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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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2
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Vajda M, Szakó L, Hegyi P, Erőss B, Görbe A, Molnár Z, Kozma K, Józsa G, Bucsi L, Schandl K. Tenodesis yields better functional results than tenotomy in long head of the biceps tendon operations-a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2022; 46:1037-1051. [PMID: 35254476 PMCID: PMC9001564 DOI: 10.1007/s00264-022-05338-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/01/2022] [Indexed: 12/29/2022]
Abstract
Background Pathology of the long head of the biceps tendon (LHBT) is a common disorder affecting muscle function and causing considerable pain for the patient. The literature on the two surgical treatment methods (tenotomy and tenodesis) is controversial; therefore, our aim was to compare the results of these interventions. Methods We performed a meta-analysis using the following strategy: (P) patients with LHBT pathology, (I) tenodesis, (C) tenotomy, (O) elbow flexion and forearm supination strength, pain assessed on the ten-point Visual Analog Scale (VAS), bicipital cramping pain, Constant, ASES, and SST score, Popeye deformity, and operative time. We included only randomized clinical trials. We searched five databases. During statistical analysis, odds ratios (OR) and weighted mean differences (WMD) were calculated for dichotomous and continuous outcomes, respectively, using the Bayesian method with random effect model. Results We included 11 studies in the systematic review, nine of these were eligible for the meta-analysis, containing data about 572 patients (279 in the tenodesis, 293 in the tenotomy group). Our analysis concluded that tenodesis is more beneficial considering 12-month elbow flexion strength (WMD: 3.67 kg; p = 0.006), 12-month forearm supination strength (WMD: 0.36 kg; p = 0.012), and 24-month Popeye deformity (OR: 0.19; p < 0.001), whereas tenotomy was associated with decreased 3-month pain scores on VAS (WMD: 0.99; p < 0.001). We did not find significant difference among the other outcomes. Conclusion Tenodesis yields better results in terms of biceps function and is non-inferior regarding long-term pain, while tenotomy is associated with earlier pain relief. Supplementary Information The online version contains supplementary material available at 10.1007/s00264-022-05338-9.
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Affiliation(s)
- Mátyás Vajda
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Saint George University Teaching Hospital of County-Fejér, Seregélyesi u. 3., 8000 Székesfehérvár, Hungary
- Department of Orthodaedics, Medical School, University of Pécs, Akác u. 1, 7632 Pécs, Hungary
| | - Lajos Szakó
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085 Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Üllői út 26, Budapest, 1085 Hungary
| | - Anikó Görbe
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
| | - Zsolt Molnár
- Institute for Translational Medicine, Medical School, University of Pécs, Szigeti út 12, 2nd floor, 7624 Pécs, Hungary
- Department of Anaesthesiology and Intensive Therapy and Pain Management, Poznan University of Medical Sciences, 49 Przybyszewskiego St, 60-355 Poznan, Poland
| | - Kincső Kozma
- Department of Ophtalmology, Medical School, University of Pécs, Rákóczi út 2, 7623 Pécs, Hungary
| | - Gergő Józsa
- Department of Paediatrics, Surgical Division, University of Pécs, József Attila u. 7, 7623 Pécs, Hungary
| | - László Bucsi
- Saint George University Teaching Hospital of County-Fejér, Seregélyesi u. 3., 8000 Székesfehérvár, Hungary
- Department of Orthodaedics, Medical School, University of Pécs, Akác u. 1, 7632 Pécs, Hungary
| | - Károly Schandl
- Saint George University Teaching Hospital of County-Fejér, Seregélyesi u. 3., 8000 Székesfehérvár, Hungary
- Department of Orthodaedics, Medical School, University of Pécs, Akác u. 1, 7632 Pécs, Hungary
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Otto A, Siebenlist S, Baldino JB, Murphy M, Muench LN, Mehl J, Obopilwe E, Cote MP, Imhoff AB, Mazzocca AD. All-suture anchor and unicortical button show comparable biomechanical properties for onlay subpectoral biceps tenodesis. JSES Int 2020; 4:833-837. [PMID: 33345223 PMCID: PMC7738569 DOI: 10.1016/j.jseint.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Hypothesis The purpose of this study was to biomechanically evaluate onlay subpectoral long head of the biceps (LHB) tenodesis with all-suture anchors and unicortical buttons in cadaveric specimens. Methods After evaluation of bone mineral density, 18 fresh-frozen, unpaired human cadaveric shoulders were randomly assigned to 2 groups: One group received an onlay subpectoral LHB tenodesis with 1 all-suture anchor, whereas the other group received a tenodesis with 1 unicortical button. The specimens were mounted in a servo-hydraulic material testing system. Tendons were initially loaded from 5 N to 100 N for 5000 cycles at 1 Hz. Displacement of the repair constructs was observed with optical tracking. After cyclic loading, each specimen was loaded to failure at a rate of 1 mm/s. Results The mean displacement after cyclic loading was 6.77 ± 3.15 mm in the all-suture anchor group and 8.41 ± 3.17 mm in the unicortical button group (P = not significant). The mean load to failure was 278.05 ± 38.77 N for all-suture anchor repairs and 291.36 ± 49.69 N for unicortical button repairs (P = not significant). The most common mode of failure in both groups was LHB tendon tearing. There were no significant differences between the 2 groups regarding specimen age (58.33 ± 4.37 years vs. 58.78 ± 5.33 years) and bone mineral density (0.50 ± 0.17 g/cm2 vs. 0.44 ± 0.19 g/cm2). Conclusion All-suture anchors and unicortical buttons are biomechanically equivalent in displacement and load-to-failure testing for LHB tenodesis. All-suture anchors can be considered a validated alternative for onlay subpectoral LHB tenodesis.
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Affiliation(s)
- Alexander Otto
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA.,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Joshua B Baldino
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Matthew Murphy
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julian Mehl
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
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Ayzenberg M, Hiller AD, Vellinga R, Snyder SJ. Arthroscopic supraglenoid origin-preserving biceps tenodesis: a reliable, simple, and cost-conscious technique. J Shoulder Elbow Surg 2020; 29:S73-S79. [PMID: 32643611 DOI: 10.1016/j.jse.2020.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to assess the midterm clinical and ultrasonographic outcomes of a new all arthroscopic supraglenoid origin-preserving tenodesis technique of the long head of the biceps (LHB) brachii tendon in the setting of small to medium-sized rotator cuff repairs. MATERIALS AND METHODS Thirty patients (33 shoulders) meeting inclusion criteria were identified who underwent LHB tenodesis with this technique in the setting of small to medium-sized rotator cuff repair at a mean age at surgery of 65.6 years between 2015 and 2017. Rotator cuff tears were repaired using the Southern California Orthopedic Institute (SCOI) row technique. The biceps tenodesis was incorporated into the anterior anchor of the rotator cuff repair after bony groove preparation, including débridement and bone vent placement. Frayed edges of the biceps tendon were gently débrided, but the intra-articular glenoid attachment was left intact. Patients were assessed at follow-up by clinical and ultrasonographic examination, as well as a satisfaction questionnaire, the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score and visual analog scale (VAS) score. RESULTS Mean follow-up was 32.9 months for the 27 patients (30 shoulders), resulting in a 91% follow-up. Average ASES score was 94.4. Average patient-reported satisfaction with shoulder function was 9.4 of 10 and with biceps contour was 9.9 of 10. Average VAS score was 0.6 of 10, and 73% of patients reported a VAS score of 0. Ultrasonography demonstrated an intact biceps tendon in 27 of 28 shoulders and an intact supraspinatus tendon in all 28 shoulders. Mean range of motion was 170° in forward flexion, 169° in abduction, 49° in external rotation, and to thoracic vertebrae 12 in internal rotation. Mean muscle grading during Jobe test was 4.8 of 5. There were no intraoperative complications. No patients required revision surgery. CONCLUSIONS In situ arthroscopic biceps tenodesis with maintenance of the glenoid attachment incorporated into rotator cuff repair yields a high rate of healing and consistently excellent functional and cosmetic outcomes as well as patient satisfaction while saving surgical time and cost.
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Affiliation(s)
- Mark Ayzenberg
- Southern California Orthopedic Institute, Van Nuys, CA, USA.
| | | | - Ryan Vellinga
- Southern California Orthopedic Institute, Van Nuys, CA, USA
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Yiannakopoulos CK, Megaloikonomos PD, Foufa K, Gliatis J. Ultrasound-guided versus palpation-guided corticosteroid injections for tendinosis of the long head of the biceps: A randomized comparative study. Skeletal Radiol 2020; 49:585-591. [PMID: 31712838 DOI: 10.1007/s00256-019-03315-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare accuracy, patient discomfort, and clinical outcome of ultrasound-guided versus palpation-guided corticosteroid injections to the bicipital groove in patients with long head of biceps (LHB) tendinosis. MATERIALS AND METHODS Forty-four patients with primary LHB tendinosis were randomized into two groups (group A, n = 22; group B, n = 22). All patients underwent treatment with a single corticosteroid injection to the bicipital groove. Injections in group A were performed under ultrasound-guidance, while in group B using a palpation-guided technique. The duration of each procedure was recorded. To assess accuracy, ultrasound examination was performed in both groups after injection. Patient discomfort was evaluated with visual analogue scale (VAS) for pain. The clinical outcome was assessed comparing the VAS, the Single Assessment Numeric Evaluation (SANE) score and the QuickDASH score before treatment and after 4 weeks and 6 months. RESULTS The mean duration of the procedure was 64 ± 6.87 s in group A and 81.91 ± 8.42 s in group B (p < 0.001). Injection accuracy in group A was 100% and in group B 68.18%. Discomfort was lower in group A, as compared to group B (22.10 vs. 35.50; p < 0.001). Symptoms, as measured by VAS, SANE and QuickDASH scores, improved in both groups at 4 weeks and 6 months (p < 0.05). Superior clinical improvement was recorded in group A in both time points (p < 0.05). CONCLUSIONS Corticosteroid injections are an effective treatment for primary LHB tendinosis. Under ultrasound guidance, injections to the bicipital groove are faster and produce lower discomfort. Superior accuracy and clinical outcomes can be achieved using the ultrasound-guided technique. LEVEL OF EVIDENCE Level II; Prospective Randomized Comparative Study.
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Affiliation(s)
- Christos K Yiannakopoulos
- Department of Arthroscopic and Shoulder Surgery, Metropolitan General Hospital, Athens, Greece.,Department of Sports Medicine & Exercise Biology, School of Physical Education and Sport Science, National and Kapodistrian, University of Athens, Athens, Greece
| | - Panayiotis D Megaloikonomos
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, ATTIKON University General Hospital, Athens, Greece.
| | | | - John Gliatis
- Department of Orthopaedics, University of Patras, Patras, Greece
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Aflatooni JO, Meeks BD, Froehle AW, Bonner KF. Biceps tenotomy versus tenodesis: patient-reported outcomes and satisfaction. J Orthop Surg Res 2020; 15:56. [PMID: 32070381 PMCID: PMC7029563 DOI: 10.1186/s13018-020-1581-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/05/2020] [Indexed: 11/15/2022] Open
Abstract
Background Biceps tenotomy and tenodesis are surgical treatments for pathology of the proximal tendon of the long head of the biceps. There is debate over which procedure provides better patient outcomes. Purpose Compare patient-reported outcomes and satisfaction between biceps tenotomy and tenodesis. Methods This retrospective cohort study including all patients undergoing arthroscopic biceps tenodesis or tenotomy as part of more extensive shoulder surgery with a single surgeon. Concomitant procedures included rotator cuff repair, subacromial decompression, acromioclavicular joint resection, and debridement. Patients 36–81 years old were contacted by phone at > 2-year post-operatively to complete a biceps-specific outcome questionnaire. Subject decision not to participate was the sole exclusion criterion. Satisfaction scores and frequencies of potential biceps-related downsides (biceps cramping/spasms, biceps pain, shoulder pain, weakness, cosmetic deformity) were analyzed for the effects of procedure, sex, and age. Results Satisfaction score distributions were similar between patients with tenodesis and patients with tenotomy (χ2 = 8.34, P = 0.08), although slightly more patients with tenodesis than patients with tenotomy reported being satisfied or very satisfied (96% versus 91%). Perceived downsides occurred more frequently among patients with tenotomy than in patients with tenodesis: 59% of patients with tenotomy reported ≥ 1 downside, versus 37% of patients with tenodesis (P < 0.01). In patients reporting ≥ 1 downside, distributions of total downsides differed between procedures (χ2 = 10.04, P = 0.04): patients with tenotomy were more likely to report multiple concurrent downsides than were patients with tenodesis (31% versus 16%). Each individual downside tended to be reported as present by a greater proportion of patients with tenotomy than patients with tenodesis. Sex had no effect on satisfaction or downsides, but there was a trend for older patients to report higher satisfaction and fewer downsides. Conclusions Biceps tenotomy and tenodesis are both viable treatments for proximal biceps tendon pathology, yielding high patient satisfaction. There were trends toward greater satisfaction and fewer problems in patients with tenodesis. Still, younger patients with tenodesis did report perceived downsides. Alternatively, older patients tended to be more satisfied with both procedures overall. Regardless of procedure, most patients receiving either tenotomy or tenodesis would undergo their respective surgery again. Level of Evidence Level III evidence, retrospective comparative cohort study
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Affiliation(s)
| | - Brett D Meeks
- Department of Orthopaedic Surgery, Wright State University, Dayton, OH, USA
| | - Andrew W Froehle
- Department of Orthopaedic Surgery, Wright State University, Dayton, OH, USA
| | - Kevin F Bonner
- Jordan-Young Institute, Orthopaedic Surgery and Sports Medicine, Virginia Beach, VA, USA
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Haupt ET, O'Keefe K, Farmer K. Arthroscopic All-Inside Biceps Tenodesis: Technique and Outcomes. Arthrosc Tech 2019; 8:e1485-e1489. [PMID: 31890527 PMCID: PMC6928359 DOI: 10.1016/j.eats.2019.07.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/24/2019] [Indexed: 02/03/2023] Open
Abstract
The long head of the biceps tendon (LHBT) is a frequent source of disorders and pathology in the shoulder. Significant evidence is available on the management of disorders of the LHBT in the literature, and the LHBT is frequently addressed intraoperatively when involved in shoulder pathology. An all-arthroscopic, intra-articular biceps tenodesis with suture anchor fixation has several advantages that have not been well described previously, and it does not add significant morbidity to arthroscopic surgery to treat the rotator cuff or other sources of pain. Intra-articular LHBT tenodesis in the bicipital groove thus has advantages of less surgical time and a decreased bone footprint.
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Affiliation(s)
- Edward Thomas Haupt
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, U.S.A,Address correspondence to Edward Thomas Haupt, M.D., Department of Orthopaedic Surgery, University of Florida, 3450 Hull Rd, Gainesville, FL 32607, U.S.A.
| | - Kevin O'Keefe
- College of Medicine, University of Florida, Gainesville, Florida, U.S.A
| | - Kevin Farmer
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, U.S.A
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Kerschbaum M, Weiss I, Mayr A, Pfeifer C, Nerlich M, Greiner S. The Arthroscopic Loop Tenodesis Procedure: An Implant-Free Technique to Treat Long Biceps Tendon Pathologies. Arthrosc Tech 2019; 8:e503-e506. [PMID: 31194191 PMCID: PMC6551698 DOI: 10.1016/j.eats.2019.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/18/2019] [Indexed: 02/03/2023] Open
Abstract
Different surgical techniques are available to treat pathologies of the long biceps tendon. Although simple tenotomy of the tendon can result in distalization of the biceps muscle, implant-associated complications can occur after bony tendon fixation within a biceps tenodesis. This article describes the arthroscopic loop tenodesis procedure. The technique is based on an enlargement of the proximal tenotomized tendon by creating a tendon loop, which subsequently blocks itself at the entrance to the bicipital groove and prevents distalization of the biceps muscle. This procedure can be performed arthroscopically, resulting in a stable fixed tendon without an anchor or other foreign materials, and might be suitable for young and old patients with biceps tendon pathologies.
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Affiliation(s)
- Maximilian Kerschbaum
- Clinic of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany,Address correspondence to: Maximilian Kerschbaum, M.D., Clinic of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss Allee 11, D-93053 Regensburg, Germany.
| | - Isabella Weiss
- Clinic of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Agnes Mayr
- Clinic of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Christian Pfeifer
- Clinic of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Michael Nerlich
- Clinic of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
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