Long Head of the Biceps Tenotomy and Tenodesis: Does Technique, Location, or Implant Influence Outcomes and Complications?

Abstract

Surgical treatment of long head of the biceps tendon (LHBT) lesions due to pain or structural damage (partial tear, dislocation) is controversial. Post-operative complications including cosmetic “Popeye” deformity, biceps cramping, biceps weakness, persistent anterior shoulder pain, and proximal humerus fracture have been reported with these techniques. We present the largest series of surgical LHBT procedures and analyze their complications. Records of patients who underwent a LHBT tenotomy +/- tenodesis at an integrated health care system by 84 surgeons were retrospectively analyzed. Inclusion criteria were patients who underwent a shoulder arthroscopic procedure where the LHBT was surgically released. Exclusion criteria included revision tenodesis, arthroplasty, neoplastic, or fracture surgery, age below 18, or incomplete data. Fixation methods, location of tenodesis, as well as indication for LHBT procedure (anterior shoulder pain versus structural), and post-operative complications were recorded. 1635 patients (1722 shoulders) were included. 1132 patients were male (69%). The average age was 54.5 years (range from 18-91). The average follow-up duration was 10.8 months. Biceps related complications are summarized in Table 1. 18 (1.04%) nerve injuries were encountered, which all completely resolved. Subpectoral tenodesis techniques had a significantly higher rate nerve injury (p = 0.016). One subpectoral tenodesis (0.12%) with a unicortical button and a 3.2mm tunnel suffered a proximal humerus fracture. Open and mini-open techniques demonstrate a significantly higher rate of superficial infection compared with arthroscopic techniques (2.32% versus 0.60%, p = 0.029). We present the largest study analyzing LHBT procedures. While tenotomy and tenodesis provide reliable pain relief, we found no difference in persistent post-operative anterior shoulder pain between tenotomy versus tenodesis, regardless of whether the technique left the LHBT in the groove or not. However, tenotomy had a significantly higher rate of biceps related post-operative complications compared with tenodesis. The overall nerve injuries were low and all recovered.