Bicipital pathology is common in patients with rotator cuff tears. Leaving biceps pathology untreated in rotator cuff repairs (RCR) may lead to suboptimal outcomes. The purpose of this study is to retrospectively compare the clinical outcomes between patients who underwent isolated RCR versus patients who underwent RCR with concomitant biceps treatment. In patients that received biceps treatment, we sought to compare 1) biceps tenodesis versus biceps tenotomy and 2) sub-pectoral tenodesis versus arthroscopic tenodesis.
Methods
A retrospective chart review of 244 patients who underwent RCR at a single multicenter institution in 2016 was performed. Patient demographics, presence of concomitant biceps pathology, pre- and postoperative American Shoulder and Elbow Surgeons (ASES) scores, rates of rotator cuff failure, revision surgery, and all complications were compiled.
Results
101 patients underwent RCR with concomitant tenotomy (n=30) or tenodesis (n=71) for biceps treatment and 143 underwent RCR alone. Patients undergoing biceps treatment were older (59.1 years vs. 56.3 years; p=0.013) and more likely to be male (45.7% vs. 30.4%; p=0.029). Patients undergoing biceps treatment were more likely to have a subscapularis tendon repair (43.6% vs. 11.2%; p=<0.001). Preoperatively, biceps treatment patients had lower ASES scores (41.2 vs 49.3; p=0.003). Postoperatively, there was no significant difference in ASES scores (79.5 biceps treatment vs. 81.5 isolated RCR; p=0.532). There was no significant difference in rates of cuff failure (p=0.766), revision RCR (p=0.703), or all complications (p=0.102) after 2 years.
There was no significant difference in average age (61.6 vs 58.1 years; p=0.054) in the tenotomy versus tenodesis groups. Males were more likely to have tenodesis than females (76% vs. 48%; p=0.011). There were significantly lower preoperative ASES scores in the tenotomy group compared to the tenodesis group (34.3 vs 44.0; p=0.036). Postoperative ASES scores were not significantly different between groups (73.5 tenotomy vs 82.1 tenodesis; p=0.149). There were no significant differences in rates of cuff failure (p=1.000), revision RCR (p=1.000), or all complications (p=1.000) after 2 years.
There was no significant difference in age between patients having subpectoral tenodesis (n=21) and those having arthroscopic tenodesis (n=50) (55.0 vs 59.4 years; p=0.058). Patients in the arthroscopic group were more likely to undergo subscapularis repair (52% vs. 40%; p=0.045). There were no significant differences in preoperative ASES between the arthroscopic and subpectoral tenodesis groups (41.1 vs. 50.4; p=0.066). Postoperative ASES scores were not significantly different (83.2 arthroscopic vs 79.6 subpectoral; p=0.592). There was no significant difference in rates of cuff failure (p=1.000), revision RCR (p=0.507), or all complications (p=1.000) after 2 years.
Conclusions
Addressing biceps pathology when performing RCR resulted in similar rates of cuff failure, revision RCR, complications, and improvement in patient-reported outcomes when compared to isolated RCR at two-years postoperatively. Furthermore, when comparing tenotomy versus tenodesis and arthroscopic versus subpectoral tenodesis, comparable outcomes with regards to rate of rotator cuff repair failure, revision RCR, complications, and patient-reported outcomes were found.