title: Increased incidence of postoperative stiffness after arthroscopic compared with open biceps tenodesis.
abstract: OBJECTIVE
  To determine the incidence of postoperative stiffness after open and arthroscopic biceps tenodesis, compare the incidence between each method, and determine relevant risk factors for its occurrence.
  
  
  METHODS
  A consecutive series of patients who underwent biceps tenodesis during a 3-year period were retrospectively reviewed.
  
  
  RESULTS
  We evaluated 249 patients, which included 143 who underwent open subpectoral tenodesis and 106 who underwent arthroscopic suprapectoral tenodesis. The mean overall follow-up period for the arthroscopic group was 9.9 months (range, 5.1 to 33.5 months). The mean overall follow-up period for the open group was 9.5 months (range, 4.7 to 49.2 months). There was no significant difference in overall follow-up duration between groups (P = .627). A significantly increased incidence of postoperative stiffness was found in the arthroscopic group compared with the open group (17.9% v 5.6%, P = .002). Within the arthroscopic group, patients with postoperative stiffness were more frequently female patients than those without stiffness (63.2% v 33.3%, P = .016) and were more likely to be smokers than those without stiffness (36.8% v 16.1%, P = .040). The tenodesis site was located significantly more proximal in the arthroscopic group of patients with postoperative stiffness compared with patients without postoperative stiffness (32.44 ± 7.8 mm from the top of the humeral head v 50.34 ± 7.8 mm, P < .0001).
  
  
  CONCLUSIONS
  Our results show a notably increased incidence of postoperative stiffness after arthroscopic suprapectoral biceps tenodesis compared with open subpectoral biceps tenodesis. This appears to occur more commonly in female patients and smokers and may have a relation to the position of the tenodesis, with a more superiorly placed tenodesis site being a potential influencing factor. On the basis of this series, this complication most commonly will improve over time and with symptom-based management.
  
  
  METHODS
  Level III, therapeutic case-control study.
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Werner
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
authors.forename: Hakan C
authors.initials: HC
authors.lastname: Pehlivan
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Hart
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Carson
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
authors.forename: David R
authors.initials: DR
authors.lastname: Diduch
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Miller
authors.affiliation: Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.. Electronic address: sfb2e@virginia.edu.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Brockmeier
mesh_terms: D000328:Adult; D000368:Aged; D000844:Ankylosis / Q000453:epidemiology*; D001182:Arthroscopy / Q000009:adverse effects* / Q000379:methods; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D012189:Retrospective Studies; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects; D013710:Tendons / Q000601:surgery; D053656:Tenodesis / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult