Biceps Soft Tissue Tenodesis

Abstract

Surgical treatment options for long head biceps (LHB) tendon disorders varies between preservation of tendon to tenotomy or tenodesis. Optimal management is debated among orthopaedic surgeons. This discussion lies in the fact that there is great controversy existing in literature on the possible functional role of LHB and on its influence on shoulder function.1 In fact, based on scientific evidence, different authors believe that the LHB tendon plays a key role as humeral head depressor, and as a secondary anterior stabilizer.2, 3, 4 LHB seems to reach its maximal efficacy in abduction and external rotation (throwing position) giving torsional rigidity to the shoulder.1,5,6 This stabilizer role seems to become most important when the primary shoulder stabilizer such as capsule-ligamentous complex or dynamic stabilizer such as rotator cuff are injured. On the other hand, some authors consider LHB tendon as a structure without any function.1,7,8 In surgical decision making, the balance between the supposed functional role of LHB and the type LHB tendon pathology responsible for shoulder pain should be taken into account.1 Numerous authors have recommended tenotomy in cases of symptomatic tendinopathy, partial or full thickness tears, subluxation or dislocation of LHB tendon with pulley lesion, isolated or associated with rotator cuff tear.7,9,10 Nevertheless, if we think about a possible functional role of LHB in shoulder biomechanics, and in particular about a secondary stabilizing effect, a simple tenotomy can be considered a critical approach.