Complications following subpectoral biceps tenodesis with interference screw fixation

Abstract

Background: Subpectoral biceps tenodesis is considered an effective and increasingly popular method to manage long head of the biceps tendon pathology and combined lesions of the biceps labral complex. The purpose of this study was to report the complications following this procedure in a large prospective group of patients using a consistent technique. Hypothesis: Subpectoral biceps tenodesis is a safe and effective method for treating long head of the biceps pathology with a low complication rate. Study design: Case series. Level of evidence IV. Methods: This study had prior Institutional Review Board approval. Over a period of 5 years, 636 patients underwent subpectoral biceps tenodesis by the same surgeon. Patients who underwent subpectoral tenodesis with interference screws using a standardized technique were included in the analysis. Those who underwent biceps tenodesis for a chronic long head biceps rupture, those who underwent concomitant shoulder arthroplasty and those who underwent revision biceps tenodesis were excluded. All patients included in the study also underwent a postoperative physical examination. Results: From November of 2005 to June of 2011, 491 patients met the inclusion criteria, 344 patients were male, 147 female and 39 were worker compensation cases. Out of the 491 patients with subpectoral biceps tenodesis, complications occurred in 12 patients of which 11 were considered minor and 1 was considered a major complication. The major complication was a proximal humerus fracture that occurred through the drill hole 2 weeks postoperatively. This was clearly due to a technical error where the drill hole was placed eccentrically in the humeral shaft. There were 11 minor complications; 5 cases had a rupture at the fixation site, 2 other cases had ruptures at the muscle-tendon junction site (distal to the tenodesis) and 1 patient had a rupture in continuity. Two cases had minor sprains that presented only with mild pain and resolved completely and one other case needed to be revised due to a prominent screw. All of the complications occurred within the first 2 months after surgery and 2 were in worker compensation cases. Conclusion: An overall complication rate of 2.4 % validates the hypothesis of a low complication rate after subpectoral biceps tenodesis. These results support the conclusions from previous biomechanical studies that have shown good bone-tendon-screw interface fixation strength.