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. 2020 Feb;19(2):861-870.
doi: 10.3892/etm.2019.8284. Epub 2019 Dec 5.

Small-incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for biceps long head tendon lesions with repair of rotator cuff tears

Gang Yi  1   2 , Jing Yang  3 , Lei Zhang  1   2 , Yang Liu  1   2 , Xiaoguang Guo  1   2 , Shijie Fu  1   2
Affiliations

Small-incision open distal subpectoral vs. arthroscopic proximal biceps tenodesis for biceps long head tendon lesions with repair of rotator cuff tears

Gang Yi et al. Exp Ther Med. 2020 Feb.

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).

Keywords: arthroscopy; pectoralis muscles; rotator cuff; tendon; tenodesis.

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Figures

Figure 1.
Figure 1.
Diagrammatic sketch of the location of LHBT lesions and peripheral ligaments. H, humerus; LHBT, long head of the biceps tendon; SSP, supraspinatus; CHL, coracohumeral ligament; SGHL, superior glenohumeral ligament; SSC, subscapularis.
Figure 2.
Figure 2.
Diagrammatic sketch of biceps tenodesis following tendectomy of the affected LHBT. (A) Removal of LHBT lesions following tendectomy of the affected LHBT, knitting and suturing of the LHBT with tendon suture line, slight polishing of the bony cortex with a grinding drill and drilling at a proper depth with a bone drill. (B) Placement of the knitted LHBT into the drilled tunnel. (C) Tightening of the interference screw. LHBT, long head of the biceps tendon.
Figure 3.
Figure 3.
Representative example of surgical position of patients. The patients were maintained in a recumbent position on the healthy side, with a fixed head and neck, suspended upper limb of the affected side with SPIDER MAN, and outspread (40°) and anteflexed (15°) limb.
Figure 4.
Figure 4.
Small-incision open distal subpectoral tenodesis. Arthroscopy images were taken of the surgical procedure. (A) The LHBT was cut off under arthroscopy, the white arrows show the point at which the LHBT was cut. (B) Removal of LHBT under ectopectoralis, knitting and suturing of the LHBT with a tendon suture line. (C) Enhanced fixation of LHBT with interference screw. Schematic illustration of small-incision open distal subpectoral tenodesis, (D) placement of the knitted LHBT into the drilled tunnel and (E) tightening of the interference screw. LHBT, long head of the biceps tendon.
Figure 5.
Figure 5.
Arthroscopic proximal tenodesis. Arthroscopy images were of the surgical procedure. (A) The white arrows point at the LHBT lesions. (B) The suture anchor was implanted. (C) The LHBT was tied and fixed by suture anchor. Schematic illustration of arthroscopic proximal biceps tenodesis, (D) placement of the knitted LHBT into the drilled tunnel and (E) the LHBT was fixed after the suture anchor was implanted. LHBT, long head of the biceps tendon.
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