Abstract
Purpose. Pathologies of the long head of the biceps tendon (LHBT) are frequently recognized in cases of rotator cuff tear. Recommendations for managing such pathologies remain debatable, and distal migration of tenotomized biceps is always a concern when only tenotomy is performed. Methods. Seventy patients of mean age 60.4 ± 6.9 years (range: 44 to 82 years) were included in this retrospective study. During subpectoral tenodesis in rotator cuff repair, pullout tensions were measured using a digital tensiometer. Measured tensions obtained were analyzed with respect to sex, tear involvement of the subscapularis, and the presence of a partial tear of LHBT, type II SLAP lesion, subluxation/dislocation of the biceps, or a pulley lesion. Results. Mean LHBT pullout tension for the 70 study subjects was 86.5 ± 42.1 N (26.7-240.5 N). Distal LHBT pullout tension was significantly greater for men than women (93.2 ± 42.7 N versus 73.7 ± 38.7 N, P = 0.041). However, LHBT pullout tensions were not significantly associated with different pathologies of surrounding tissues or of LHBTs (all Ps > 0.05). Conclusion. The study failed to show pullout tension differences associated with pathologies affect distal migration of a tenotomized LHBT. Gender was the only factor found to affect LHBT pullout strength. Risk of distal migration of tenotomized LHBT could not be predicted with intraoperative arthroscopic pathologic findings.
Highlights
Lesions of the long head of the biceps tendon (LHBT) and surrounding tissues, such as partial tear of the LHBT, subluxation or dislocation of LHBT, a superior labral anterior and posterior lesion (SLAP lesion), and tear of the anterior or posterior biceps pulley, are observed during rotator cuff repair [1, 2]
Pathologies of the LHBT and surrounding tissues are known to be critical for LHBT stability, and it is possible that the vinculum prevents distal migration of the LHBT
Information on the pullout strength of the LHBT in real clinical situations is valuable because it enables the risk of distal migration of the tendon to be predicted in the presence of different pathologies
Summary
Lesions of the long head of the biceps tendon (LHBT) and surrounding tissues, such as partial tear of the LHBT, subluxation or dislocation of LHBT, a superior labral anterior and posterior lesion (SLAP lesion), and tear of the anterior or posterior biceps pulley (pulley lesions), are observed during rotator cuff repair [1, 2]. Biceps tenotomy is a recognized, successful procedure [6, 7], but there are always concerns of Popeye deformity or cramping pain and strength loss due to distal migration of the tendon, and tenodesis of the LHBT has been recommended by some authors [8]. Pathologies of the LHBT and surrounding tissues are known to be critical for LHBT stability, and it is possible that the vinculum prevents distal migration of the LHBT. In one study [15], the pullout strength of the LHBT after tenotomy was measured in a human cadaver, but this study did not represent clinical situations with associated pathologies. Information on the pullout strength of the LHBT in real clinical situations is valuable because it enables the risk of distal migration of the tendon to be predicted in the presence of different pathologies
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