Outcomes and Complications After Primary Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis for Superior Labral Anterior-Posterior Tears or Biceps Abnormalities: A Systematic Review and Meta-analysis

Abstract

Background: Biceps tenodesis is a surgical treatment for both superior labral anterior-posterior (SLAP) tears and long head of the biceps tendon (LHBT) abnormalities. Biceps tenodesis can be performed either above or below the pectoralis major tendon with arthroscopic or open techniques. Purpose: To analyze the outcomes and complications comparing primary arthroscopic suprapectoral versus open subpectoral biceps tenodesis for either SLAP tears or LHBT disorders. Study Design: Systematic review; Level of evidence, 4. Methods: A search strategy based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) protocol was used to include 18 articles (471 patients) from a total of 974 articles identified. Overall exclusion criteria included the following: non–English language, non–full text, biceps tenodesis with concomitant rotator cuff repair, review articles, meta-analyses, and case reports. Data were extracted and analyzed according to procedure type and tenodesis location: arthroscopic suprapectoral biceps tenodesis (295 patients) versus open subpectoral bicepts tenodesis (176 patients). Results: For arthroscopic suprapectoral biceps tenodesis, the weighted mean American Shoulder and Elbow Surgeons (ASES) score was 90.0 (97 patients) and the weighted mean Constant score was 88.7 (108 patients); for open subpectoral biceps tenodesis, the mean ASES score was 91.1 (199 patients) and mean Constant score was 84.7 (65 patients). Among the 176 patients who underwent arthroscopic biceps tenodesis, there was an overall complication rate of 9.1%. Among the 295 patients who underwent open biceps tenodesis, there was an overall complication rate of 13.5%. Both residual pain (5.7% vs 4.7%, respectively) and Popeye deformity (1.7% vs 1.0%, respectively) rates were similar between the groups. Open subpectoral biceps tenodesis had higher reoperation (3.0% vs 0.0%, respectively), wound complication (1.0% vs 0.0%, respectively), and nerve injury (0.7% vs 0.0%, respectively) rates postoperatively. A meta-analysis of 3 studies demonstrated that both methods had similar ASES scores ( P = .36) as well as all-cause complication rates (odds ratio, 0.76 [95% CI, 0.13-4.48]; P = .26). Conclusion: Patients undergoing arthroscopic suprapectoral biceps tenodesis for either SLAP tears or LHBT abnormalities had similar outcome scores and complication rates compared with those undergoing open subpectoral biceps tenodesis. Additionally, both residual pain and Popeye deformity rates were similar between the 2 groups.

Short-Term Clinical and Return-to-Work Outcomes After Arthroscopic Suprapectoral Onlay Biceps Tenodesis With a Single Suture Anchor

“…42 Other investigators have reported much lower incidences of persistent cosmetic deformity after arthroscopic tenodesis (<5%), with some reporting no instances of cosmetic deformity postoperatively. 12,43,46 Although the average biceps apex distance between the operative and nonoperative sides did not differ in our analysis, a noticeable Popeye deformity developed postoperatively in 5 patients SHORT-TERM ARTHROSCOPIC TENODESIS e7 (10.0%). These findings are clinically significant considering that many authors advocate the performance of tenodesis versus tenotomy in active or working populations, such as our population, owing to the decreased reported risk of cosmetic deformity.…”

“…These findings may suggest that patients experiencing postoperative cosmetic deformity may also perceive some functional deficit. However, these findings should be interpreted with caution because this comparison is likely underpowered given the small sample size of failures and insufficient to draw 46,53,54 Perhaps other options for suture anchor fixationdor the use of additional anchors to fortify the repairdmay lead to improved tenodesis fixation and decreased rates of deformity. In addition, an onlay technique may result in decreased tendonbone healing in comparison to tunnel-based techniques, contributing to failure.…”

“…The most commonly described complications after arthroscopic biceps tenodesis include persistent bicipital groove pain (5.7%-34.8%), stiffness (9.4%-17.9%), and tenodesis failure or Popeye deformity (2.9%-15.2%). 36,[41][42][43][44][45][46] In a retrospective analysis of 33 patients who underwent arthroscopic biceps tenodesis with concomitant rotator cuff repair, Jeong et al 42 reported the highest described rate of postoperative Popeye deformity in the literature of 15.6%. This was greater than the rate in their comparative open biceps tenodesis cohort of 39 patients (5.2%), but this finding did not reach statistical significance.…”

Surgical Management of Superior Labral Tears in Athletes: Focus on Biceps Tenodesis

“…It has been reported that arthroscopic suprapectoral versus open subpectoral tenodesis techniques have unique complications. 76 This text will focus primarily on open subpectoral tenodesis complications. In a 2020 systematic review and meta-analysis by Deng et al, it was noted that patients had residual pain in 4.7% of cases after open tenodesis.…”

“…Two of the 295 (0.7%) open cases were reported to have nerve-related injuries, though one was determined to be due to an interscalene block perioperatively. 76 Surgeons should pay close attention to sterile technique and be gentle with traction during tenodesis procedures, as branches of the brachial plexus, particularly the musculocutaneous nerve, may traverse near the tenodesis site. Neurovascular complications and infection risk are the most commonly cited reasons for an arthroscopic approach to the BT, however, the senior author has performed over 500 BT procedures using the technique described above with no neurovascular complications or need to return to the operating room for irrigation and debridement.…”