Outcomes of Primary Biceps Subpectoral Tenodesis in an Active Population: A Prospective Evaluation of 101 Patients

Purpose: To evaluate the surgical outcomes of a primary subpectoral biceps tenodesis for long head of the biceps tendon (LHBT) pathology in a large cohort of prospectively, serially collected, patients in a young active population that has known high physical demands and requirements of their shoulder to perform their vocation.

Methods: A retrospective review of prospectively collected data from an active military personnel with a diagnosis of a Type II SLAP tear or biceps tenosynovitis was performed. Outcomes were evaluated at a minimum follow-up time of 18 months based on preoperative and postoperative assessments of the Single Assessment Numeric Evaluation, Western Ontario Rotator Cuff index, biceps position, and return to active duty. Inclusion criteria were (1) SLAP tears on magnetic resonance arthrogram (classified into SLAP group), and (2) no SLAP tear but examination findings of biceps tendonitis (placed in the LHBT tendonitis group). Patients were excluded for full-thickness rotator cuff tears, high-grade partial thickness tears requiring repair, acromioclavicular joint pathology, and labral pathology outside of the SLAP lesion. Patients from both groups subsequently were treated with open, subpectoral tenodesis.

Results: Over a 6-year period at a mean follow-up of 2.75 years (range 1.5-5.7 years), 125 active-duty military personnel with mean age of 42.6 years (range 26.3-56.5) were enrolled. A total of 101 of 125 patients (81%) completed study requirements at a mean of 2.75 years (range 1.5-5.7 years). In total, 40 patients were diagnosed with type II SLAP tears (39.6%) and 61 with biceps tendonitis without SLAP tear (60.4%). Following open, subpectoral tenodesis, there was a significant improvement in patient outcomes (Western Ontario Rotator Cuff = 54% preoperative vs 89% postoperative, Single Assessment Numeric Evaluation = 58 preoperative vs 89.5 postoperative, P < .01). In total, 82% of patients returned to full activity at a mean of 4.1 months. The biceps muscle measured relative to the antecubital fossa of operative (mean 3.20 cm) versus nonoperative (3.11 cm) was not clinically different (P = .57). There was an 8% complication rate, including 3 requiring revision, 2 superficial infections, and 3 transient neurapraxias.

Conclusions: Primary subpectoral open biceps tenodesis for SLAP tears or pathology of the LHBT provides significant improvement in shoulder outcomes with a reliable return to activity level with low risk for complications.

Level of evidence: Level IV (Case series).