Short Term Clinical Outcomes Following Arthroscopic Suprapectoral Onlay Biceps Tenodesis with a Single Suture Anchor

OBJECTIVES: The long head of the biceps tendon is a well-recognized potential source of anterior shoulder pain. Arthroscopic biceps tenodesis has emerged as a popular surgical option, however, limited studies exist evaluating postoperative outcomes after an arthroscopic approach. The purpose of this study was to assess short term clinical and functional outcomes after arthroscopic suprapectoral onlay biceps tenodesis with a single suture anchor. METHODS: A prospective case series of 50 patients undergoing arthroscopic suprapectoral biceps tenodesis by a single surgeon. Patients were evaluated preoperatively and postoperatively at six months with the American Shoulder and Elbow Surgeons (ASES) questionnaire, Visual Analog Scale (VAS), Single Assessment Numeric Evaluation (SANE), Veteran Rand 12-Item Health Survey (VR-12), and 12-Item Short Form Survey (SF-12). Strength, range of motion (ROM), biceps apex distance, provocative tests and return to work (RTW) were assessed postoperatively. RESULTS: 26 males and 24 females were evaluated. Average ± SD age at surgery was 50.14 ± 10.94 years, and average follow up was 6.48 ± 1.28 months. Biceps apex distance, active/passive elbow flexion, extension, supination, or pronation ROM did not differ (p>0.192 for all) between affected and unaffected sides. Elbow flexion strength significantly increased postoperatively (p=0.004). Significant improvements were noted (p ≤ 0.001 for all) in ASES, VAS pain, SANE, Constant-Murley, and VR/SF-12 Physical Component scores. Four procedures were revisions (8.0%), which were significantly correlated with postoperative bicipital groove pain (p = 0.034), positive Yergason’s test (p = 0.047), and takingpostoperative opioids (p = 0.037). These revision cases and patients with increased BMI were significantly less likely to achieve MCID for VR/SF-12 Physical Component scores (p < 0.05). No patients required subsequent surgery involving the biceps. Out of 45 employed patients, 32 (71.11%) returned to work at an average of 4.68 ± 2.95 months. Light duty had a statistically greater return to work rate compared to heavy duty (p = 0.027). Popeye deformity was seen in 5 (10%) patients, which had significantly increased biceps apex distances (p = 0.029). However, no significant differences were noted in these patients (p > 0.05 for all) for patient-reported outcomes, range or motion, or strength. Only one reported awareness of cosmetic deformity. CONCLUSION: Shoulder strength, ROM, and multiple outcome measures improved significantly post-operatively with use of arthroscopic biceps tenodesis using a single anchor technique. Although 10% of patients developed cosmetic deformity, this did not significantly affect postoperative outcomes. Revision patients should be counseled preoperatively regarding the increased likelihood of postoperative pain and appropriate opioid medication use.