Arthroscopic Suprapectoral Tenodesis For Isolated Long Head Of The Biceps Lesion In 21 Patients

Background long head tendon(LHBT)lesion an common finding that can be the cause of chronic anterior shoulder pain resulting in limited function.Isolated LHBT lesion is rarely,But is most commonly found in conjunction with impingement syndrome.It has been proposed that older patients develop LHBT lesion due to the degeneration of the LHBT tendon,which commonly occurs concurrently with rotator cuff tears.Conversely,LHBT lesion in isolation is rare and occurs most frequently in active patients associated with repetitive movement and overuse,such as from sports activities,acute trauma,Initial management of LHBT lesion consists of nonoperative treatment that includes nonsteroidal antiinflammatory drugs,physiotherapy,and corticosteroid injections.Surgery can be considered in cases that have failed a trial of conservative treatment with persistent shoulder pain and dysfunction.The two recommended surgical treatment options are biceps tenotomy and tenodesis.While there is no consensus on which LHBT surgical technique is superior,several studies have shown that LHBT tenodesis,in contrast to tenotomy,has a lower complication rate,better shoulder function,and less postoperative cramping pain and deformity,with better cosmesis.Subsequently,tenodesis seems to be the more appropriate intervention for an active population with biceps pathology.Biceps tenotomy is simple,so mainly used for older patients and less demanding on the shoulder function.Biceps tenodesis(BT)can be performed in either a suprapectoral or subpectoral technique based mainly on surgeon preference.Several studies showing no significant difference between the outcomes of suprapectoral and subpectoral BT techniques for treatment of different pathologies,resulting in decreased pain,improved function,high satisfaction,and improved quality of life.Recently,there have been multiple outcomes studies for BT treatment of LHBT tenosynovitis in conjunction with other LHBT pathology and rotator cuff tears.However,there has been a lack of outcome studies for BT treatment of LHBT lesion without any other concomitant reparative or reconstructive procedures.The objective of this study was to assess the outcomes after subpectoral BT for isolated LHBT lesion.Object The main object of this study was to evaluate the effect of suprapectoral tenodesis in the treatment of the long head tendon(LHBT)lesion.Methods A total of 21 patients who accepted arthroscopic suprapectoral tenodesis between April 2014 to July 2016 were chosen.The inclusion criteria include:1.The pain of the anterior shoulder region lasted for more than 1 year,and had no improvement after conservative treatment at least half a year;2.The diagnose of LHBT lesion were confirmed preoperatively and postoperatively,no other construction pathologies such as glenoid labrum lesion,rotator cuff tear,shoulder fracture,acromioclavicular joint lesion and so on;3.Only suprapectoral tenodesis and subacromial decompression or acromioplasty were taken in the surgery,no other repair or reconstruction operations were taken simultaneously.4.Accepted standard rehabilitation exercise and could follow up until 1 year postoperative.The exclusion criteria include:1.Patients with comorbidity such as glenoid labrum lesion,rotator cuff tear,shoulder fracture,acromioclavicular joint lesion and so on,and need other repair or reconstruction operations;2.The pain of anterior shoulder region lasted less than 1 year,or had improvements after conservative treatment time less than half a year;3.Patients couldn't accept standard rehabilitation exercise or lost of follow up at 1 year postoperative.VAS score,ADL score,American Shoulder and Elbow Surgeons(ASES),Constant score,and LHBT score were assessed preoperative and 1 year postoperative.Results All scores and the range of motion of the operated shoulders at 1 year postoperative were improved significantly(P<0.001),there was no complication such as popeye syndrome,neurovascular injury or infection.Conclusion The arthroscopic suprapectoral tenodesis of the LHBT provides excellent functional results,it's an efficient and safety surgery for LHBT lesion.