OPEN VERSUS ARTHROSCOPIC BICEPS TENODESIS: A COMPARISON OF FUNCTIONAL OUTCOMES Kyle R. Duchman, MD, David E. DeMik, PharmD, Bastian Uribe, MD, Brian R. Wolf, MD, MS, Matthew Bollier, MD
ABSTRACT Background: The proximal aspect of the long head of the biceps brachii (LHB) is a frequent source of anterior shoulder pain. Multiple techniques for LHB tenodesis have been described. However, comparative outcomes are lacking. The present study aims to compare functional results, patient reported outcomes, complications, and clinical failures for patients undergoing open versus arthroscopic LHB tenodesis. Methods: All patients who underwent open or arthroscopic LHB tenodesis from 2009-2012 at a single institution were identified. Patient demographics, comorbidities, and operative variables of interest, including concomitant procedures, were recorded. Minimum 1-year follow-up was required for inclusion. Outcomes, including patient reported outcomes, physical exam findings, and complications were compared between open and arthroscopic LHB tenodesis patients. Results: Overall, 45 patients (25 open, 20 arthroscopic) were available for analysis. In total, there was a single clinical failure in a patient who underwent arthroscopic LHB tenodesis. No other complications or failures were noted. Active shoulder forward elevation was increased in the open tenodesis group as compared to the arthroscopic
Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA Corresponding Author: Kyle R. Duchman, MD University of Iowa Hospitals and Clinics Department of Orthopedics & Rehabilitation 200 Hawkins Dr., 01008 JPP Iowa City, IA 52242 Phone: (319)356-1616 Fax: (319)353-6754 [email protected] This study received approval from the Institutional Review Board at the University of Iowa. This study has not been published previously nor is it currently in review for publication with another journal. There was no external funding or support provided for this contribution. All authors confirm no potential conflict of interest related to the content of this study.
tenodesis group (177.8 ± 9.3° vs. 171.3 ± 11.7°; p = 0.049). Otherwise, there was no difference in range of motion or strength. For both groups, both the SF-36 and ASES scores improved significantly from preoperative values. Conclusion: Both open and arthroscopic LHB tenodesis provide good to excellent outcomes with few complications. Given the recent increased utilization of LHB tenodesis, future studies should use randomization and prospective data collection in order to determine if discrete patient populations are better ser ved by either open or arthroscopic LHB tenodesis techniques. INTRODUCTION The proximal aspect of the long head of the biceps brachii (LHB) is a common source of anterior shoulder pain. With failure of conservative treatment options, proximal LHB tenodesis has been described as a viable surgical treatment option for a variety of LHB pathologies, including LHB tendonitis, tendinopathy, instability, and superior labrum anterior-posterior lesions (SLAP)1-3. While previous studies have failed to provide a definitive advantage for LHB tenodesis compared with tenotomy4-8, tenodesis provides the reported advantage of improved strength and decreased cramping pain through maintenance of the LHB length-tension relationship as well as more consistent cosmetic results9. Clinically, many patients under the age of 40 prefer tenodesis to tenotomy due to the more consistent cosmetic results and concerns with weakness and cramping associated with tenotomy in this young, active population. Multiple techniques for LHB tenodesis have been described10-15. Technical considerations include open versus arthroscopic approach, fixation technique, and tenodesis location, which are generally described as suprapectoral or subpectoral. In some cases, the approach utilized for LHB tenodesis may be dictated by concomitant pathology, including rotator cuff or labral pathology, but this is ultimately at the discretion of the treating surgeon. While comparative studies are limited to Level III and IV evidence16-19, satisfactory results have consistently been reported regardless of approach and fixation technique20-22. However, there is limited evidence to suggest that LHB tenodesis location, specifically withVolume 36 79
K. R. Duchman, D. E. DeMik, B. Uribe, B. R. Wolf, M. Bollier in the bicipital groove, may result in inferior outcomes as compared to a more distal tenodesis location18,23. Few studies have previously compared outcomes following arthroscopic and open LHB tenodesis techniques16-18. Given the increasing incidence of biceps tenodesis24,25, particularly arthroscopic biceps tenodesis, further study is warranted. The goal of the present study was to compare function, patient reported outcomes, complications, and clinical failures following arthroscopic and open LHB tenodesis. METHODS Institutional Review Board Approval This study received approval from the University of Iowa Institutional Review Board. Data Collection All patients undergoing LHB tenodesis from January 1, 2009 to December 31, 2012 at a single institution were identified using Common Procedural Terminology (CPT) codes 23430 (tenodesis of long tendon of biceps) and 29828 (arthroscopy, shoulder, surgical; biceps tenodesis). A total of 93 patients were identified. In all cases, operative reports were reviewed to confirm that tenodesis was performed and to determine surgical technique (open versus arthroscopic). Study inclusion criteria included patient age ≥ 18 years, proximal biceps tendon pathology including biceps tendonitis, tendinopathy, instability, or SLAP tears, diagnosed preoperatively with physical exam and/or imaging and confirmed during diagnostic arthroscopy, and minimum 1-year follow-up with a documented physical exam at the time of followup. Exclusion criteria included absence of a documented physical exam despite >1-year follow-up or follow-up 60% chart completion of both preoperative and postoperative measures. Several continuous variables were also categorically defined and reported to allow further comparison between arthroscopic and open tenodesis groups as well as preoperative and postoperative measures. All statistical analysis was performed with SPSS Statistics (IBM Corp., Armonk, NY, USA). A p-value of >0.05 was considered statistically significant. RESULTS Overall, there were 45/95 patients available for analysis (48.4%) between 2009 and 2012 that underwent proximal LHB tenodesis with mean follow-up of 3.2 ± 1.1 years. Of these, 25 (55.6%) underwent open tenodesis and 20 (44.4%) underwent arthroscopic tenodesis procedures. The was 43.8 ± 12.5 years, and the majority of patients were male (82.2%). Patients undergoing arthroscopic tenodesis were significantly older than those undergoing open tenodesis (49.9 ± 11.8 years vs. 38.9 ± 11.0 years; p = 0.003) (Table I). Concomitant procedures were performed in 41/45 (91.1%) of patients. Rotator cuff repair was the most commonly performed concomitant procedure (66.7%), and was performed more frequently in patients undergoing arthroscopic tenodesis as compared to open tenodesis (85.0% vs. 52.0%; p = 0.027). There were no other significant differences in demographic characteristics, comorbidities, and operative variables between the two cohorts. Volume 36 81
K. R. Duchman, D. E. DeMik, B. Uribe, B. R. Wolf, M. Bollier
Table I. Demographic Characteristics, Comorbidities, and Operative Variables of Open and Arthroscopic Biceps Tenodesis Patients
All (n=45)
Open (n=25)
Arthroscopic (n=20)
p value*
Demographic Characteristics Age
43.8 ± 12.5
38.9 ± 11.0
49.9 ± 11.8
Male
82.2
88.0
75.0
Female
17.8
12.0
25.0
†
Sex (%)
0.003 0.435
Race (%)
0.332
White
88.9
88.0
90.0
Black
4.4
8.0
0.0
Other
6.7
2.2
4.4
66.7
76.0
55.0
0.205
Dominant Arm (%)
A ipsilateral shoulder surgery (%) Prior Follow-up (yrs)†
13.3
12.0
15.0
1.000
3.2 ± 1.1
3.1 ± 0.9
3.4 ± 1.3
0.428
Comorbidities Charlson Comorbidity Index
0.9 ± 1.7
0.6 ± 1.8
1.2 ± 0.5
0.274
ASA†
1.7 ± 0.6
1.6 ± 0.5
1.8 ± 0.6
0.395
†
Smoking Status (%)
0.879
Nonsmoker
64.4
65.0
64.0
Former smoker
17.8
20.0
16.0
Current smoker
17.8
15.0
20.0
Operative Variables Fixation (%)
1.000
Screw
88.9
88.0
90.0
Suture Anchor
11.1
12.0
10.0
Concomitant Procedures (%)
Rotator Cuff Repair
66.7
52.0
85.0
0.027
Rotator Cuff Debridement
4.4
8.0
0.0
0.495
Labral Repair
8.9
16.0
0.0
0.117
Cartilage Procedure
2.2
4.0
0.0
1.000
Subacromial Decompression
80.0
72.0
90.0
0.260
Distal Clavicle Resection
11.1
8.0
15.0
0.642
*Open versus arthroscopic comparison.†Listed as mean ± standard deviation. In total, there was a single clinical failure identified at 9 weeks postoperatively in a patient who underwent arthroscopic tenodesis with interference screw fixation, leading to an overall failure rate of 2.2%. There was no significant difference in clinical failures between the arthroscopic and open tenodesis cohorts (5.0% vs. 0.0%, p = 0.444). The single clinical failure was the only identified complication, as there were no wound infections or reoperations reported during the follow-up period. Active shoulder forward elevation was significantly decreased in the arthroscopic tenodesis group as compared with the open tenodesis group (171.3 ± 11.7° vs. 177.8 ± 9.3°; p = 0.049) (Table II). Otherwise, there were no differences in active range of motion between 82 The Iowa Orthopedic Journal
the two groups. Similarly, there were no differences in elbow flexion, shoulder abduction, or forearm supination strength between the two groups. Average biceps apex difference for the entire cohort was 0.6 ± 0.8 cm and was equivalent for open and arthroscopic groups (0.5 ± 0.5 cm vs. 0.9 ± 1.0 cm; p = 0.112). The percentage of patients who had a biceps apex difference of 0, or equal to the contralateral arm, was 44.0% and 30.0% for the open and arthroscopic tenodesis groups, respectively (p = 0.336). Persistent bicipital groove tenderness was noted in 15.6% of patients after LHB tenodesis, with no significant difference in the frequency of bicipital groove tenderness between the open and arthroscopic tenodesis groups (20.0% vs. 10.0%, p = 0.437).
Open versus Arthroscopic Biceps Tenodesis: A Comparison of Functional Outcomes Table II. Outcomes Following Open and Arthroscopic Biceps Tenodesis*
All (n=45)
Open (n=25)
Arthroscopic (n=20)
p value‡
Patient Reported Outcome Measures SF-36 PCS
46.4 ± 11.5
48.2 ± 10.0
44.1 ± 13.0
0.272
SF-36 MCS
52.4 ± 9.3
53.0 ± 7.4
51.7 ± 11.4
0.675
ASES
81.1 ± 21.1
82.3 ± 20.4
79.6 ± 22.3
0.681
DASH
12.3 ± 14.4
11.3 ± 14.5
13.7 ± 14.8
0.649
SANE
88.9 ± 16.9
88.9 ± 18.0
88.8 ± 16.1
0.981
SST
10.9 ± 1.9
10.8 ± 2.2
11.1 ± 1.4
0.701
Constant-Murley Score
87.4 ± 16.3
88.0 ± 19.7
86.7 ± 11.1
0.774
97.8
96.0
100.0
1.000
Bicipital groove tenderness (%)
15.6
20.0
10.0
0.437
Positive Speed’s test (%)
2.2
4.0
0.0
1.000
Positive Yergason’s test (%)
4.4
4.0
5.0
1.000
Biceps apex difference (cm)†
0.6 ± 0.8
0.5 ± 0.5
0.9 ± 1.0
0.112
Biceps circumference difference (cm)†
-0.2 ± 1.3
-0.1 ± 1.2
-0.3 ± 1.4
0.609
Elbow Flexion
-1.7 ± 8.9
-0.4 ± 7.4
-3.3 ± 10.6
0.307
Forearm Supination
-0.4 ± 2.3
-0.2 ± 1.5
-0.6 ± 2.9
0.654
Shoulder Abduction
-2.5 ± 5.1
-3.8 ± 5.3
-1.0 ± 4.6
0.057
Shoulder forward elevation (degrees)
174.9 ± 10.7
177.8 ± 9.3
171.3 ± 11.7
0.049
Shoulder abduction (degrees)
Would recommend surgery again (%)
Physical Exam Findings
Strength (lbs)†
Range of motion
174.9 ±10.5
177.4 ± 9.3
171.8 ±11.4
0.081
Internal rotation deficit†
6.7
4
10
0.577
External rotation deficit†
2.2
0
5
0.444
Wound Infection
0.0
0.0
0.0
1.000
Reoperation
0.0
0.0
0.0
1.000
Loss of proximal fixation
2.2
0.0
5.0
0.444
Complications (%)
*Listed as mean ± standard deviation except where noted. Compared to contralateral arm. Open versus arthroscopic comparison. †
‡
Table III. Pre- and Postoperative Outcome Measures Following Biceps Tenodesis Percent Available (%)
Preoperative
Postoperative
Difference
p value
SF-36 PCS
77.8
41.6 ± 8.3
46.2 ± 11.2
4.6 ± 8.7
0.004
SF-36 MCS
77.8
51.6 ± 9.4
52.8 ± 9.7
1.3 ± 8.3
0.379
ASES
64.4
14.7 ± 6.3
81.6 ± 20.8
66.9 ± 19.6
ABSTRACT Background: The proximal aspect of the long head of the biceps brachii (LHB) is a frequent source of anterior shoulder pain. Multiple techniques for LHB tenodesis have been described. However, comparative outcomes are lacking. The present study aims to compare functional results, patient reported outcomes, complications, and clinical failures for patients undergoing open versus arthroscopic LHB tenodesis. Methods: All patients who underwent open or arthroscopic LHB tenodesis from 2009-2012 at a single institution were identified. Patient demographics, comorbidities, and operative variables of interest, including concomitant procedures, were recorded. Minimum 1-year follow-up was required for inclusion. Outcomes, including patient reported outcomes, physical exam findings, and complications were compared between open and arthroscopic LHB tenodesis patients. Results: Overall, 45 patients (25 open, 20 arthroscopic) were available for analysis. In total, there was a single clinical failure in a patient who underwent arthroscopic LHB tenodesis. No other complications or failures were noted. Active shoulder forward elevation was increased in the open tenodesis group as compared to the arthroscopic
Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA Corresponding Author: Kyle R. Duchman, MD University of Iowa Hospitals and Clinics Department of Orthopedics & Rehabilitation 200 Hawkins Dr., 01008 JPP Iowa City, IA 52242 Phone: (319)356-1616 Fax: (319)353-6754 [email protected] This study received approval from the Institutional Review Board at the University of Iowa. This study has not been published previously nor is it currently in review for publication with another journal. There was no external funding or support provided for this contribution. All authors confirm no potential conflict of interest related to the content of this study.
tenodesis group (177.8 ± 9.3° vs. 171.3 ± 11.7°; p = 0.049). Otherwise, there was no difference in range of motion or strength. For both groups, both the SF-36 and ASES scores improved significantly from preoperative values. Conclusion: Both open and arthroscopic LHB tenodesis provide good to excellent outcomes with few complications. Given the recent increased utilization of LHB tenodesis, future studies should use randomization and prospective data collection in order to determine if discrete patient populations are better ser ved by either open or arthroscopic LHB tenodesis techniques. INTRODUCTION The proximal aspect of the long head of the biceps brachii (LHB) is a common source of anterior shoulder pain. With failure of conservative treatment options, proximal LHB tenodesis has been described as a viable surgical treatment option for a variety of LHB pathologies, including LHB tendonitis, tendinopathy, instability, and superior labrum anterior-posterior lesions (SLAP)1-3. While previous studies have failed to provide a definitive advantage for LHB tenodesis compared with tenotomy4-8, tenodesis provides the reported advantage of improved strength and decreased cramping pain through maintenance of the LHB length-tension relationship as well as more consistent cosmetic results9. Clinically, many patients under the age of 40 prefer tenodesis to tenotomy due to the more consistent cosmetic results and concerns with weakness and cramping associated with tenotomy in this young, active population. Multiple techniques for LHB tenodesis have been described10-15. Technical considerations include open versus arthroscopic approach, fixation technique, and tenodesis location, which are generally described as suprapectoral or subpectoral. In some cases, the approach utilized for LHB tenodesis may be dictated by concomitant pathology, including rotator cuff or labral pathology, but this is ultimately at the discretion of the treating surgeon. While comparative studies are limited to Level III and IV evidence16-19, satisfactory results have consistently been reported regardless of approach and fixation technique20-22. However, there is limited evidence to suggest that LHB tenodesis location, specifically withVolume 36 79
K. R. Duchman, D. E. DeMik, B. Uribe, B. R. Wolf, M. Bollier in the bicipital groove, may result in inferior outcomes as compared to a more distal tenodesis location18,23. Few studies have previously compared outcomes following arthroscopic and open LHB tenodesis techniques16-18. Given the increasing incidence of biceps tenodesis24,25, particularly arthroscopic biceps tenodesis, further study is warranted. The goal of the present study was to compare function, patient reported outcomes, complications, and clinical failures following arthroscopic and open LHB tenodesis. METHODS Institutional Review Board Approval This study received approval from the University of Iowa Institutional Review Board. Data Collection All patients undergoing LHB tenodesis from January 1, 2009 to December 31, 2012 at a single institution were identified using Common Procedural Terminology (CPT) codes 23430 (tenodesis of long tendon of biceps) and 29828 (arthroscopy, shoulder, surgical; biceps tenodesis). A total of 93 patients were identified. In all cases, operative reports were reviewed to confirm that tenodesis was performed and to determine surgical technique (open versus arthroscopic). Study inclusion criteria included patient age ≥ 18 years, proximal biceps tendon pathology including biceps tendonitis, tendinopathy, instability, or SLAP tears, diagnosed preoperatively with physical exam and/or imaging and confirmed during diagnostic arthroscopy, and minimum 1-year follow-up with a documented physical exam at the time of followup. Exclusion criteria included absence of a documented physical exam despite >1-year follow-up or follow-up 60% chart completion of both preoperative and postoperative measures. Several continuous variables were also categorically defined and reported to allow further comparison between arthroscopic and open tenodesis groups as well as preoperative and postoperative measures. All statistical analysis was performed with SPSS Statistics (IBM Corp., Armonk, NY, USA). A p-value of >0.05 was considered statistically significant. RESULTS Overall, there were 45/95 patients available for analysis (48.4%) between 2009 and 2012 that underwent proximal LHB tenodesis with mean follow-up of 3.2 ± 1.1 years. Of these, 25 (55.6%) underwent open tenodesis and 20 (44.4%) underwent arthroscopic tenodesis procedures. The was 43.8 ± 12.5 years, and the majority of patients were male (82.2%). Patients undergoing arthroscopic tenodesis were significantly older than those undergoing open tenodesis (49.9 ± 11.8 years vs. 38.9 ± 11.0 years; p = 0.003) (Table I). Concomitant procedures were performed in 41/45 (91.1%) of patients. Rotator cuff repair was the most commonly performed concomitant procedure (66.7%), and was performed more frequently in patients undergoing arthroscopic tenodesis as compared to open tenodesis (85.0% vs. 52.0%; p = 0.027). There were no other significant differences in demographic characteristics, comorbidities, and operative variables between the two cohorts. Volume 36 81
K. R. Duchman, D. E. DeMik, B. Uribe, B. R. Wolf, M. Bollier
Table I. Demographic Characteristics, Comorbidities, and Operative Variables of Open and Arthroscopic Biceps Tenodesis Patients
All (n=45)
Open (n=25)
Arthroscopic (n=20)
p value*
Demographic Characteristics Age
43.8 ± 12.5
38.9 ± 11.0
49.9 ± 11.8
Male
82.2
88.0
75.0
Female
17.8
12.0
25.0
†
Sex (%)
0.003 0.435
Race (%)
0.332
White
88.9
88.0
90.0
Black
4.4
8.0
0.0
Other
6.7
2.2
4.4
66.7
76.0
55.0
0.205
Dominant Arm (%)
A ipsilateral shoulder surgery (%) Prior Follow-up (yrs)†
13.3
12.0
15.0
1.000
3.2 ± 1.1
3.1 ± 0.9
3.4 ± 1.3
0.428
Comorbidities Charlson Comorbidity Index
0.9 ± 1.7
0.6 ± 1.8
1.2 ± 0.5
0.274
ASA†
1.7 ± 0.6
1.6 ± 0.5
1.8 ± 0.6
0.395
†
Smoking Status (%)
0.879
Nonsmoker
64.4
65.0
64.0
Former smoker
17.8
20.0
16.0
Current smoker
17.8
15.0
20.0
Operative Variables Fixation (%)
1.000
Screw
88.9
88.0
90.0
Suture Anchor
11.1
12.0
10.0
Concomitant Procedures (%)
Rotator Cuff Repair
66.7
52.0
85.0
0.027
Rotator Cuff Debridement
4.4
8.0
0.0
0.495
Labral Repair
8.9
16.0
0.0
0.117
Cartilage Procedure
2.2
4.0
0.0
1.000
Subacromial Decompression
80.0
72.0
90.0
0.260
Distal Clavicle Resection
11.1
8.0
15.0
0.642
*Open versus arthroscopic comparison.†Listed as mean ± standard deviation. In total, there was a single clinical failure identified at 9 weeks postoperatively in a patient who underwent arthroscopic tenodesis with interference screw fixation, leading to an overall failure rate of 2.2%. There was no significant difference in clinical failures between the arthroscopic and open tenodesis cohorts (5.0% vs. 0.0%, p = 0.444). The single clinical failure was the only identified complication, as there were no wound infections or reoperations reported during the follow-up period. Active shoulder forward elevation was significantly decreased in the arthroscopic tenodesis group as compared with the open tenodesis group (171.3 ± 11.7° vs. 177.8 ± 9.3°; p = 0.049) (Table II). Otherwise, there were no differences in active range of motion between 82 The Iowa Orthopedic Journal
the two groups. Similarly, there were no differences in elbow flexion, shoulder abduction, or forearm supination strength between the two groups. Average biceps apex difference for the entire cohort was 0.6 ± 0.8 cm and was equivalent for open and arthroscopic groups (0.5 ± 0.5 cm vs. 0.9 ± 1.0 cm; p = 0.112). The percentage of patients who had a biceps apex difference of 0, or equal to the contralateral arm, was 44.0% and 30.0% for the open and arthroscopic tenodesis groups, respectively (p = 0.336). Persistent bicipital groove tenderness was noted in 15.6% of patients after LHB tenodesis, with no significant difference in the frequency of bicipital groove tenderness between the open and arthroscopic tenodesis groups (20.0% vs. 10.0%, p = 0.437).
Open versus Arthroscopic Biceps Tenodesis: A Comparison of Functional Outcomes Table II. Outcomes Following Open and Arthroscopic Biceps Tenodesis*
All (n=45)
Open (n=25)
Arthroscopic (n=20)
p value‡
Patient Reported Outcome Measures SF-36 PCS
46.4 ± 11.5
48.2 ± 10.0
44.1 ± 13.0
0.272
SF-36 MCS
52.4 ± 9.3
53.0 ± 7.4
51.7 ± 11.4
0.675
ASES
81.1 ± 21.1
82.3 ± 20.4
79.6 ± 22.3
0.681
DASH
12.3 ± 14.4
11.3 ± 14.5
13.7 ± 14.8
0.649
SANE
88.9 ± 16.9
88.9 ± 18.0
88.8 ± 16.1
0.981
SST
10.9 ± 1.9
10.8 ± 2.2
11.1 ± 1.4
0.701
Constant-Murley Score
87.4 ± 16.3
88.0 ± 19.7
86.7 ± 11.1
0.774
97.8
96.0
100.0
1.000
Bicipital groove tenderness (%)
15.6
20.0
10.0
0.437
Positive Speed’s test (%)
2.2
4.0
0.0
1.000
Positive Yergason’s test (%)
4.4
4.0
5.0
1.000
Biceps apex difference (cm)†
0.6 ± 0.8
0.5 ± 0.5
0.9 ± 1.0
0.112
Biceps circumference difference (cm)†
-0.2 ± 1.3
-0.1 ± 1.2
-0.3 ± 1.4
0.609
Elbow Flexion
-1.7 ± 8.9
-0.4 ± 7.4
-3.3 ± 10.6
0.307
Forearm Supination
-0.4 ± 2.3
-0.2 ± 1.5
-0.6 ± 2.9
0.654
Shoulder Abduction
-2.5 ± 5.1
-3.8 ± 5.3
-1.0 ± 4.6
0.057
Shoulder forward elevation (degrees)
174.9 ± 10.7
177.8 ± 9.3
171.3 ± 11.7
0.049
Shoulder abduction (degrees)
Would recommend surgery again (%)
Physical Exam Findings
Strength (lbs)†
Range of motion
174.9 ±10.5
177.4 ± 9.3
171.8 ±11.4
0.081
Internal rotation deficit†
6.7
4
10
0.577
External rotation deficit†
2.2
0
5
0.444
Wound Infection
0.0
0.0
0.0
1.000
Reoperation
0.0
0.0
0.0
1.000
Loss of proximal fixation
2.2
0.0
5.0
0.444
Complications (%)
*Listed as mean ± standard deviation except where noted. Compared to contralateral arm. Open versus arthroscopic comparison. †
‡
Table III. Pre- and Postoperative Outcome Measures Following Biceps Tenodesis Percent Available (%)
Preoperative
Postoperative
Difference
p value
SF-36 PCS
77.8
41.6 ± 8.3
46.2 ± 11.2
4.6 ± 8.7
0.004
SF-36 MCS
77.8
51.6 ± 9.4
52.8 ± 9.7
1.3 ± 8.3
0.379
ASES
64.4
14.7 ± 6.3
81.6 ± 20.8
66.9 ± 19.6
