Increased Incidence of Postoperative Stiffness After Arthroscopic Compared With Open Biceps Tenodesis Brian C. Werner, M.D., Hakan C. Pehlivan, B.A., Joseph M. Hart, Ph.D., Eric W. Carson, M.D., David R. Diduch, M.D., Mark D. Miller, M.D., and Stephen F. Brockmeier, M.D.
Purpose: To determine the incidence of postoperative stiffness after open and arthroscopic biceps tenodesis, compare the incidence between each method, and determine relevant risk factors for its occurrence. Methods: A consecutive series of patients who underwent biceps tenodesis during a 3-year period were retrospectively reviewed. Results: We evaluated 249 patients, which included 143 who underwent open subpectoral tenodesis and 106 who underwent arthroscopic suprapectoral tenodesis. The mean overall follow-up period for the arthroscopic group was 9.9 months (range, 5.1 to 33.5 months). The mean overall follow-up period for the open group was 9.5 months (range, 4.7 to 49.2 months). There was no significant difference in overall follow-up duration between groups (P ¼ .627). A significantly increased incidence of postoperative stiffness was found in the arthroscopic group compared with the open group (17.9% v 5.6%, P ¼ .002). Within the arthroscopic group, patients with postoperative stiffness were more frequently female patients than those without stiffness (63.2% v 33.3%, P ¼ .016) and were more likely to be smokers than those without stiffness (36.8% v 16.1%, P ¼ .040). The tenodesis site was located significantly more proximal in the arthroscopic group of patients with postoperative stiffness compared with patients without postoperative stiffness (32.44 7.8 mm from the top of the humeral head v 50.34 7.8 mm, P < .0001). Conclusions: Our results show a notably increased incidence of postoperative stiffness after arthroscopic suprapectoral biceps tenodesis compared with open subpectoral biceps tenodesis. This appears to occur more commonly in female patients and smokers and may have a relation to the position of the tenodesis, with a more superiorly placed tenodesis site being a potential influencing factor. On the basis of this series, this complication most commonly will improve over time and with symptom-based management. Level of Evidence: Level III, therapeutic case-control study.
L
esions of the intra-articular long head of the biceps (LHB) tendon have long been considered significant pain generators in the shoulder.1-3 Despite considerable research into the anatomy of the LHB and the various pathologies that affect it, there remains persistent controversy regarding the function of the LHB and, most importantly, appropriate management
From the Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A. The authors report the following potential conflict of interest or source of funding: E.W.C. is an unpaid consultant for KFx. D.R.D. receives support from Mitek, Genzyme, Zimmer, Moximed, Arthrex, ArthroCare. S.F.B. receives support from MicroAire Surgical Instruments, Arthrex, Springer. Received November 18, 2013; accepted March 27, 2014. Address correspondence to Stephen F. Brockmeier, M.D., Department of Orthopaedic Surgery, Sports Medicine and Shoulder Surgery, University of Virginia Health System, 400 Ray C Hunt Dr, Ste 330, Charlottesville, VA 22908, U.S.A. E-mail: [email protected] Ó 2014 by the Arthroscopy Association of North America 0749-8063/13801/$36.00 http://dx.doi.org/10.1016/j.arthro.2014.03.024
of its disorders.4 Although nonoperative options exist for mild symptoms or lesser pathologies such as tendinopathy or partial tears (5 cm, documented as “massive” in the operative note or rotator cuff tears that required protection of the repair postoperatively), which required longer postoperative immobilization. Postoperative stiffness was defined as (1) persistent range-of-motion deficit (
Purpose: To determine the incidence of postoperative stiffness after open and arthroscopic biceps tenodesis, compare the incidence between each method, and determine relevant risk factors for its occurrence. Methods: A consecutive series of patients who underwent biceps tenodesis during a 3-year period were retrospectively reviewed. Results: We evaluated 249 patients, which included 143 who underwent open subpectoral tenodesis and 106 who underwent arthroscopic suprapectoral tenodesis. The mean overall follow-up period for the arthroscopic group was 9.9 months (range, 5.1 to 33.5 months). The mean overall follow-up period for the open group was 9.5 months (range, 4.7 to 49.2 months). There was no significant difference in overall follow-up duration between groups (P ¼ .627). A significantly increased incidence of postoperative stiffness was found in the arthroscopic group compared with the open group (17.9% v 5.6%, P ¼ .002). Within the arthroscopic group, patients with postoperative stiffness were more frequently female patients than those without stiffness (63.2% v 33.3%, P ¼ .016) and were more likely to be smokers than those without stiffness (36.8% v 16.1%, P ¼ .040). The tenodesis site was located significantly more proximal in the arthroscopic group of patients with postoperative stiffness compared with patients without postoperative stiffness (32.44 7.8 mm from the top of the humeral head v 50.34 7.8 mm, P < .0001). Conclusions: Our results show a notably increased incidence of postoperative stiffness after arthroscopic suprapectoral biceps tenodesis compared with open subpectoral biceps tenodesis. This appears to occur more commonly in female patients and smokers and may have a relation to the position of the tenodesis, with a more superiorly placed tenodesis site being a potential influencing factor. On the basis of this series, this complication most commonly will improve over time and with symptom-based management. Level of Evidence: Level III, therapeutic case-control study.
L
esions of the intra-articular long head of the biceps (LHB) tendon have long been considered significant pain generators in the shoulder.1-3 Despite considerable research into the anatomy of the LHB and the various pathologies that affect it, there remains persistent controversy regarding the function of the LHB and, most importantly, appropriate management
From the Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A. The authors report the following potential conflict of interest or source of funding: E.W.C. is an unpaid consultant for KFx. D.R.D. receives support from Mitek, Genzyme, Zimmer, Moximed, Arthrex, ArthroCare. S.F.B. receives support from MicroAire Surgical Instruments, Arthrex, Springer. Received November 18, 2013; accepted March 27, 2014. Address correspondence to Stephen F. Brockmeier, M.D., Department of Orthopaedic Surgery, Sports Medicine and Shoulder Surgery, University of Virginia Health System, 400 Ray C Hunt Dr, Ste 330, Charlottesville, VA 22908, U.S.A. E-mail: [email protected] Ó 2014 by the Arthroscopy Association of North America 0749-8063/13801/$36.00 http://dx.doi.org/10.1016/j.arthro.2014.03.024
of its disorders.4 Although nonoperative options exist for mild symptoms or lesser pathologies such as tendinopathy or partial tears (5 cm, documented as “massive” in the operative note or rotator cuff tears that required protection of the repair postoperatively), which required longer postoperative immobilization. Postoperative stiffness was defined as (1) persistent range-of-motion deficit (
