann B, Raschke MJ. The Long Head of the Biceps Has a Stabilizing Effect on the Glenohumeral Joint in Simulated Infraspinatus or Subscapularis but Not Supraspinatus Rotator Cuff Deficiency: A Biomechanical Study. Arthroscopy 2024; 40:1059-1065. [PMID: 37625659 DOI: 10.1016/j.arthro.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE To investigate the stabilizing role of the long head of the biceps (LHB) for different simulated rotator cuff (RC) tears. METHODS Human cadaveric specimens (n = 8) were fixed in a robotic-based experimental setup with a static loading of the RC, deltoid, and the LHB. RC tears were simulated by unloading of the corresponding muscles. A throwing motion and an anterior load-and-shift test were simulated under different RC conditions by unloading the supraspinatus (SS), subscapularis (SSc), infraspinatus (IS), and combinations (SS + SSc, SS + IS, SS + SSc + IS). The LHB was tested in 3 conditions: unloaded, loaded, and tenotomy. Translation of the humeral head and anterior forces depending on loading of the RC and the LHB was captured. RESULTS Loading of LHB produced no significant changes in anterior force or glenohumeral translation for the intact RC or a simulated SS tear. However, if SSc or IS were unloaded, LHB loading resulted in a significant increase of anterior force ranging from 3.9 N (P = .013, SSc unloaded) to 5.2 N (P = .001, simulated massive tear) and glenohumeral translation ranging from 2.4 mm (P = .0078, SSc unloaded) to 7.4 mm (P = .0078, simulated massive tear) compared to the unloaded LHB. Tenotomy of the LHB led to a significant increase in glenohumeral translation compared to the unloaded LHB in case of combined SS + SSc (2.6 mm, P = .0391) and simulated massive tears of all SS + SSc + IS (4.6 mm, P = .0078). Highest translation was observed in simulated massive tears between loaded LHB and tenotomy (8.1 mm, P = .0078). CONCLUSIONS Once SSc or IS is simulated to be torn, the LHB has a stabilizing effect for the glenohumeral joint and counteracts humeral translation. With a fully loaded RC, LHB loading has no influence. CLINICAL RELEVANCE With an intact RC, the condition of the LHB showed no biomechanical effect on the joint stability. Therefore, from a biomechanical point of view, the LHB could be removed from the joint when the RC is intact or reconstructable. However, since there was a positive effect even of the unloaded LHB in this study when SSc or IS is deficient, techniques with preservation of the supraglenoid LHB origin may be of benefit in such cases.
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Affiliation(s)
- J Christoph Katthagen
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Jens Wermers
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Münster, Münster, Germany; Department of Engineering Physics, Münster University of Applied Sciences, Münster, Germany
| | - Christoph Paus
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Philipp A Michel
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Alina Köhler
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Benedikt Schliemann
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Münster, Münster, Germany; Department of Trauma, Hand, and Orthopaedic Surgery, Herz-Jesu Hospital Münster, Münster, Germany.
| | - Michael J Raschke
- Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Münster, Münster, Germany
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Chiang CH, Ho W, Lin CH, Chih WH, Su WR, Hong CK. Modified arthroscopic intra-articular transtendinous looped biceps tenodesis leads to satisfactory functional outcomes and less frequent Popeye deformity compared to biceps tenotomy. J Orthop Surg Res 2023; 18:603. [PMID: 37587498 PMCID: PMC10428633 DOI: 10.1186/s13018-023-04078-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
PURPOSE The present study aimed to propose a modified intra-articular transtendinous looped biceps tenodesis (mTLBT) using a suture anchor and to compare the functional outcomes and incidence of Popeye deformities between biceps tenotomy and mTLBT. METHODS Medical records of patients who underwent either tenotomy or mTLBT for the long head of the biceps tendon (LHBT) lesion between January 2016 and April 2021 were retrospectively reviewed. The inclusion criteria were patients aged 40-70 years with LHBT pathologies, such as superior labrum anterior to posterior (SLAP) lesions > type II, LHBT pulley system rupture with bicipital instability, and intra-articular LHBT tear. The exclusion criteria were full-thickness supraspinatus tears, frozen shoulder, shoulder fracture, and postoperative traumatic events that affected the operated shoulder. All patients were followed up for at least 1 year. Popeye deformity, bicipital cramping pain, visual analog scale (VAS) pain score, and functional outcome scores (University of California at Los Angeles [UCLA] and American Shoulder and Elbow Surgeons [ASES] scores) were recorded. Fisher's exact test and Chi-square test were used for categorical variables, whereas the Mann-Whitney U test was used for nonparametric variables. RESULTS The mTLBT and tenotomy groups included 15 and 40 patients, respectively. The incidence of Popeye deformity and biceps cramping pain in the tenotomy group (52.5% and 50%, respectively) was significantly higher than that in the mTLBT group (13.3% and 20%, respectively) (p = 0.009 and p = 0.045, respectively). The postoperative VAS, UCLA, and ASES scores were not significantly different between the two groups. One patient in the tenodesis group experienced metallic-anchor pullout. CONCLUSION mTLBT is an arthroscopic intra-articular top of the groove tenodesis that can be performed completely in the intra-articular space and is especially suitable for patients with an intact or partially torn rotator cuff. This technique is reliable for treating biceps pathologies as it results in similar functional outcome scores, lesser biceps cramping pain, and less frequent Popeye deformity compared to biceps tenotomy. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Chen-Hao Chiang
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Wei Ho
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chang-Hao Lin
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Wei-Hsing Chih
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, North Dist., Tainan, 70428, Taiwan
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, North Dist., Tainan, 70428, Taiwan.
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan.
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D’Orazio GT, Arza IM, Arellano CH, Gutiérrez MA. Fast Arthroscopic Biceps Tenodesis Without Penetrating Grasper. Arthrosc Tech 2022; 12:e101-e105. [PMID: 36814986 PMCID: PMC9939719 DOI: 10.1016/j.eats.2022.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/27/2022] [Indexed: 12/24/2022] Open
Abstract
Long head of the biceps pathology is a common cause of shoulder pain and dysfunction. Surgical treatment can be either a tenotomy or a tenodesis. Long-term results may be similar in both surgical techniques; however, the latest systematic reviews indicate that tenodesis offers superior clinical and functional results in young patients and athletes. Considering the favorable results with the biceps tenodesis, we present this arthroscopic tenodesis in which the long head of the biceps is fixed in the bicipital groove with an all-suture anchor passed directly through the tendon, providing a stable and fast fixation without using penetrating grasper.
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Affiliation(s)
- Giovanni Tiso D’Orazio
- Alai Sports Medicine Clinic, Madrid, Spain,Address correspondence to Giovanni Tiso D’Orazio, M.D., Alai Sports Medicine Clinic, C/ Arturo Soria 342, 28033 Madrid, Spain.
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Zhou M, Zhou C, Cui D, Long Y, Guo J, Zheng Z, Meng K, Zhang J, Hou J, Yang R. The high resistance loop (H-loop) technique used for all-inside arthroscopic knotless suprapectoral biceps tenodesis: A case series. Front Surg 2022; 9:917853. [PMID: 36189379 PMCID: PMC9515399 DOI: 10.3389/fsurg.2022.917853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Suprapectoral tenodesis is a common technique for the treatment of long head biceps tendon lesions. However, so far, there is no gold standard treatment in all-inside arthroscopy. The purpose of the present study was to introduce and evaluate the functional outcomes of an innovative, all-inside arthroscopic high resistance loop (H-loop, high resistance to tissue cutout and 360° grasping of the tendon) technique for long head of biceps (LHB) tenodesis. Method From September 2020 to March 2022, a series of cases of 32 consecutive patients (28 rotator cuff tear with LHBT pathology and 4 superior labrum anterior-posterior (SLAP) tears which including 2 type II and 2 type IV) who received LHB tenodesis using all-inside arthroscopic high resistance loop technique were included in this study. The American Shoulder and Elbow Surgeon Score (ASES), Visual Analog Scale (VAS), Simple Shoulder Test Score (SST), Constant–Murley scores, and University of California at Los Angeles Scoring System (UCLA) were used to evaluate the clinical outcomes of patients in preoperative and final follow-up. Meanwhile, postoperative complications were also observed. Result 32 patients (14 women and 18 men, average age was 55.7 years) underwent all-inside arthroscopic knotless suprapectoral biceps tenodesis using the H-Loop stitch technique. The mean time of follow-up was 16.2 ± 2.6 months. The ASES, VAS, Constant–Murley, SST, and UCLA scores improved from 51.5 ± 15.8, 5.5 ± 1.6, 57.8 ± 14.7, 5.0 ± 2.8, and 16.1 ± 3.8 preoperatively, to 89.1 ± 7.5, 1.0 ± 0.8, 87.3 ± 5.5, 10.4 ± 1.5, and 31.3 ± 2.6 in the last follow-up, respectively (p < 0.001). During the follow-up, no patients in this study experienced postoperative complications such as infection of the wound, injury of nerves, and hardware failure; no patients required revision after their operation. In addition, none of the patients had cramping or a “Popeye” deformity during follow-up. Conclusion This article presents an innovative, all-arthroscopic H-loop technique for LHB tenodesis. This technique for LHB tenodesis showed favorable functional and cosmetic outcomes, as well as high satisfaction rates. Due to its simplicity of operation and satisfactory preliminary clinical outcomes, H-loop technique is perhaps another option to choose in all-inside arthroscopic LHB tenodesis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Rui Yang
- Correspondence: Rui Yang Jingyi Hou
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Zhang X, Liu H. Letter to the Editor concerning "Tenodesis yields better functional results than tenotomy in long head of the biceps tendon operations-a systematic review and meta-analysis". INTERNATIONAL ORTHOPAEDICS 2022; 46:1673-1674. [PMID: 35403866 DOI: 10.1007/s00264-022-05396-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Xiang Zhang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, 610041, China.
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