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Rotator cuff repair with and without biceps tenodesis yielded equivalent outcomes
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Results showed equivalent patient-determined outcomes between patients who underwent rotator cuff repair with and those who had the procedure without a percutaneous intra-articular transtendon technique biceps tenodesis.
Keith M. Baumgarten, MD, and colleagues compared preoperative and postoperative patient-determined outcome scores between patients undergoing primary arthroscopic rotator cuff repair with (n=131) and without (n=153) a percutaneous intra-articular transtendon technique biceps tenodesis. Researchers collected Western Ontario Rotator Cuff score, American Shoulder and Elbow Surgeons score, single assessment numeric evaluation, simple shoulder test and shoulder activity level. Patients with a partial, long head, biceps tendon tear or biceps instability/subluxation were indicated for a concomitant biceps tenodesis.
Results showed improvements in Western Ontario Rotator Cuff, ASES, single assessment numeric evaluation and simple shoulder test scores in patients who underwent rotator cuff repair with or without biceps tenodesis. Both groups also had deteriorations in the shoulder activity level, according to researchers. Researchers found no differences in the change in outcome scores and in complications that required revision surgery among both groups.
“Outcomes of the [percutaneous intra-articular transtendon technique] PITT tenodesis in patients with combined rotator cuff and biceps pathology were equivalent with patients undergoing rotator cuff repair without biceps pathology,” Baumgarten told Healio.com/Orthopedics. “Lastly, male gender appears to be a risk factor for biceps pathology found during rotator cuff repair.” – by Casey Tingle
Disclosures: Baumgarten reports he receives speaking fees from Arthrex and Wright Medical and consulting fees from Wright Medical. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Mark A. Mighell, MD
To date, no consensus has been reached with respect to the ideal location and fixation method to perform proximal biceps tenodesis.
Baumgarten and colleagues report outcomes on percutaneous intra-articular tendon technique (PITT) to manage pathology of the long head of the biceps tendon in conjunction with arthroscopic rotator cuff repairs (RCR) in a retrospective cohort study of 311 shoulders. When the authors compared RCR with PITT vs. RCR alone, they found no difference in functional outcome scores between the two groups.
This technique as described allows for proximal fixation of the tendon without the necessity of implants. It is a simple technique that is reliable. Patient dissatisfaction resulting in a subsequent open subpectoral tenodesis was reported in only two cases (1.5%).
The long head of the biceps is an important stabilizer of the shoulder and provides proprioceptive function for shoulder mechanics. It is important to assess biceps pathology at the time of surgery to determine whether the patient would benefit from tenodesis. The authors do a nice job describing their technique in this article.
Tampa, Florida
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