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

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.

Biceps tenotomy versus tenodesis for lesions of the long head of the biceps tendon

“…Five of these 9 studies included only patients with concomitant reparable rotator cuff tears, [ 5 , 16 , 17 , 25 , 26 ] 1 of these 9 only included patients with isolated LHB lesions, [ 24 ] and the remaining 2 included patients with both concomitant rotator cuff tears and isolated LHB lesions. [ 4 , 12 ] There were 770 patients in total, initially. However, 97 patients were withdrawed, leaving 608 patients for analysis.…”

“…[ 8 , 9 ] Advocates of biceps tenotomy suggest that, compared with biceps tenodesis, tenotomy is technically simpler, more cost-effective, and easier to plan for postoperative rehabilitation. [ 10 – 12 ] However, tendon retraction may occur after tendon dissection. Therefore, some authors advocate biceps tenodesis, as it is better to maintain length and tension of the proximal LHBT, potentially resulting in decreased risk of Popeye deformity of upper arm and less strength loss.…”

“…Therefore, some authors advocate biceps tenodesis, as it is better to maintain length and tension of the proximal LHBT, potentially resulting in decreased risk of Popeye deformity of upper arm and less strength loss. [ 8 , 12 ]…”

Total Shoulder Arthroplasty, an Overview, Indicatins and Prosthetic Options

“…Between tuberosities of the humeral head, the long head of biceps can be palpated. It is normally tenotomized [15]. The anterior circumflex vessels (three sisters) are landmarks of the lower board of the subscapularis, that is isolated and usually osteotomized with lesser tuberosity.…”

Clinical Effectiveness of Various Surgical Procedures Addressing Long Head of Biceps Pathology: Protocol for a Systematic Review and Meta-Analysis

“…This is a technically simple and well tolerated procedure with minimal post-operative rehabilitation. Some patients report adverse effects including ‘Popeye’ deformity, cramps, and fatigue [ 6 7 8 9 ]. Biceps tenodesis is a common alternative, which may be favoured in some patients and allows a closer restoration of normal anatomy [ 9 10 ].…”