Conversion of Failed Proximal Long Head of the Biceps Tenodesis to Distal Subpectoral Tenodesis: Outcomes in an Active Population

Authors:

Peter J. Millett, M.D., M.Sc., Liam A. Peebles, B.A., Kaare S. Midtgaard, M.D., Zachary S. Aman, B.A., Philip-Christian Nolte, M.D., M.A., CAPT Matthew T. Provencher, M.D., M.C., U.S.N.R.

Abstract:

Purpose

To assess failure rates and patient-reported outcomes following revision of failed proximal long head of the biceps (LHB) tenodesis.

Methods

Patients from an active-military population who underwent revision proximal (suprapectoral) to distal (subpectoral) LHB tenodesis were prospectively enrolled. Patients were included if they were between the ages of 16 and 60 years presenting after a previous biceps tenodesis with mechanical failure and clinical failure, defined as Single Assessment Numeric Evaluation (SANE) or American Shoulder and Elbow Surgeons (ASES) <70. Exclusion criteria were concomitant rotator cuff repair or debridement, full-thickness rotator cuff tear, extensive labral tears, or any evidence of glenohumeral arthritis. Pre- and postoperative SANE and ASES were documented and analyzed.

Results

From 2004 to 2010, a total of 12 patients (all male) with a mean age of 39.9 years (range, 30-54 years) were assessed at a mean follow-up time of 29 months (range, 24-38 months). Nine patients presented with a failed tenodesis construct located at the top of the bicipital groove and 9 patients had LHB tendons originally affixed with an interference screw. Diagnostic arthroscopy revealed that the majority of patients (10/12) had excessive scarring at the site of previous fixation. Mean preoperative assessments of SANE (70.4) and ASES (59.9) improved postoperatively to SANE (90.3; P < .01) and ASES (89.8; P < .01). No patients were lost due to follow-up, and there were no reported complications or failures. All patients returned to full active duty and were able to perform all required physical tests before returning to their vocation.

Conclusions

Patients presenting with symptoms following a proximal LHB tenodesis can be successfully converted to a distal (subpectoral) LHB tenodesis with favorable outcomes. Although in a small sample, there was excessive scarring and synovitis in a majority, which improved significantly when treated with a revision subpectoral tenodesis with minimal complication risk and no reported failures.

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Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!