RESUMO
Background: Studies to date evaluating biceps tenotomy versus tenodesis in the setting of concomitant rotator cuff repair (RCR) have demonstrated relatively equivalent pain and functional outcomes. Hypothesis: It was hypothesized that a significant difference could be demonstrated for pain and functional outcome scores comparing biceps tenotomy versus tenodesis in the setting of RCR if the study was adequately powered. Study Design: Cohort study; Level of evidence, 3. Methods: The Arthrex Surgical Outcomes System database was queried for patients who underwent arthroscopic biceps tenotomy or tenodesis and concomitant RCR between 2013 and 2021; included patients had a minimum of 2 years of follow-up. Outcomes between treatment types were assessed using the American Shoulder and Elbow Surgeons Shoulder (ASES), Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and Veterans RAND 12-Item Health Survey (VR-12) scores preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Results were stratified by age at surgery (3 groups: <55, 55-65, >65 years) and sex. Results: Overall, 1936 primary RCRs were included for analysis (1537 biceps tenodesis and 399 biceps tenotomy patients). Patients who underwent tenotomy were older and more likely to be female. A greater proportion of female patients aged <55 years and 55 to 65 years received a biceps tenotomy compared with tenodesis (P = .012 and .026, respectively). All scores were comparable between the treatment types preoperatively and at 3 months, 6 months, and 1 year postoperatively. At 2-year follow-up, patients who received a biceps tenodesis had statistically more favorable ASES, SANE, VAS pain, and VR-12 scores (P ≤ .031); however, the differences did not exceed the minimal clinically important difference (MCID) for these measures. Conclusion: Our findings indicate that surgeons are more likely to perform a biceps tenotomy in female and older patients. Biceps tenodesis provided improved pain and functional scores compared with tenotomy at 2-year follow-up; however, the benefit did not exceed previously reported MCID for the outcome scores. Both procedures provided improvement in outcomes; thus, the choice of procedure should be a shared decision between the surgeon and patient.
RESUMO
PURPOSE: Recent interest in suture button fixation has developed with regard to proximal biceps tenodesis fixation. Biomechanical studies have demonstrated viability of a unicortical suture button technique in vitro. Despite this, no clinical data has been reported to validate the biomechanical data. The purpose of this study is to report on complication and failure rates in the early postoperative period after bicep tenodesis with a unicortical suture button. METHODS: A retrospective review was performed of all biceps tenodesis performed at our institution over a 36-month period using a unicortical suture button for fixation. All included patients had a minimum 12 weeks follow up. Failures were defined as complete loss of fixation, change in biceps contour during the early postoperative period, acute pain at the tenodesis site, or acute loss of supination strength. RESULTS: 145 of 166 biceps tenodesis procedures performed by the 4 surgeons at our institution met inclusion criteria. 80.1% of the patients were active duty military at the time of surgery. The average age was 38.2 years. There were 7 total complications (4.8%), including one failure (0.7%) requiring revision. CONCLUSION: Failure and complication rates in the early postoperative period using a unicortical suture button for biceps tenodesis fixation are consistent with other reported techniques. This study adds clinical data to the existing biomechanical reports that this technique is strong enough to provide stable fixation of the biceps tendon to allow healing of the tendon to the humerus.