Early Versus Delayed Active Range of Motion After Open Subpectoral Biceps Tenodesis

Laura E Keeling; Austin M Looney; Andrew J Curley; Cooper B Ehlers; Alexandra M Galel; Youssef M Khalafallah; Tarun K Vippa; Brandon J Bryant; Edward S Chang

doi:10.1177/23259671211026619

Early Versus Delayed Active Range of Motion After Open Subpectoral Biceps Tenodesis

Orthop J Sports Med. 2021 Aug 25;9(8):23259671211026619. doi: 10.1177/23259671211026619. eCollection 2021 Aug.

Authors

Laura E Keeling¹, Austin M Looney¹, Andrew J Curley¹, Cooper B Ehlers², Alexandra M Galel³, Youssef M Khalafallah⁴, Tarun K Vippa³, Brandon J Bryant³, Edward S Chang³

Affiliations

¹ Department of Orthopaedics, Georgetown University Hospital, Washington DC, USA.
² Georgetown University School of Medicine, Washington, DC, USA.
³ Department of Orthopaedics, Inova Fairfax Hospital, Falls Church, Virginia, USA.
⁴ Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.

Abstract

Background: Little is known regarding the effect of early active elbow range of motion (ROM) protocols on failure rates and outcomes after open subpectoral biceps tenodesis.

Hypothesis: We hypothesized that patients managed using an early active ROM protocol after open subpectoral biceps tenodesis would demonstrate similar failure rates and functional outcomes compared to patients managed using a traditional delayed active ROM protocol.

Study design: Cohort study; Level of evidence, 3.

Methods: We evaluated 63 patients who underwent open subpectoral biceps tenodesis with unicortical suture button fixation. Based on surgeon preference, 22 patients were managed using an early active motion protocol consisting of no restrictions on elbow flexion or forearm supination, while 41 patients were managed using a delayed motion protocol postoperatively. Primary outcome measures included failure of biceps tenodesis and American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores. Secondary outcomes included shoulder and elbow ROM at 6 months postoperatively.

Results: The mean follow-up for the 63 patients was 24.2 months postoperatively. One patient (2.4%) in the delayed active motion cohort and no patients in the early active motion cohort experienced failure. Final outcome scores as well as 6-month shoulder and elbow ROM indicated excellent functional outcomes, with no significant difference between motion cohorts. The median postoperative ASES scores were 97.99 in the early active motion cohort (mean ± standard deviation [SD], 95.49 ± 7.68) and 95.42 in the delayed motion cohort (mean ± SD, 90.93 ± 16.08), while median postoperative SANE scores were 96 in the early motion cohort (mean ± SD, 94.23 ± 6.68) and 95 in the delayed motion cohort (mean ± SD, 88.39 ± 17.98). Subgroup analysis demonstrated no significant difference in outcome scores based on the performance of concomitant rotator cuff repair or hand dominance.

Conclusion: Early active ROM after open subpectoral biceps tenodesis with unicortical suture button fixation resulted in low failure rates and excellent clinical outcomes, comparable to the results of patients managed using delayed active ROM protocols. This suggests that patients undergoing open subpectoral biceps tenodesis may be managed using either early or delayed active motion protocols without compromising functional outcome.

Keywords: biceps tendinitis; biceps tenodesis; range of motion; subpectoral; suture button.