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Pianka MA, Sundaram V, Wolfe I, Lezak B, Moore MR, Alaia MJ, Feldman AJ, Jazrawi LM. Long-term patient-reported outcomes of open subpectoral biceps tenodesis with cortical button fixation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024:10.1007/s00590-024-04036-z. [PMID: 39060553 DOI: 10.1007/s00590-024-04036-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Open subpectoral biceps tenodesis (OSBT) with cortical button fixation has been shown to deliver acceptable results in the short and intermediate term for long head of the biceps (LHB) pathology with the benefit of smaller bone tunnel diameter and a reduced risk of postoperative humeral shaft fracture. The primary purpose of this study was to determine whether OSBT with cortical button fixation results in significant improvements in patient reported outcomes (PROs) from pre-operative to long-term final follow-up. METHODS A retrospective analysis of patients who underwent OSBT with cortical button fixation at a single institution between the years of 2012 and 2014 was conducted and PROs were collected in the intermediate (> 2 years follow-up) and long term (> 9 years follow-up). PROs were measured pre-operatively, at intermediate follow-up, and at long-term follow-up using three validated questionnaires: American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Oxford Shoulder Score (OSS). Patients were additionally asked at final follow-up if they would undergo the same procedure again if they needed it. RESULTS Twenty-nine (29) patients with a mean age of 51.16 ± 9.06 years at the time of surgery were included in the study at final follow-up. Mean final follow-up time was 10.2 ± 0.5 years (range: 9.2-11.1 years). All PROs (ASES, OSS, and DASH) demonstrated statistically significant improvements from pre-operative to final follow-up with p < 0.01 for each. The proportions of patients exceeding established values for minimum clinically important difference (MCID) were 96.55%, 93.10%, and 75.86% for ASES, OSS, and DASH respectively. Only one patient had required re-operation as of final follow-up. None experienced humeral fractures post-operatively. A significant majority (89.66%; p < 0.01) of patients reported that they would undergo the same procedure again if they needed it. Fifty-three (53) patients were included in the study at intermediate follow-up with a mean follow-up time of 3.5 ± 1.4 years (range: 2-5.3 years). There were no statistically significant differences in any of the PRO measures from intermediate to long-term follow-up. CONCLUSION This study reported a minimum 9-year follow-up of patients undergoing OSBT with cortical button fixation for the management of LHBT pathology in the setting of concomitant shoulder procedures. All patients had significantly improved functional outcomes assessed with ASES, OSS, and DASH and no obvious differences in median group scores were found between patients assessed at intermediate (mean 3.5 years) and final (mean 10.2 years) follow-up. No infections, fractures, or fixation failures were reported.
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Affiliation(s)
- Mark A Pianka
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Vishal Sundaram
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA.
| | - Isabel Wolfe
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Bradley Lezak
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Michael R Moore
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Michael J Alaia
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Andrew J Feldman
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, NYU Langone Health, 333 East 38th St, New York, NY, 10016, USA
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Onlay Versus Inlay Biceps Tenodesis for Long Head of Biceps Tendinopathy: A Systematic Review and Meta-analysis. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202212000-00010. [PMID: 36732300 PMCID: PMC9746747 DOI: 10.5435/jaaosglobal-d-22-00255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Proximal biceps tenodesis is a common surgical treatment of tendinosis of the long head of the biceps tendon. Two of the most common techniques incorporate onlay and inlay fixation methods, which can be done arthroscopically or open and in a variety of anatomic locations. The purpose of this meta-analysis was to compare the clinical outcomes between onlay versus inlay humeral fixation for biceps tenodesis for long head of the biceps tendon pathology. METHODS A literature search was conducted using PubMed, EMBASE, and Cochrane Library. Only studies reporting outcomes and complications after onlay and inlay biceps tenodeses were included. RESULTS Six studies with a total of 418 patients (252 onlay, 166 inlay) with a mean age of 56.84 years were included. Visual analog pain scale scores, Constant score, and American Shoulder and Elbow Surgeons shoulder score did not differ. "Popeye" deformity was found in 17 patients (7.80%) in the onlay group and in 15 patients (11.28%) in the inlay group (odds ratio, 0.28; P = 0.07). No difference in postoperative cramping or failure rates was found. CONCLUSION Both onlay and inlay biceps tenodeses result in improved clinical outcomes and are at low risk of Popeye deformities, with no statistically significant differences between either method. Additional studies are required to assess the clinical significance of these differences.
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Lalehzarian SP, Agarwalla A, Liu JN. Management of proximal biceps tendon pathology. World J Orthop 2022; 13:36-57. [PMID: 35096535 PMCID: PMC8771414 DOI: 10.5312/wjo.v13.i1.36] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/10/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
The long head of the biceps tendon is widely recognized as an important pain generator, especially in anterior shoulder pain and dysfunction with athletes and working individuals. The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures, function, and relevant clinical information such as evaluation, treatment options, and complications in hopes of helping orthopaedic surgeons counsel their patients. An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally. The biceps-labral complex has been identified and broken down into different regions that can further enhance a physician’s knowledge of common anterior shoulder pain etiologies. Although various physical examination maneuvers exist meant to localize the anterior shoulder pain, the lack of specificity requires orthopaedic surgeons to rely on patient history, advanced imaging, and diagnostic injections in order to determine the patient’s next steps. Nonsurgical treatment options such as anti-inflammatory medications, physical therapy, and ultrasound-guided corticosteroid injections should be utilized before entertaining surgical treatment options. If surgery is needed, the three options include biceps tenotomy, biceps tenodesis, or superior labrum anterior to posterior repair. Specifically for biceps tenodesis, recent studies have analyzed open vs arthroscopic techniques, the ideal location of tenodesis with intra-articular, suprapectoral, subpectoral, extra-articular top of groove, and extra-articular bottom of groove approaches, and the best method of fixation using interference screws, suture anchors, or cortical buttons. Orthopaedic surgeons should be aware of the complications of each procedure and respond accordingly for each patient. Once treated, patients often have good to excellent clinical outcomes and low rates of complications.
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Affiliation(s)
- Simon P Lalehzarian
- The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, United States
| | - Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Joseph N Liu
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA 90033, United States
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Huddleston HP, Kurtzman JS, Gedailovich S, Koehler SM, Aibinder WR. The rate and reporting of fracture after biceps tenodesis: A systematic review. J Orthop 2021; 28:70-85. [PMID: 34880569 PMCID: PMC8633822 DOI: 10.1016/j.jor.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The purpose of this systematic review was to (1) define the cumulative humerus fracture rate after BT and (2) compare how often fracture rate was reported compared to other complications. METHODS A systematic review was performed using the PRISMA guidelines. RESULTS 39 studies reported complications and 30 reported no complications. Of the 39 studies that reported complications, 5 studies reported fracture after BT (n = 669, cumulative incidence of 0.53%). The overall non-fracture complication rate was 12.9%. DISCUSSION Due to the relatively high incidence of fracture, surgeons should ensure that this complication is disclosed to patients undergoing BT.
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Affiliation(s)
- Hailey P. Huddleston
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - Joey S. Kurtzman
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - Samuel Gedailovich
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - Steven M. Koehler
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
| | - William R. Aibinder
- SUNY Downstate Medical Center, Department of Orthopaedic Surgery and Rehabilitation Medicine, Brooklyn, NY, 11203, USA
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Kyhos J, Haselman W, Banffy MB. All-Arthroscopic Anatomic Length-Tension Biceps Tenodesis With Unicortical Button. Arthrosc Tech 2021; 10:e1505-e1510. [PMID: 34258197 PMCID: PMC8252847 DOI: 10.1016/j.eats.2021.02.017] [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: 12/17/2020] [Accepted: 02/09/2021] [Indexed: 02/03/2023] Open
Abstract
The long head of the biceps tendon is a frequent cause of persistent anterior shoulder pain. Biceps tenodesis is a popular choice for surgical management of this pathology, with myriad approach and fixation variations described. We describe an all-arthroscopic suprapectoral biceps tenodesis in the anatomic length-tension relation using a unicortical button. This technique offers an alternative method that provides proper tendon fixation at anatomic length with minimized additional surgical morbidity and postoperative complications.
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Affiliation(s)
- Justin Kyhos
- Address correspondence to Justin Kyhos, M.D., Cedars-Sinai Kerlan-Jobe Institute, 6801 Park Terr, Ste 500, Los Angeles, CA 90045, U.S.A.
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Hurley ET, Anil U, Kingery MT, Pauzenber L, Mullett H, Strauss EJ. Response to Cao et al regarding: "Surgical treatment for long head of the biceps tendinopathy: a network meta-analysis". J Shoulder Elbow Surg 2021; 30:e36-e37. [PMID: 32956778 DOI: 10.1016/j.jse.2020.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/13/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Eoghan T Hurley
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA; Department of Trauma and Orthopaedics, Royal College of Surgeons in Ireland, Dublin, Ireland; Sports Surgery Clinic, Dublin, Ireland.
| | - Utkarsh Anil
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Matthew T Kingery
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | | | | | - Eric J Strauss
- Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Arthroscopic Proximal Subpectoral Tenodesis of the Long Head of the Biceps. Arthrosc Tech 2020; 10:e1-e7. [PMID: 33532200 PMCID: PMC7823062 DOI: 10.1016/j.eats.2020.08.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/31/2020] [Indexed: 02/03/2023] Open
Abstract
Biceps tenodesis is a common treatment method for biceps pathology. When tenodesis is located in intra-articular or suprapectoral areas, the biceps is fixed proximally to the zone of degeneration and inflammation, which can cause residual pain as a possible postsurgical complication. The main advantage of this method is that this technique is comparatively easy and can be performed arthroscopically. Typically, in terms of professional athletes, the best post-biceps tenodesis results are observed after undergoing subpectoral tenodesis because of the solid fixation and localization distally to any kind of biceps tendon degeneration and inflammation zone. However, subpectoral tenodesis has several disadvantages, as it is an open procedure that can lead to possible scar and hematoma formation, infection, bioabsorbable screw reaction, neurovascular injury, and fractures. Soft-tissue tenodesis to the proximal part of pectoralis major tendon is a well-known step in shoulder arthroplasty surgery and shows acceptable results. We suggest a technique of proximal subpectoral arthroscopic tenodesis, which combines the advantages of the location in the subpectoral zone with an all-suture anchor and that of soft-tissue tenodesis to the pectoralis major tendon, which can be performed fully arthroscopically, improving results in terms of healing by increasing the contact area.
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Erickson BJ, Cohen BS, Romeo AA. First Report of a Humeral Fracture From Pitching After Latissimus Repair. Orthop J Sports Med 2020; 8:2325967120964482. [PMID: 33209945 PMCID: PMC7645764 DOI: 10.1177/2325967120964482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/10/2020] [Indexed: 12/04/2022] Open
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Frank RM. Editorial Commentary: Biceps Tenodesis Fixation: Screw, Button, or None of the Above? Arthroscopy 2020; 36:1261-1263. [PMID: 32370888 DOI: 10.1016/j.arthro.2020.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 02/02/2023]
Abstract
Clinical outcomes following shoulder subpectoral biceps tenodesis are generally favorable, with a very low complication rate (2%). One of the most devastating complications following this procedure is the occurrence of a proximal humerus fracture. Although all constructs have their unique advantages and disadvantages, creating a smaller bone hole while achieving good biomechanical outcomes is worth considering. This may be most advantageous in overhead-throwing athletes, tennis players, and/or volleyball athletes, who subject their shoulders to more torsional load due to the requirements of their sport. Thus, in addition to screws and buttons, smaller-diameter suture anchors could also be thoughtfully considered as a biceps tenodesis fixation option.
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