In a new study published in the January 2017 issue of Arthroscopy, both all arthroscopic suprapectoral and open subpectoral tenodesis on the long head of the biceps brachii without the use of interference screws resulted in positive patient outcomes.
Positive Results With both Arthroscopic and Open Tenodesis
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“There is controversy in the literature as to where the biceps tenodesis should be performed and if there is superiority of one location over the other and we have tried to address the issue to help treating orthopedic surgeons best manage their patients,” Mark H. Getelman, M.D., co-director sports medicine fellowship at the Southern California Orthopedic Institute in Van Nuys, California told OTW.
The study included 23 patients who had open subpectoral biceps tenodesis and 15 who received all-arthroscopic suprapectoral biceps tenodesis. The average follow-up was 4.5 years. All patients were evaluated for Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and satisfaction with function and biceps contour.
Overall, there were no significant differences in anterior shoulder pain VAS, ASES scores, or satisfaction rates. The average anterior shoulder VAS was 0.7 ± 1.1 for the open group and 0.9 ± 1.8 for the arthroscopic group (p =0.74). The mean ASES score for the open group was 90.6 ± 11.4 and 91.4 ± 13.9 for the arthroscopic group (p = 0.69). According to this study, open subpectoral biceps tenodesis and all-arthroscopic suprapectoral biceps tenodesis are both successful surgeries with consistently positive outcomes that can be performed in either location without interference screw fixation.
Getelman said that the most challenging part of conducting this study was ensuring that they were comparing the outcomes from biceps alone.
“We excluded those patients who also had rotator cuff repairs to get a more uniform patient profile and then getting the necessary number of patients to be sure that the paper was appropriately powered.”
For Getelman, the most surprising finding was that the outcomes were similar. He said, “There are advocates for both location techniques and we found that when the procedure is performed with a similar technique arthroscopically or open, the outcomes are similar whether performed supra pectoral or sub pectoral.”
He added that a prospective randomized trial may add further strength to the findings they have reported so far. Getelman won Arthroscopy’s 2016 Best Clinical Research for this study.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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