Arthroscopic Suprapectoral Biceps Tenodesis: The "Double Secure Loop Technique" Using an All-Suture Anchor and an Arthroscopic Suture Passer

An Expedited Sling Immobilization Protocol After Isolated Biceps Tenodesis Results in Clinical and Patient-Reported Postoperative Outcomes Equivalent to a Standard Rehabilitation Protocol

Purpose

To characterize clinical and patient-reported outcomes for patients after isolated biceps tenodesis (BT) who underwent either standard or expedited sling immobilization protocols following surgery.

Methods

This retrospective cohort study compared patients who were assigned to use a sling for either 4 to 6 weeks (standard) or 0 to 2 weeks (expedited) following an isolated BT. Primary endpoint included rate of re-rupture, surgical revision, loss of fixation, and Popeye deformity. Secondary endpoints included shoulder range of motion (ROM) as well as pre- and postoperative patient-reported outcomes (PROs) of pain and function. Missing data were managed via multiple imputation with chained equations. Complication prevalence 95% confidence intervals were calculated using the Clopper Pearson method and a series of hierarchical mixed effects linear regressions were performed to assess differences between sling interventions in PROs and ROM.

Results

The average age of the standard cohort (n = 66) was 49 years (±14 years), and the average age of the expedited cohort (n = 69) was 47 years (±14 years). The expedited and standardized cohorts demonstrated 0.4 and 0.3 complications per 10,000 exposure days, respectively, with no significant difference between groups (1.4 [95% confidence interval 0.2-10.0], P = .727). There was no demonstrated difference in forward flexion, abduction, or external ROM. The expedited group had less improvement in visual analog scale for pain scores that was not clinically significant and there were no differences in PROs of function.

Conclusions

No statistically significant difference in the rate of re-rupture, surgical revision, loss of fixation, or Popeye deformity was noted between protocols after isolated BT. Furthermore, there were no clinically significant differences in ROM or PROs identified between protocols after isolated BT. This study suggests that patients who have undergone isolated BT may safely discontinue sling use within 2 weeks after surgery.

Level of Evidence

Level III, retrospective comparative study.

Ultrasound-Guided Suprapectoral Tenodesis of the Long Head of the Biceps Brachii

When the long head of the biceps tendon is diseased, tenodesis is an appropriate treatment strategy. The specific technique used is dependent on visualization, fixation method and hardware, and tenodesis location. For suprapectoral tenodesis techniques, those that fix the tendon within or below the bicipital groove can be challenging owing to the transverse humeral ligament covering the groove. To accurately identify the biceps tendon in this area, the ligament often requires resection. Ultrasound provides surgeons with a safe and noninvasive tool to visualize the biceps tendon as it exits the bicipital groove, negating the need for unroofing and other pitfalls associated with traditional techniques. This technical note describes an ultrasound-guided suprapectoral biceps tenodesis procedure.

Arthroscopic Extra-articular 2-Position Fixation of the Long Head of the Biceps

Disorders of the long head of the biceps (LHB) are common conditions that lead to an impediment of shoulder function. Fixation of the LHB is an effective way to alleviate LHB-related symptoms while maintaining its muscular function. However, fixation failure usually occurs after LHB tenodesis with routine 1-position fixation. To reduce the fixation failure rate, we introduce a 2-position LHB fixation technique. This includes locating the extra-articular part of the LHB efficiently, thorough debridement of the anterior subdeltoid space and the region around the LHB, and 2-position fixation with knotless suture anchors at the superior edge of the pectoralis major and at the proximal end of the bicipital groove. Our clinical experience indicates that this procedure can be performed safely and effectively when certain guidelines are followed. We believe that the introduction of this technique will provide a special fixation option for patients with LHB disorders.