Abstract
Objectives:
Long Head Biceps Tendon (LHBT) pathology has been reported to be as high as 76% in rotator cuff tears and is often addressed with either tenotomy or tenodesis during rotator cuff repair (RCR). The theoretical benefit of addressing the biceps in addition to arthroscopic rotator cuff repair has been mixed. It has been shown that biceps tenotomy or tenodesis in patients with rotator cuff tears can provide favorable outcomes and that there are morphologic changes to the untreated LHBT following rotator cuff repair. However, studies have also noted no significant difference in outcomes among patients receiving rotator cuff repair with or without concomitant LHBT procedure. Our study aimed to investigate both surgical and patient reported outcomes amongst patients who underwent primary rotator cuff repair without concomitant LHBT intervention. We hypothesized that among patients who underwent RCR without concomitant LHBT procedure, patients with untreated LHBT pathology identified intraoperatively would have higher rates of failure and lower patient-reported outcomes compare to patients without LHBT pathology noted intraoperatively.
Methods:
This was a retrospective review of all patients who underwent arthroscopic rotator cuff repair without concomitant biceps tenotomy or tenodesis between 2009 and 2023 at a single academic institution. All cases and intra-operative evaluations of LHBT pathology were performed by a fellowship-trained orthopaedic shoulder specialist (senior author AL). Patients were excluded from the study if either a biceps tenotomy or tenodesis was performed, if the surgery was a revision procedure, or if they lacked follow-up data. 228 total patients were identified, and 174 patients were deemed eligible. Of these, 24 patients were identified as having LHBT pathology noted intra-operatively. Propensity score analysis was done to match patients in a 4:1 ratio with patients matched for sex, age, BMI, and date of surgery giving us 96 matched patients with intra-operative LHBT pathology noted and 120 patients overall included in the final analysis. Failure was defined as any return of symptomatic LHBT pathology and/or return to the operating room for LHBT procedure on the ipsilateral shoulder. Student t-test was utilized for continuous variables and chi-square test or Fisher’s exact test was used for categorical variables. Mean clinically important differences (MCID) thresholds used patient-reported outcomes (PROs) included 15.2 points for American Shoulder and Elbow Surgeons (ASES), 13.5 points for Subjective Shoulder Value (SSV), and 1.1 points for visual analog scale (VAS) pain score. A p-value less than 0.05 was considered statistically significant.
Results:
Among the 120 patients included the in analysis, the mean age was 52.2 ± 14.8 years with average follow up of 16.8 ± 21.4 months. The most common intraoperative biceps pathology included type II SLAP tear (41%) and type V SLAP tear (20.8%), Table 1. Patients with LHBT pathology noted intra-operatively had significantly decreased postoperative range-of-motion in external rotation compared to patients without LHBT pathology noted intra-operatively (p = 0.013). Zero (0%) patients with or without LHBT pathology noted intra-operatively failed (p = 1.00), Table 2. Difference of preoperative and postoperative PROs showed significantly lower rates of achieving MCID for patients with biceps pathology compared to controls (0% vs. 57.1%, p = 0.019), while difference between preoperative and postoperative SSV and VAS were similar between groups, Table 3
Conclusions:
Patients undergoing primary arthroscopic rotator cuff repair with LHBT pathology who did not have concomitant biceps intervention showed comparable rates of postoperative complications, improvements in both SSV and VAS, and failure as defined by either need for reoperation for LHBT procedure or inadequate pain relief after surgery. However, these patients had decreased improvements in PROMs and external rotation after surgery compared to patients without biceps pathology. Thus, this study suggests that patients with LHBT pathology that is left untreated during RCR are more likely to have poorer PROMs and postoperative external rotation than those without LHBT pathology
