Complications of biceps tenodesis based on location, fixation, and indication: a review of 1526 shoulders

Background: Long head of the biceps tendon (LHBT) tenodesis is predominantly performed for 2 reasons: anterior shoulder pain (ASP) or structural reasons (partial tear, dislocation). Methods: Between 2006 and 2014, all cases of primary LHBT tenodesis performed at an integrated health care system were retrospectively reviewed. Complications were analyzed by tenodesis location (below or out of the groove [OOG] vs leaving tendon in the groove [ITG]), fixation method (soft tissue vs implant), and indication (preoperative ASP vs structural). Results: Among 1526 shoulders, persistent ASP did not differ by fixation method (11.0% for implant vs 12.8% for soft tissue, P =.550) or location (10.8% for OOG vs 12.9% for ITG, P =.472). Soft-tissue tenodesis cases had more frequent new-onset ASP (11.9% vs 2.6%, P <.001) and subjective weakness (8.50% vs 3.92%, P <.001) but less frequent revisions (0% vs 1.19%, P =.03) than implant tenodesis cases. No difference was found between ITG and OOG for persistent ASP (12.9% vs 10.8%, P =.550), new-onset ASP (6.5% vs 2.8%, P =.339), cramping (1.70% vs 2.31%, P =.737), deformity (4.72% vs 4.62%, P =.532), or subjective weakness (6.23% vs 4.32%, P =.334), but ITG cases had more revisions (1.51% vs 0.60%, P =.001). Among implant tenodesis cases, 1 shoulder (0.085%) sustained a fracture. Conclusion: The overall complication rate of LHBT tenodesis was low. Of the shoulders, 10.8% to 12.9% continued to have ASP, regardless of whether the LHBT was left ITG. Soft-tissue tenodesis cases had higher rates of new-onset ASP and subjective weakness. No significant difference for tenodesis ITG or OOG was found in biceps-related complications.