Background: Tears of the subscapularis tendon commonly are
associated with instability of the long head of the biceps tendon. Standard
surgical treatment includes tenodesis or tenotomy of the biceps tendon.
However, chronic discomfort from spasms and cosmetic disadvantages have been
reported following both procedures, while the potential for functional
impairments remains controversial. We investigated the outcome of
stabilization of the long head of the biceps tendon in the context of early
repair of traumatic tears of the subscapularis tendon.
Methods: We performed stabilization of an unstable, structurally
intact long head of the biceps tendon in twenty-one patients in the acute
phase after a traumatic tear of the subscapularis tendon. The average period
from the injury to the surgery was 6.2 weeks. Open tendon stabilization and
subscapularis reconstruction were performed with transosseous sutures. The
follow-up consisted of clinical examination (with determination of the
absolute, age and genderrelated, and individual relative Constant scores;
clinical evaluation of the long head of the biceps; and subjective
determination of shoulder function) and dynamic ultrasound examination.
Results: The average follow-up period was 28.4 months. The mean
absolute Constant score increased from 26.3 points preoperatively to 79.3
points postoperatively (p < 0.01). The mean age and gender-related Constant
score improved from 28.0% to 87.0% (p < 0.01). Seven patients showed
clinical symptoms consistent with mild biceps tendinopathy. Using dynamic
ultrasound examination, we found two cases of recurrent instability (medial
subluxation) of the long head of the biceps tendon. Secondary rupture of the
long head of the biceps tendon occurred in one patient, twenty-six months
after the surgery.
Conclusions: The functional outcomes of stabilization of the long
head of the biceps tendon in the context of early repair of a traumatic tear
of the subscapularis tendon were comparable with the results of tenodesis or
tenotomy reported in previous studies. The cosmetic results were superior, and
chronic discomfort from spasms was not observed. Stabilization of the tendon
of the long head of the biceps can be recommended as a treatment option for
selected patients and should be discussed as an alternative to tenodesis or
tenotomy, particularly in a young patient.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.