Isolated Biceps Reflection Pulley Tears Treated With Subpectoral Biceps Tenodesis: Minimum 2-Year Outcomes

Purpose: To investigate if patients younger than 50 years old had improved functional outcomes after subpectoral biceps tenodesis (BT) for the treatment of biceps reflection pulley (BRP) lesions at minimum 2-year postoperative follow-up.

Methods: Patients who had arthroscopically confirmed BRP tears that were treated with subpectoral BT and were at least 2 years out from surgery were included; patients were excluded if they had concomitant reconstructive or reparative procedures at index surgery. Patient-centered outcomes including return to activity, American Shoulder and Elbow Surgeons (ASES), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Short Form-12 Physical Component Summary (SF-12 PCS) scores, and patient satisfaction were collected. The pre- and postoperative scores were compared with a Wilcoxon test. Failure was defined as revision BT.

Results: Between January 2006 and July 2014, of 1,184 patients who underwent open subpectoral BT, 14 patients (6 male, 8 female) with mean age 37 (range, 16-49 years) met the inclusion criteria. Minimum 2-year outcomes data were available for all 14 patients (100% follow-up). The mean follow-up was 3.6 ± 1.3 years. There were significant improvements postoperatively for all outcome scores (P = .017 ASES, P = .002 QuickDASH, P = .003 SF-12 PCS). There was no correlation between age and outcome scores (P > .05). Median patient satisfaction was 9 of 10. Five patients (36%) reported return to recreational activity with no modifications; 9 (64%) indicated a return to activity with modifications. The 5 patients who returned to recreational activity with no modification had significantly less time from initial injury/onset of symptoms until surgery in comparison with the 9 patients who modified their activity (P = .028). No complications or reoperations were reported.

Conclusions: Patients younger than 50 years old with a symptomatic isolated BRP lesion experienced excellent results, high return to recreational activity, little postoperative pain, and high degrees of satisfaction when treated with subpectoral BT.

Level of evidence: Level IV, therapeutic case series.