Comparison of Clinical Failure Rates After 2 Techniques of Subpectoral Mini-Open Biceps Tenodesis: Sequence and Suture Passage Technique Matter

Abstract

Background: A number of techniques are available for performing biceps tenodesis, the majority of which result in good or excellent outcomes. However, failure may result in pain and/or dissatisfying biceps deformity. Purpose: To compare the clinical failure rates of 2 methods of suture passage in subpectoral biceps tenodesis with suture anchors performed by the senior author. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective chart review was conducted of patients who underwent biceps tenodesis under the care of the senior author. Operative notes were used to determine whether the procedure was performed with a BirdBeak (BB) suture passer or a free needle (FN). Each subsequent clinical follow-up note was used to determine participation in physical therapy and duration, follow-up duration, and whether clinical tenodesis failure had occurred. Biceps tenodesis failure was defined as either cosmetic deformity (“Popeye” sign), pain at the tenodesis site, or need for revision. Results: Overall, 163 patients met the inclusion criteria (BB, n = 112; FN, n = 51). Mean follow-up was 5.3 months and 4.1 months in the BB and FN groups, respectively. Significantly more tenodesis failures occurred in the BB group (BB, 12%; FN, 2%, P =.042). Among all BB patients, 10% experienced failure due to cosmetic deformity, 2% required revision, and 4% had postoperative pain at the tenodesis site by latest follow-up. The 1 patient in the FN group who experienced failure presented with cosmetic deformity postoperatively. Conclusion: Biceps tenodesis with the use of an FN to pass the suture resulted in a significantly lower clinical failure rate compared with the use of a BB suture passer.