Arthroscopic inlay suprapectoral vs. mini-open onlay subpectoral biceps tenodesis: a prospective, randomized analysis of clinical outcomes and ultrasound-assessed structural integrity.

Abstract

Surgical techniques for biceps tenodesis vary in approach, fixation strategy, and anatomic location without a clear superior technique for this common procedure. The purpose of this study was to prospectively evaluate a randomized cohort of patients who underwent arthroscopic suprapectoral biceps tenodesis (ASBT) with interference screw fixation using an inlay technique vs. mini-open subpectoral biceps tenodesis (MOBT) with a unicortical button implant using an onlay technique with regard to (1) clinical outcome measures and (2) structural healing as evaluated by ultrasound. From May 2017 to April 2021, patients who had undergone biceps tenodesis were preoperatively randomized to either ASBT or MOBT. American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, and visual analog scale scores were recorded at baseline, 3 months, and 2 years postoperatively. The integrity of the biceps tendon at the tenodesis site was independently examined via ultrasound by a musculoskeletal-trained radiologist at 3 months and 2 years postoperatively. t tests were performed for continuous variables, whereas χ² tests were performed for categorical variables. A total of 52 patients (24 ASBT and 28 MOBT) were randomized and completed follow-up. At baseline, 3 months, and 2 years postoperatively, the mean American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, and Visual Analog Scale scores were not statistically different between ASBT and MOBT. At the 3-month postoperative ultrasound, 23 of 24 (96%) ASBT patients and 26 of 28 (93%) MOBT patients were noted to have a clearly intact biceps tenodesis. At 2 years, all biceps tenodeses regardless of group were noted to be intact and healed, including all 3 shoulders whose ultrasound noted a questionably intact repair without significant retraction of the tendon at previous 3-month ultrasound evaluation. This study demonstrates similar clinical outcomes at 2-year follow-up between ASBT and MOBT. Both groups demonstrated improvement that exceeded the reported patient acceptable symptom state and minimal clinically important difference. Ultrasound showed excellent structural healing rates for both inlay and onlay biceps tenodesis techniques.