Arthroscopic suprapectoral and open subpectoral biceps tenodesis showed similar outcomes
Future research will evaluate fixation methods comparing the two techniques.
Click Here to Manage Email Alerts
Patients who underwent arthroscopic suprapectoral biceps tenodesis had no differences in patient-reported outcome measures when compared with patients who underwent open subpectoral biceps tenodesis, according to results of a randomized prospective analysis published in Arthroscopy.
Results showed patients in both groups also showed no differences in functional outcomes or complication rates.
Brian Forsythe, MD, assistant professor at Rush University Medical Center, Midwest Orthopaedics at Rush, and his colleagues randomly assigned 77 patients with anterior shoulder pain, bicipital groove tenderness and positive provocative maneuvers to undergo either arthroscopic suprapectoral biceps tenodesis or open subpectoral biceps tenodesis using polyether ether ketone, interference Tenodesis screws (Arthrex). Researchers assessed range of motion and strength at 3, 6 and 12 months postoperatively, as well as American Shoulder and Elbow Surgeons shoulder score, Single Assessment Numeric Evaluation score and Constant score preoperatively and at 6 and 12 months postoperatively.
Arthroscopic vs open tenodesis
Results showed a significantly greater surgical time among the arthroscopic suprapectoral biceps tenodesis group vs. the open subpectoral biceps tenodesis group.
“We did find that the arthroscopic technique, as it is a little bit more technically involved, took on average about 7 minutes longer to perform intraoperatively,” Forsythe said.
However, at 3 months, 6 months and 1 year postoperatively, researchers found no significant differences in strength or anterior shoulder pain between the groups.
“There were no significant differences in the clinical outcome scores at 6 months and 1 year between the two groups,” Forsythe said.
Both groups experienced improved ASES scores that exceeded the minimal clinically important difference, according to the results.
Although researchers confirmed their hypothesis of no differences between the arthroscopic suprapectoral and open subpectoral biceps tenodesis groups, they were surprised to find similar, low complications in both groups, and similar clinical outcomes, Forsythe said.
“It is believed by some that with an arthroscopic approach, you will not get the same results as the mini-open approach because it is more difficult to resect and remove diseased tissue,” he said. “My belief is the reason we were able to achieve equivalent outcomes is because we performed a thorough release of the bicipital groove or zone 2, which is the region just above the pectoralis major tendon.”
Evaluation of fixation methods
Forsythe and his colleagues are now following up this study with an evaluation of different methods of fixation that compares interference screws with suture anchor fixation in arthroscopic suprapectoral biceps tenodesis and open subpectoral biceps tenodesis procedures. Forsythe said they are also using radiostereometric analysis to review “the effect of fixation technique on the degree of tendon slippage and musculotenodinous remodeling”.
“Our hypothesis is that we might observe differences in construct stability between suture anchors and interference screws [and] that we might see a greater degree of lengthening in the less stable construct,” Forsythe said. “That might have implications for muscle tendon length and tension and potentially biceps cramping or cosmetic deformity.”
- Reference:
- Forsythe B, et al. Arthroscopy. 2020; doi:10.1016/j.arthro.2019.07.009..
- For more information:
- Brian Forsythe, MD, can be reached at 1611 W. Harrison St., Chicago, IL 60612; email: brian.forsythe@rushortho.com.
Collapse
Read more about
Click Here to Manage Email Alerts