Trends in the Treatment of Biceps Pathology: An Analysis of the American Board of Orthopaedic Surgery Database

Overview

Journal Orthop J Sports Med

Specialty Orthopedics

Date 2021 Jan 15

PMID 33447620

Citations 4

Authors

John W Belk

Steven D Jones

Stephen G Thon

Rachel M Frank

Affiliations

Soon will be listed here.

Abstract

Background: Long head of biceps tendon pathology is a well-described source of pain in the anterior adult shoulder. Shoulder arthroscopic surgeons face this condition on a frequent basis because of the increasing aging population. Trends in treatment for this condition have varied over recent decades. An understanding of these trends may help orthopaedic surgeons counsel these patients.

Purpose: To evaluate trends in treatment selection, patient population, and complications in recent part II examinees of the American Board of Orthopaedic Surgery (ABOS) board examination.

Study Design: Cross-sectional study.

Methods: Using a database maintained by the ABOS, we accessed and analyzed examinee data from 2008 to 2019 to evaluate trends in the following categories: examination year/subspecialty, region, patient age/sex, International Classification of Diseases code, Current Procedural Terminology code, and complications. These data points were analyzed for all board-eligible candidates from 2008 to 2019.

Results: The annual number of proximal biceps tendon (PBT) procedures performed increased significantly from 597 cases in 2008 to 2203 cases in 2019 ( < .001). Incidence of biceps tendon tenotomy significantly decreased between the years 2007 and 2018 ( < .001). Both open and arthroscopic biceps tenodesis significantly increased between 2007 and 2018 ( < .001). Most PBT cases were performed simultaneously with other procedures (17,283/17,861; 96.8%). The most common PBT procedure performed overall was open tenodesis of long tendon of biceps (∼60.8%). Complication rates for PBT procedures reported each year did not significantly change between 2007 and 2018 (7.5% vs 9.7%; = .103).

Conclusion: PBT procedures are being increasingly performed among recently trained orthopaedic surgeons. Proximal biceps tenotomy has significantly declined, whereas proximal biceps tenodesis, open or arthroscopic, has significantly increased, demonstrating a possible shift in the standard of care among new surgeons.

Citing Articles

Biceps tenotomy vs. tenodesis: an ACS-NSQIP analysis of postoperative outcomes and utilization trends.

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Modified arthroscopic intra-articular transtendinous looped biceps tenodesis leads to satisfactory functional outcomes and less frequent Popeye deformity compared to biceps tenotomy.

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Subpectoral, Suprapectoral, and Top-of-Groove Biceps Tenodesis Procedures Lead to Similar Good Clinical Outcomes: Comparison of Biceps Tenodesis Procedures.

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References

Osbahr D, Diamond A, Speer K . The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis. Arthroscopy. 2002; 18(5):483-7. DOI: 10.1053/jars.2002.32233. View

Parker B, Hurwitz S, Spang J, Creighton R, Kamath G . Surgical Trends in the Treatment of Meniscal Tears: Analysis of Data From the American Board of Orthopaedic Surgery Certification Examination Database. Am J Sports Med. 2016; 44(7):1717-23. DOI: 10.1177/0363546516638082. View

Wolf R, Zheng N, Weichel D . Long head biceps tenotomy versus tenodesis: a cadaveric biomechanical analysis. Arthroscopy. 2005; 21(2):182-5. DOI: 10.1016/j.arthro.2004.10.014. View

Meraner D, Sternberg C, Vega J, Hahne J, Kleine M, Leuzinger J . Arthroscopic tenodesis versus tenotomy of the long head of biceps tendon in simultaneous rotator cuff repair. Arch Orthop Trauma Surg. 2015; 136(1):101-6. DOI: 10.1007/s00402-015-2343-2. View

Ribeiro F, Ursolino A, Ramos V, Takesian F, Tenor Junior A, Costa M . Disorders of the long head of the biceps: tenotomy tenodesis. Rev Bras Ortop. 2017; 52(3):291-297. PMC: 5497000. DOI: 10.1016/j.rboe.2017.04.001. View

Shang X, Chen J, Chen S . A meta-analysis comparing tenotomy and tenodesis for treating rotator cuff tears combined with long head of the biceps tendon lesions. PLoS One. 2017; 12(10):e0185788. PMC: 5633150. DOI: 10.1371/journal.pone.0185788. View

Richards D, Burkhart S . A biomechanical analysis of two biceps tenodesis fixation techniques. Arthroscopy. 2005; 21(7):861-6. DOI: 10.1016/j.arthro.2005.03.020. View

Frost A, Zafar M, Maffulli N . Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii. Am J Sports Med. 2008; 37(4):828-33. DOI: 10.1177/0363546508322179. View

Hassan S, Patel V . Biceps tenodesis versus biceps tenotomy for biceps tendinitis without rotator cuff tears. J Clin Orthop Trauma. 2019; 10(2):248-256. PMC: 6383069. DOI: 10.1016/j.jcot.2018.12.013. View

10.

Galdi B, Southren D, Brabston E, Popkin C, Jobin C, Levine W . Patients Have Strong Preferences and Perceptions for Biceps Tenotomy Versus Tenodesis. Arthroscopy. 2016; 32(12):2444-2450. DOI: 10.1016/j.arthro.2016.04.022. View

11.

Hufeland M, Wicke S, Verde P, Krauspe R, Patzer T . Biceps tenodesis versus tenotomy in isolated LHB lesions: a prospective randomized clinical trial. Arch Orthop Trauma Surg. 2019; 139(7):961-970. DOI: 10.1007/s00402-019-03136-4. View

12.

Friedman J, Fitzpatrick J, Rylander L, Bennett C, Vidal A, McCarty E . Biceps Tenotomy Versus Tenodesis in Active Patients Younger Than 55 Years: Is There a Difference in Strength and Outcomes?. Orthop J Sports Med. 2015; 3(2):2325967115570848. PMC: 4555607. DOI: 10.1177/2325967115570848. View

13.

Mazzocca A, Rios C, Romeo A, Arciero R . Subpectoral biceps tenodesis with interference screw fixation. Arthroscopy. 2005; 21(7):896. DOI: 10.1016/j.arthro.2005.04.002. View

14.

Ahmad C, DiSipio C, Lester J, Gardner T, Levine W, Bigliani L . Factors affecting dropped biceps deformity after tenotomy of the long head of the biceps tendon. Arthroscopy. 2007; 23(5):537-41. DOI: 10.1016/j.arthro.2006.12.030. View

15.

Boileau P, Baque F, Valerio L, Ahrens P, Chuinard C, Trojani C . Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am. 2007; 89(4):747-57. DOI: 10.2106/JBJS.E.01097. View

16.

Gombera M, Kahlenberg C, Nair R, Saltzman M, Terry M . All-arthroscopic suprapectoral versus open subpectoral tenodesis of the long head of the biceps brachii. Am J Sports Med. 2015; 43(5):1077-83. DOI: 10.1177/0363546515570024. View

17.

Murthi A, Vosburgh C, Neviaser T . The incidence of pathologic changes of the long head of the biceps tendon. J Shoulder Elbow Surg. 2000; 9(5):382-5. DOI: 10.1067/mse.2000.108386. View

18.

Franceschi F, Longo U, Ruzzini L, Papalia R, Rizzello G, Denaro V . To detach the long head of the biceps tendon after tenodesis or not: outcome analysis at the 4-year follow-up of two different techniques. Int Orthop. 2006; 31(4):537-45. PMC: 2267623. DOI: 10.1007/s00264-006-0206-8. View

19.

Frank R, Cotter E, Hannon C, Harrast J, Cole B . Cartilage Restoration Surgery: Incidence Rates, Complications, and Trends as Reported by the American Board of Orthopaedic Surgery Part II Candidates. Arthroscopy. 2019; 35(1):171-178. DOI: 10.1016/j.arthro.2018.08.028. View

20.

Patel K, Bravman J, Vidal A, Chrisman A, McCarty E . Biceps Tenotomy Versus Tenodesis. Clin Sports Med. 2015; 35(1):93-111. DOI: 10.1016/j.csm.2015.08.008. View