Implant-free Loop Tenodesis significantly improves functional outcome in the treatment of long head of biceps tendon lesions - two-year results of a prospective case series.

Background: The purpose of this study was to investigate mid-term functional and structural results of the implant-free arthroscopic technique of loop tenodesis procedure for treatment of tendon pathologies of the long head of biceps (LHB).

Methods: For a prospective case series, patients presenting with LHB tendinopathy, instability, partial tear or SLAP lesions and undergoing shoulder arthroscopy were recruited between November 2018 and November 2019. All patients received loop tenodesis of the long head of biceps tendon alongside concomitant rotator cuff repair or labral procedures. Follow-up visits were scheduled at 6 weeks, 6 months, 12 months, and 24 months postoperatively. Biceps-related functional outcome was assessed by using the LHB score as a primary outcome parameter. Secondary outcome measures included global shoulder functional scores (Constant-Murley Score [CMS], Subjective Shoulder Value [SSV]), ultrasound assessment for tenodesis integrity, and evaluations of supination torque and elbow flexion strength.

Results: Eighty-one patients (age 51.5 ± 9.5 years) underwent loop tenodesis to address LHB pathologies, of which 64 patients (79%) were available for the last follow-up after 24 months. The LHB score increased from a preoperative mean of 77 ± 13 to 82 ± 16 at the 6-month assessment, and to 89 ± 15 at 24 months postoperatively (p < .001). Additionally, significant improvements were observed in CMS (preoperative 57 ± 18; 24-months postoperative 87 ± 13; p < .001) and SSV (preoperative 47 ± 19; 24-months postoperative 88 ± 15; p < .001). Minimal clinically important differences (MCID) of the CMS and SSV were reached by 87% and 94% of patients at 24 months, respectively. A higher 12-months LHB score significantly increased the likelihood of achievement of the MCID of the CMS (OR 1.402; 95%-CI [1.073, 1.834]; p = 0.013). Ultrasound examination revealed structural failure was identified in only 2 patients (3.2%) over the entire follow-up. No patients required revision surgery due to biceps-related issues or tenodesis failure.

Conclusion: Loop tenodesis for treatment of LHB tendon lesions significantly improved functional outcome scores within the first 2 years, providing stable suprapectoral fixation without the need for an implant. Comparative studies are needed to validate the technique.

Level of evidence: Level IV; Case Series; Treatment Study.