Biceps Lesion Associated With Rotator Cuff Tears: Open Subpectoral and Arthroscopic Intracuff Tenodesis

Abstract

Background: Various tenodesis methods are being used for long head of the biceps tendon lesions. However, there is no consensus on the most appropriate surgical method.

Hypothesis: There are significant differences in incidence of cosmetic deformity and persistent bicipital pain between open subpectoral and arthroscopic intracuff tenodesis groups.

Study design: Cohort study; Level of evidence, 3.

Methods: This study included 72 patients who underwent biceps tenodesis and rotator cuff repair between January 2009 and May 2014 and who were followed for at least 1 year. Open subpectoral tenodesis was performed in 39 patients (group A), and arthroscopic intracuff tenodesis was performed in 33 patients (group B).

Results: In group A, the mean visual analog scale (VAS) score for pain during motion and mean University of California, Los Angeles (UCLA) and Constant scores significantly improved from 4.6, 18.6, and 64.5 preoperatively to 1.9, 30.5, and 86.5 at last follow-up, respectively (P < .001 for all). In group B, these scores significantly improved from 5.1, 17.6, and 62.9 preoperatively to 1.8, 31.5, and 85.9 at last follow-up, respectively (P < .001 for all). Popeye deformity was noted in 2 (5.2%) patients from group A and 5 (15.6%) patients from group B (P = .231). Additionally, persistent bicipital tenderness was noted in 1 (2.6%) patient from group A and 8 (24.2%) patients from group B (P = .012).

Conclusion: Both open subpectoral tenodesis and arthroscopic intracuff tenodesis show good clinical outcomes for long head of the biceps tendon lesions. However, open subpectoral tenodesis may be more appropriate, considering the low incidence of Popeye deformity and tenderness.

Keywords: biceps tendon; intracuff tenodesis; shoulder; soft tissue tenodesis; subpectoral tenodesis; tenodesis.

Figure 1.

Open subpectoral tenodesis technique at the superior border of the axilla. The pectoralis major muscle was retracted laterally. A tenodesis site was identified as far proximal on the humerus as possible while remaining in line with the normal biceps position.

Figure 2.

Arthroscopic subacromial view of intracuff tenodesis after tying over the rotator cuff. Two Ethibond loops were placed under the biceps and tied over the rotator cuff. LHBT, long head of biceps tendon.

Figure 3.

Tenotomized biceps tendon was sutured under the rotator cuff, thereby making the long head of the biceps tendon come into contact with the undersurface of the articular portion of the rotator cuff. Reproduced with permission from Cho et al.