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. 2020 Feb 28;8(2):2325967120904361.
doi: 10.1177/2325967120904361. eCollection 2020 Feb.

Risk Factors and Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon

Raffy Mirzayan  1 , Christopher McCrum  2 , Rebecca K Butler  3 , Ram Kiran Alluri  4
Affiliations

Risk Factors and Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon

Raffy Mirzayan et al. Orthop J Sports Med. .

Abstract

Background: Controversy exits regarding performing a tenotomy versus a tenodesis of the long head of the biceps tendon (LHBT).

Purpose: To evaluate the complications after arthroscopic tenotomy of the LHBT and characterize the incidence of cosmetic deformity, cramping, subjective weakness, and continued anterior shoulder pain (ASP). Additionally, to identify patient-related factors that may predispose a patient to these complications.

Study design: Case-control study; Level of evidence, 3.

Methods: Records of patients who underwent an arthroscopic LHBT tenotomy at an integrated health care system under the care of 55 surgeons were retrospectively reviewed. Exclusion criteria included LHBT tenodesis, arthroplasty, neoplastic, or fracture surgery; age younger than 18 years; incomplete documentation of physical examination; or incomplete operative reports. Characteristic data, concomitant procedures, LHBT morphology, and postoperative complications were recorded. Patients with and without postoperative complications-including cosmetic deformity, subjective weakness, continued ASP, and cramping-were analyzed by age, sex, dominant arm, body mass index (BMI), smoking status, workers' compensation status, and intraoperative LHBT morphology to identify risk factors for developing these postoperative complications.

Results: A total of 192 patients who underwent LHBT tenotomy were included in the final analysis. Tenotomy was performed with concomitant shoulder procedures in all but 1 individual. The mean ± SD patient age was 60.6 ± 9.5 years, and 55% were male. The overall complication rate was 37%. The most common postoperative complications include cosmetic (Popeye) deformity (14.1%), subjective weakness (10.4%), cramping (10.4%), and continued postoperative ASP over the bicipital groove (7.8%). Every 10-year increase in age was associated with 0.52 (95% CI, 0.28-0.94) times the odds of continued ASP and 0.59 (95% CI, 0.36-0.98) times the odds of cramping pain. Male patients had 3.9 (95% CI, 1.4-10.8) times the odds of cosmetic (Popeye) deformity. Patients who had active workers' compensation claims had 12.5 (95% CI, 2.4-63.4) times the odds of having continued postoperative ASP. Tenotomy on the dominant arm, BMI, and active smoking status demonstrated no statistically significant association with postoperative complications.

Conclusion: Patients experiencing complications after tenotomy were significantly younger and more likely to be male and to have a workers' compensation injury. LHBT tenotomy may best be indicated for elderly patients, female patients, and those without active workers' compensation claims.

Keywords: biceps release; biceps tenotomy; long head of the biceps tendon; shoulder arthroscopy; tenodesis.

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Conflict of interest statement

One or more of the authors declared the following potential conflict of interest or source of funding: R.M. has received research support from Arthrex and the Joint Restoration Foundation; grant support from DJO; educational support from Arthrex; royalties from Zimmer Biomet, Thieme, and Wolters Kluwer; and honoraria from Arthrex. C.M. has received grant support from Arthrex and educational support from Smith & Nephew and Pylant Medical. R.K.A. has received research support from Accumed, Trimmed, and Arthrex and has stock/stock options in Zimmer Biomet, Stryker, Medtronic, and Axogen. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Postoperative complications after long head of the biceps tendon arthroscopic tenotomy. ASP, anterior shoulder pain.
See this image and copyright information in PMC

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