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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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Lu Y, Agarwalla A, Patel BH, Nolte MT, Cancienne J, Verma N, Cole BJ, Forsythe B. Influence of workers' compensation status on postoperative outcomes in patients following biceps tenodesis: a matched-pair cohort analysis. J Shoulder Elbow Surg 2020; 29:2530-2537. [PMID: 33190754 DOI: 10.1016/j.jse.2020.03.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND HYPOTHESIS Although the literature on the association of workers' compensation (WC) status with negative outcomes after orthopedic surgery is extensive, there is a paucity of evidence on outcomes in WC recipients undergoing biceps tenodesis. We hypothesized that WC patients would report significantly worse outcomes postoperatively on patient-reported outcome measures (PROMs). METHODS Functional and health-related quality-of-life PROMs and a visual analog scale score for pain were administered preoperatively and at 12 months postoperatively to consecutive patients undergoing isolated biceps tenodesis between 2014 and 2018 at our institution. Thirty-eight WC patients were matched 1:2 to non-WC patients by age, body mass index, and operative limb. The minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state were calculated for all patients via anchor- and distribution-based methods. Rates of achievement and the likelihood of achievement were determined. RESULTS All patients showed significant improvements in all outcome measures (P < .001). WC patients reported inferior postoperative scores on all PROMs examined. WC status significantly predicted a reduced likelihood of achieving substantial clinical benefit for the American Shoulder and Elbow Surgeons score (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.17-0.81; P = .01) and the patient acceptable symptom state (OR, 0.28; 95% CI, 0.12-0.65; P = .003) for the American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score (OR, 0.24; 95% CI, 0.10-0.61; P = .003), Constant-Murley Subjective Assessment (OR, 0.25; 95% CI, 0.08-0.77; P = .016), and visual analog scale pain score (OR, 0.27; 95% CI, 0.16-0.47; P < .001). CONCLUSION WC patients reported inferior scores on all postoperative PROMs and demonstrated lower odds of achieving substantial benefit and satisfaction regarding improvements in both function and pain compared with non-WC patients.
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Affiliation(s)
- Yining Lu
- Department of Orthopaedics, Mayo Clinic, Rochester, MN, USA
| | - Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Bhavik H Patel
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Michael T Nolte
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Jourdan Cancienne
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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Deng ZJ, Yin C, Cusano J, Abdul-Rassoul H, Curry EJ, Novikov D, Ma R, Li X. Outcomes and Complications After Primary Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis for Superior Labral Anterior-Posterior Tears or Biceps Abnormalities: A Systematic Review and Meta-analysis. Orthop J Sports Med 2020; 8:2325967120945322. [PMID: 32923502 PMCID: PMC7457415 DOI: 10.1177/2325967120945322] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/31/2020] [Indexed: 01/02/2023] Open
Abstract
Background: Biceps tenodesis is a surgical treatment for both superior labral
anterior-posterior (SLAP) tears and long head of the biceps tendon (LHBT)
abnormalities. Biceps tenodesis can be performed either above or below the
pectoralis major tendon with arthroscopic or open techniques. Purpose: To analyze the outcomes and complications comparing primary arthroscopic
suprapectoral versus open subpectoral biceps tenodesis for either SLAP tears
or LHBT disorders. Study Design: Systematic review; Level of evidence, 4. Methods: A search strategy based on the PRISMA (Preferred Reporting Items for
Systematic Meta-Analyses) protocol was used to include 18 articles (471
patients) from a total of 974 articles identified. Overall exclusion
criteria included the following: non–English language, non–full text, biceps
tenodesis with concomitant rotator cuff repair, review articles,
meta-analyses, and case reports. Data were extracted and analyzed according
to procedure type and tenodesis location: arthroscopic suprapectoral biceps
tenodesis (295 patients) versus open subpectoral bicepts tenodesis (176
patients). Results: For arthroscopic suprapectoral biceps tenodesis, the weighted mean American
Shoulder and Elbow Surgeons (ASES) score was 90.0 (97 patients) and the
weighted mean Constant score was 88.7 (108 patients); for open subpectoral
biceps tenodesis, the mean ASES score was 91.1 (199 patients) and mean
Constant score was 84.7 (65 patients). Among the 176 patients who underwent
arthroscopic biceps tenodesis, there was an overall complication rate of
9.1%. Among the 295 patients who underwent open biceps tenodesis, there was
an overall complication rate of 13.5%. Both residual pain (5.7% vs 4.7%,
respectively) and Popeye deformity (1.7% vs 1.0%, respectively) rates were
similar between the groups. Open subpectoral biceps tenodesis had higher
reoperation (3.0% vs 0.0%, respectively), wound complication (1.0% vs 0.0%,
respectively), and nerve injury (0.7% vs 0.0%, respectively) rates
postoperatively. A meta-analysis of 3 studies demonstrated that both methods
had similar ASES scores (P = .36) as well as all-cause
complication rates (odds ratio, 0.76 [95% CI, 0.13-4.48]; P
= .26). Conclusion: Patients undergoing arthroscopic suprapectoral biceps tenodesis for either
SLAP tears or LHBT abnormalities had similar outcome scores and complication
rates compared with those undergoing open subpectoral biceps tenodesis.
Additionally, both residual pain and Popeye deformity rates were similar
between the 2 groups.
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Affiliation(s)
- Zi Jun Deng
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Clark Yin
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Joseph Cusano
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Hussein Abdul-Rassoul
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily J Curry
- Boston University School of Public Health, Boston, Massachusetts, USA.,Boston Medical Center, Boston, Massachusetts, USA
| | - David Novikov
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Boston University School of Public Health, Boston, Massachusetts, USA
| | - Richard Ma
- Missouri Orthopaedic Institute, Columbia, Missouri, USA
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
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Yi G, Yang J, Zhang L, Liu Y, Guo X, Fu S. Small-incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for biceps long head tendon lesions with repair of rotator cuff tears. Exp Ther Med 2019; 19:861-870. [PMID: 32010246 PMCID: PMC6966230 DOI: 10.3892/etm.2019.8284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 10/24/2019] [Indexed: 01/14/2023] Open
Abstract
The curative effect of small-incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for lesions in the long head of the biceps tendon (LHBT) combined with rotator cuff repairs (RCR) has remained controversial. The aim of the present study was to compare the two surgical methods. A total of 71 patients who received surgical treatment for LHBT lesions accompanied by RC tears were analyzed. Following arthroscopic RCR and tendectomy of the affected LHBT, 35 patients underwent small-incision open distal subpectoral tenodesis through a small incision (the subpectoral group), while the remaining 36 patients received arthroscopic proximal tenodesis (the arthroscopic group). The surgery time and intra-operative blood loss were compared between the two groups. In addition, the clinical outcomes were evaluated using scoring systems for the functional assessment of the shoulder joint. The subpectoral group had a shorter surgery time and less intra-operative blood loss than the arthroscopic group (P<0.05). The functional scores of the two groups significantly improved as time passed (P<0.05). The subpectoral group was significantly superior to the arthroscopic group with regard to the American Shoulder and Elbow Surgeons score at 2 weeks post-operatively and visual analog scale score at 2 weeks and 3 months post-operatively (P<0.05). Small-incision open distal subpectoral and arthroscopic proximal tenodesis were demonstrated to effectively improve the function of the shoulder joint and relieve pain caused by LHBT lesions accompanied by RCR. However, small-incision open distal subpectoral tenodesis had the additional advantage of shorter surgery time, less intra-operative bleeding and encouraging early results compared to arthroscopic proximal tenodesis. The study was registered as a clinical trial in the Chinese Trial Registry (no. ChiCTR1800015643).
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Affiliation(s)
- Gang Yi
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China.,Academician Workstation in Luzhou, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Jing Yang
- Department of Obstetrics and Gynecology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Lei Zhang
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China.,Academician Workstation in Luzhou, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Yang Liu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China.,Academician Workstation in Luzhou, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Xiaoguang Guo
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China.,Academician Workstation in Luzhou, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
| | - Shijie Fu
- Department of Orthopedics, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China.,Academician Workstation in Luzhou, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 646600, P.R. China
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Lohakitsathian C, Mayr F, Mehl J, Siebenlist S, Imhoff AB. Similar clinical outcomes of biceps tenodesis with various kinds of fixation techniques: a systematic review. J ISAKOS 2019. [DOI: 10.1136/jisakos-2019-000275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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A biomechanical comparison of two arthroscopic suture techniques in biceps tenodesis: whip-stitch vs. simple suture techniques. J Shoulder Elbow Surg 2019; 28:1531-1536. [PMID: 30948215 DOI: 10.1016/j.jse.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/02/2019] [Accepted: 01/06/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The aim of this study was to compare the biomechanical performance of whip-stitch (WS) and simple suture techniques (SST) of the long head of the biceps tendon in suprapectoral intraosseous tenodesis with interference screw fixation. METHODS A total of 10 paired cadavers (61.1 ± 4.6 years) were randomized to receive WS or SST biceps tenodesis beginning at the musculotendinous junction. Both groups implemented a No. 2 FiberLoop wire and underwent suprapectoral fixation with a polyetheretherketone interference screw at the bicipital grove. A Materials Testing System performed cyclic testing (500 cycles), followed by load to failure at 1 mm/s. Load, displacement, and time were recorded during cyclic and failure testing. A 2-tailed Student's t-test and χ2 analysis were performed for failure load and mode of failure, respectively. RESULTS Two SST specimens and 1 WS specimen failed during cyclic loading via tendon rupture at the screw-tendon interface. There was no significant statistical difference in the cyclic displacement after 500 cycles between the WS (12.9 mm ± 4.4 mm) and SST groups (14.0 mm ± 3.8 mm, P = .2); cyclic strain, defined as the peak displacement at the 500th cycle divided by the initial gauge length, between the WS (0.4 ± 0.2) and SST groups (0.7 ± 0.7, P = .3); maximal load (162.7 N ± 56.8 N vs. 153.1 N ± 39.3 N, respectively, P = .6); and stiffness (50.5 N/mm ± 17.7 N/mm vs. 43.3 N/mm ± 10.9 N/mm, respectively, P = .3). All specimens ruptured at the screw-tendon interface. CONCLUSION The WS technique can provide equivalent biomechanical performance to the SST in suprapectoral intraosseous biceps tenodesis with interference screw fixation.
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Liechti DJ, Mitchell JJ, Menge TJ, Hackett TR. Immediate physical therapy without postoperative restrictions following open subpectoral biceps tenodesis: low failure rates and improved outcomes at a minimum 2-year follow-up. J Shoulder Elbow Surg 2018; 27:1891-1897. [PMID: 29804912 DOI: 10.1016/j.jse.2018.02.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 02/14/2018] [Accepted: 02/17/2018] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS We aimed to determine patient-reported outcomes in patients undergoing open subpectoral biceps tenodesis with a dual-fixation construct who had no postoperative range-of-motion or weight-bearing restrictions. Our hypothesis was that patients without postoperative restrictions would have low failure rates with improved patient-reported outcomes. We further hypothesized that this technique would allow an earlier return to activity and similar functional outcomes when compared with those reported in the literature. METHODS In this institutional review board-approved retrospective outcome study, we evaluated 105 patients who underwent primary open subpectoral biceps tenodesis with a bicortical suture button and interference screw construct without postoperative restrictions. The primary outcome measure was failure of the biceps tenodesis. Postoperative outcome scores included the Short Form 12 (SF-12) Physical Component Score; SF-12 Mental Component Score; American Shoulder and Elbow Surgeons total score and subscales; and Disabilities of the Arm, Shoulder and Hand score. RESULTS A total of 98 patients (85%) were available for final follow-up at an average of 3.5 years. There were 2 failures (2.2%), at 5 weeks and 9 weeks postoperatively. Four patients underwent additional surgery unrelated to the previous tenodesis procedure. Final outcome scores indicated high levels of function, including the SF-12 Physical Component Score (mean, 51.5; SD, 7.8), SF-12 Mental Component Score (mean, 54.7; SD, 6.7), American Shoulder and Elbow Surgeons total score (mean, 89.4; SD, 14.2), and Disabilities of the Arm, Shoulder and Hand score (mean, 11.3; SD, 13.4). CONCLUSION Open subpectoral biceps tenodesis using a dual-fixation construct with no postoperative motion restrictions resulted in excellent outcomes with a low incidence of failure.
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Affiliation(s)
| | | | | | - Thomas R Hackett
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
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