Higher complication rate is associated with suprapectoral biceps tenodesis as compared to subpectoral tenodesis: a systematic review and meta-analysis of comparative studies.

INTRODUCTION

Biceps tenodesis techniques can be grouped into open or arthroscopic according to surgical approach, and into subpectoral or suprapectoral according to location of fixation. The purpose of this meta-analysis is to critically analyse the current evidence with regard to comparing two methods of biceps tenodesis, viz subpectoral vs supratenodesis.

METHODS

Primary electronic search was conducted on MEDLINE (PubMed), Embase, Scopus, and Cochrane Library databases for published literature from year of inception to August 2024. The current review included any prospective or retrospective English studies that evaluated the outcomes of suprapectoral versus subpectoral. Primary outcomes of interest were American shoulder and elbow society (ASES) score, constant score (CS), UCLA score, SST score, VAS, and complications. The secondary outcomes of interest was range of movements.

RESULTS

Thirteen studies were included in our quantitative analysis, comprising three RCTs and ten non-randomized comparative studies. ASES score was slightly higher in most of studies in favour of subpectoral tenodesis [95% CI (- 1.35, 0.10); I = 43%] (P > 0.05). We found no statistically significant difference between the two groups (P = 0.81), although the subpectoral tenodesis group had slightly higher mean CS 95% CI (- 0.95, 0.85), p = 0.81, I = 0%]. Our meta-analysis found a slightly higher SST in suprapectoral tenodesis group [95% CI (- 0.18, 0.49); I = 0%], while higher UCLA scores [P = 0.98; 95% CI (- 0.52, 0.50); I = 45%] in the subpectoral group (P > 0.05). Higher overall complication rate was noted with suprapectoral tenodesis group [OR 2.65; 95% CI (1.57, 4.45), I = 49%] (P = 0.0002).

CONCLUSION

Both the techniques of biceps tenodesis have shown comparable functional outcomes in most of the trials. On performing meta-analysis, suprapectoral tenodesis was associated with higher rate postoperative complications. Hence, it is advisable to choose subpectoral tenodesis, as and when possible.