Long Head Of Biceps Tenodesis Research Articles

Is the long head of the biceps related to anterior shoulder pain? A histopathological study

Objectives. Pathologies of the long head of the biceps have been viewed as a source of anterior shoulder pain and disability. Thus, we performed a histopathological and immunohistochemical examination of the biceps tendon with regard to the neuronal structure, the number of mechano[1]receptors and immunohistochemical types, to investigate the relationship of these factors with pain. Materials and Methods. This is a single-center prospective comparative study, on 11 patients divided into Group A (n=5) and Group B (n=6). Patients who underwent arthroplasty due to Neer type[1]4 proximal humeral fractures were selected as the control group (Group A). Group B consisted of patients with chronic anterior shoulder pain who underwent subpectoral biceps tenodesis during arthroscopic rotator cuff repair. The long head of biceps tenodesis was performed in all patients. Results. Hyalinization in the tendon was observed in 2 patients of group B. Chondroid degeneration was found in one patient with hyalinization. Inflammation, calcification, or matrix formation were not detected in any patients. Normal nerve fibers were observed around the tendon in 9 patients with S-100 immunohistochemical staining. In 1 patient, weak staining was observed in the nerve sheath with EMA immunohistochemical stain. No tactile body was detected. Conclusions. We did not observe any histo[1]pathological findings that could be considered the cause of pain in the two groups. Biomolecular and biomechanical studies, in addition to microscopic studies, are needed to explain why the biceps is a potential source of pain.

The high resistance loop (H-loop) technique used for all-inside arthroscopic knotless suprapectoral biceps tenodesis: A case series.

IntroductionSuprapectoral tenodesis is a common technique for the treatment of long head biceps tendon lesions. However, so far, there is no gold standard treatment in all-inside arthroscopy. The purpose of the present study was to introduce and evaluate the functional outcomes of an innovative, all-inside arthroscopic high resistance loop (H-loop, high resistance to tissue cutout and 360° grasping of the tendon) technique for long head of biceps (LHB) tenodesis.MethodFrom September 2020 to March 2022, a series of cases of 32 consecutive patients (28 rotator cuff tear with LHBT pathology and 4 superior labrum anterior-posterior (SLAP) tears which including 2 type II and 2 type IV) who received LHB tenodesis using all-inside arthroscopic high resistance loop technique were included in this study. The American Shoulder and Elbow Surgeon Score (ASES), Visual Analog Scale (VAS), Simple Shoulder Test Score (SST), Constant–Murley scores, and University of California at Los Angeles Scoring System (UCLA) were used to evaluate the clinical outcomes of patients in preoperative and final follow-up. Meanwhile, postoperative complications were also observed.Result32 patients (14 women and 18 men, average age was 55.7 years) underwent all-inside arthroscopic knotless suprapectoral biceps tenodesis using the H-Loop stitch technique. The mean time of follow-up was 16.2 ± 2.6 months. The ASES, VAS, Constant–Murley, SST, and UCLA scores improved from 51.5 ± 15.8, 5.5 ± 1.6, 57.8 ± 14.7, 5.0 ± 2.8, and 16.1 ± 3.8 preoperatively, to 89.1 ± 7.5, 1.0 ± 0.8, 87.3 ± 5.5, 10.4 ± 1.5, and 31.3 ± 2.6 in the last follow-up, respectively (p < 0.001). During the follow-up, no patients in this study experienced postoperative complications such as infection of the wound, injury of nerves, and hardware failure; no patients required revision after their operation. In addition, none of the patients had cramping or a “Popeye” deformity during follow-up.ConclusionThis article presents an innovative, all-arthroscopic H-loop technique for LHB tenodesis. This technique for LHB tenodesis showed favorable functional and cosmetic outcomes, as well as high satisfaction rates. Due to its simplicity of operation and satisfactory preliminary clinical outcomes, H-loop technique is perhaps another option to choose in all-inside arthroscopic LHB tenodesis.

Histopathology of long head of biceps tendon removed during tenodesis demonstrates degenerative histopathology and not inflammatory changes

BackgroundThe aim of this study is to describe and quantitatively analyze the histopathology of proximal long head biceps (LHB) tendinopathy in patients who have undergone LHB tenodesis. The hypothesis is that severe histopathologic changes of the LHB tendon (LHBT) will most likely be reflected with improved postoperative clinical outcomes.MethodsThe study included patients with isolated LHB tendinopathy or LHB tendinopathy associated with concomitant shoulder pathologies. All had failed conservative treatment (12 months) and had a positive pain response (> 50% reduction) pre-operatively after LHB tendon injection with local anesthetic. All underwent biceps tenodesis procedure between 2008 and 2014. Tendon specimens were collected and histologically analyzed with the semi-quantitative Bonar scoring system. Minimum follow-up time was 1 year. A subset of patients was retrospectively reviewed postoperatively and evaluated employing visual analogue score (VAS), short form survey (SF-12), American Shoulder and Elbow Surgeon (ASES) score, Disability of Arm, Shoulder and Hand (DASH) score, and Oxford Shoulder Score (OSS) and postoperative return to work status.ResultsForty-five biceps tendon specimens were obtained from 44 patients (mean age 50 ± 9.6 years). Histopathological analyses demonstrated advanced degenerative changes with myxoid degeneration and marked collagen disorganization. Minimal inflammation was identified. There were no regional differences in histopathological changes. Clinical outcomes did not correlate significantly with severity of histopathologic changes.ConclusionsThis study confirms that LHBT specimens in patients undergoing tenodesis demonstrate with the use of the Bonar score histopathologic changes of chronic degeneration and not inflammation. The correct histopathologic terminology for this process is LHB tendinosis. The histopathological changes appear uniform throughout the entire length of the LHBT which may inform the nature of the procedure performed.

Long head of biceps in proximal fractures of the humerus: an underestimated problem?

Background and aim of the work:The long head of biceps (LHB) is one of the tendons of the rotator cuff that runs strictly close to the humeral head. In case of pathology, it can be responsible for pain and shoulder impairment: in such cases, surgical options include tenotomy or tenodesis. The management of LHB along with surgery of the rotator cuff or during shoulder prosthetic replacement has been widely discussed in the literature. Conversely, the possibility of acute impingement and incarceration of LHB in proximal humerus fractures, as well as its role in shoulder pain in outcomes of these fractures, has been poorly considered.Methods:The following aspects in the literature on LHB and proximal humerus fractures have been analysed: its management during fixation of fractures, the possibility of interference of the tendon with reduction of fractures or dislocations of the shoulder and its possible role in chronic pain after fixation of proximal humerus fractures.Results:LHB can be an obstacle in the reduction of fractures, dislocations and fracture-dislocations. Only a few papers take into account acute surgery to LHB (tenotomy or tenodesis); most of the studies on fixation of proximal humerus fractures simply ignore the problem of LHB. The tendon can be a source of pain and a cause of disability in sequelae of these fractures.Conclusions:LHB should be taken into consideration both in the acute phase of fractures of the proximal humerus and in the outcomes. Other studies are needed to better understand its optimal management during fracture surgery. (www.actabiomedica.it)

Open subpectoral vs. arthroscopic proximal biceps tenodesis: A comparison study of clinical outcomes.

The purpose of the present study was to compare the results of open subpectoral biceps tenodesis and arthroscopic proximal biceps tenodesis for treating long head of biceps (LHB) lesions. From January 2015 to June 2016, a total of 259 patients underwent LHB tenodesis surgery. Among them, 117 patients (60 females and 57 males) who met the inclusion and exclusion criteria were enrolled into the present study and were randomly divided into two groups, including an open subpectoral tenodesis group (OSPBT; n=62) and an arthroscopic proximal tenodesis group (ASPBT; n=55). All patients were followed up for at least 12 months. The demographic characteristics of each patient were recorded in detail. Moreover, clinical examinations of LHB lesions, such as shoulder range of motion (ROM), Visual Analog Scale (VAS) scores (0, no pain, to 10, most severe pain), American Shoulder and Elbow Surgeons (ASES) scores, and Constant-Murley shoulder outcome scores, were investigated prior to surgery, as well as 3, 6 and 12 months after surgery. Postoperative complications were also comprehensively investigated. There were no significant differences in sex, body mass index, dominant shoulder, duration of pain, injury type and operation time between the groups. The mean length of hospital stay in the ASPBT group was significantly lower than that of the OSPBT group (5.4±1.8 days vs. 9.3±2.9 days; P<0.05). The clinical outcomes, including shoulder ROMs, VAS scores, ASES scores and Constant-Murley shoulder outcome scores, were significantly improved after either OSPBT or ASPBT treatment. Specifically, the VAS score, incidence of postoperative stiffness and bicipital groove tenderness in the OSPBT group were significantly lower than those in the ASPBT group at 3 months post-surgery (P<0.05). Additionally, there were no significant difference in the improvement of other clinical outcomes and postoperative complications between the two groups. ASPBT and OSPBT were both effective and safe techniques for treating LHB lesions. However, tenderness of the bicipital groove was more common in the early stages of recovery post-surgery in the ASPBT group, which may be related to tendinitis of the LHB in the bicipital groove.

Injuries of the Biceps and Superior Labral Complex in Overhead Athletes.

To summarize the current anatomy, biomechanics, presentation, treatment, and outcomes of injuries to the biceps and superior labral complex in overhead athletes. The biceps and superior labral complex is composed of anatomically distinct zones. The inability to accurately diagnose biceps lesions contributes to continued morbidity especially as arthroscopy and advanced imaging fail to fully evaluate the entire course of the biceps tendon. Superior labrum anterior and posterior (SLAP) repair, long head of biceps tenodesis, and tenotomy are the most common operative techniques for surgical treatment of biceps-labral complex (BLC) pathology. Labral repair in overhead athletes has resulted in mixed outcomes for athletes and is best indicated for patients under age 40years old. Injuries to the BLC are potentially challenging injuries to diagnose and treat, particularly in the overhead athlete. SLAP repair remains the treatment of choice for high-level overhead athletes and patients younger than 40years of age, while biceps tenodesis and tenotomy are preferred for older patients.

Trends in Open and Arthroscopic Long Head of Biceps Tenodesis.

In young and active patients, long head of biceps (LHB) tenodesis has become a common procedure for managing LHB pathology, but it remains unclear whether it is performed in isolation or along with other shoulder procedures and whether open and arthroscopic techniques produce different complications. We sought to determine and compare open and arthroscopic LHB tenodesis in terms of (a) trends in overall use, (b) trends in use in isolation and in association with rotator cuff repair (RCR) and superior labral tear from anterior-to-posterior (SLAP) debridement/repair, and (c) the rates of post-operative complications. We performed a retrospective analysis of data from an insurance database to identify LHB tenodesis procedures performed from 2011 to 2014. The overall annual rates of open and arthroscopic LHB tenodesis were determined and then stratified according to concurrent RCR and SLAP repair/debridement. A multivariate logistic regression analysis that controlled for patient demographics (age, sex, comorbidity) was performed. Overall, 8547 patients underwent LHB tenodesis, of which 43.5% were open and 56.5% were arthroscopic procedures. There was a significant increase in the utilization of LHB tenodesis from 2011 to 2014. In isolation, open LHB tenodesis was the more common technique overall and by year. Arthroscopic LHB tenodesis was the most common tenodesis technique performed in conjunction with RCR and SLAP repair/debridement. The overall complication rate was 2.9%; only wound dehiscence demonstrated a difference between techniques. The rates of open and arthroscopic LHB tenodesis procedures increased significantly from 2011 to 2014, with open techniques more common when LHB tenodesis is performed in isolation and arthroscopic techniques more common when performed as a concomitant procedure. Our use of a population database did not allow us to evaluate biomechanical or cost-related phenomena, and future research should examine these and other relevant differences between these two LHB tenodesis techniques.

PREVALENCE OF POPEYE DEFORMITY AFTER LONG HEAD BICEPS TENOTOMY AND TENODESIS.

ABSTRACTObjective:To evaluate whether body mass index (BMI) 30 can be used as a cut-off point in decisions about whether or not to perform long head biceps (LHB) tenodesis, leading to a low rate of esthetic complaints, and to compare two tenodesis techniques.Methods:Ninety-six patients underwent shoulder arthroscopy where tenotomy was performed separately in patients with a BMI ≥30 and was followed by tenodesis when BMI <30. The patients were assessed on the basis of their personal perception of the deformity and by 3 independent observers.Results:The patient's perception of esthetic deformity in the arm was 15.6%. In the tenotomy group (12.5%) and in the tenodesis group (17.9%) - (p = 0.476). Patients with rocambole-like tenodesis perceived the deformity in 13.2% of cases, while patients with anchor tenodesis noticed the deformity 27.8% (p = 0.263) of the time. There was no statistical difference in the perception of deformity among the independent examiners.Conclusion:BMI 30 can be used as a cut-off point in decisions about whether or not to perform LHB tenodesis, leading to low rates of esthetic complaint by patients (12.5%). The rocambole-like tenodesis technique appears to be more able to avoid esthetic deformity of the arm after the LHB tenotomy according to the patients' observations. Level of evidence II, Prospective comparative study.

Arthroscopic knotless suprapectoral tenodesis of the long head of biceps: clinical and structural results.

Different techniques for tenodesis of the long head of biceps (LHB) have been described. Previous studies focused on intraosseously performed techniques while only little clinical data exists for epiosseously performed knotless LHB tenodesis. The hypothesis is that arthroscopic suprapectoral knotless epiosseous tenodesis of the LHB would have good clinical, cosmetic and structural results. Forty-nine patients [16 women, 33 men; mean age 58; mean follow-up 36.4months (range 24-57months)], in whom a tenodesis of the long biceps tendon (LHB) has been performed, were included into this study. The clinical evaluation included the Constant score as well as the LHB score. In addition elbow flexion and supination strength were assessed. The integrity of the tenodesis construct was evaluated indirectly by sonographic detection of the LHB in the bicipital groove. The overall Constant score did not reveal any significant differences comparing both sides [mean, 86±19 points vs. 89±16 points (p>0.05)]. The mean LHB score reached 88.3 points (range 54-100 points). Thirty-four patients (69%) presented an examiner-dependent upper arm deformity although only three patients (6%) confirmed a subjective cosmetic deformity. Both, flexion and supination strength were significantly decreased compared to the non-operated side (p<0.05). In five patients (10%) it was not possible to verify the LHB sonographically in the bicipital groove. Therefore the biceps tenodesis was classified as a failure. The arthroscopic suprapectoral epiosseous knotless tenodesis of the LHB provides good functional results. The high rate of examiner-dependent upper arm deformities can be explained by a non-physiological situation of the primary length-tension relationship or an elongation of the tendon after fixation.

Biceps tenodesis (long head): arthroscopic keyhole technique versus arthroscopic interference screw: a prospective comparative clinical and radiographic marker study

The long head biceps tenodesis (LHBT) is an alternative to tenotomy in order to prevent Popeye sign.Biomechanical studies showed that interference screw(IFS) was the strongest fixation but there might be complications and cost. What's more, the analyses of tenodesis failures are undervalued because they only take visible deformations of the arm into account. The purpose of this study was to compare a modified arthroscopic "keyhole" LHBT (modified @KH) with an arthroscopic IFS LHBT(@IFS) using an objective method. We hypothesized that modified @KH gave similar clinical outcomes as @IFS without its hassles or drawbacks. We present a 12-month prospective comparative study (modified @KH versus @IFS) performed by two experienced orthopedic surgeons. Modified @KH was performed on one hundred and nine patients versus @IFS that was performed on one hundred and two. A radiopaque marker was placed into the tendon. The review was conducted in the sixth month with clinical examination and plain standard X-ray to objectify the potential migration of the marker. Modified @KH showed 2.4 % visible deformity without any Popeye sign but 3.4 % radiographic metallic marker migrations. No complications were noted. @IFS showed 5.8 % visible deformity with 2.9 % Popeye sign and with 10.3 % radiographic metallic marker migrations;pain at tenodesis location was noted in 2 %. P value (0.13) indicates that there were no statistically significant differences. We confirm the hypothesis that the modified@KH gives clinical and radiographic outcomes at least similar to @IFS without any complications and cost. The establishment of the radiopaque marker allows us to know the exact number of failures.Level of evidence Consecutive prospective comparative clinical, Level II-1 studies.

An Arthroscopic Technique for Long Head of Biceps Tenodesis With Double Knotless Screw

Tenodesis of the long head of the biceps (LHB) is a frequently performed procedure during shoulder arthroscopy for the treatment of degenerative, traumatic, or inflammatory lesions of the LHB tendon. Arthroscopic techniques for LHB tenodesis using knotless screw techniques offer the advantage of circumventing the need for arthroscopic knot tying. In 2012 Song and Williams described a novel tenodesis technique that does not require any knot-tying procedures by using a knotless anchor. However, a single-anchor configuration may not offer adequate stabilization of the LHB tendon. Therefore we propose a modified method that uses a double knotless anchor that offers advantages over the single knotless anchor, such as an increase in the contact area between the tendon and bone to facilitate tendon-to-bone healing and strengthening of the tenodesis construct.

Surgical indications for long head biceps tenodesis: a systematic review.

Tenodesis as a treatment for a symptomatic long head of biceps (LHB) tendon is becoming more prevalent and new techniques exist which are purported to make the procedure faster and more effective. The determination of appropriate surgical indications for the procedure will facilitate proper analysis and comparisons of the varied techniques. This review analyses the reported indications in the literature in an attempt to guide future research and treatment. The EMBASE and MEDLINE databases were searched to identify surgical studies that report indications for LHB tenodesis. After title, abstract searches, and full-text reviews, 39 studies were included. Study information was extracted including author, publication date, patient numbers, patient age, follow-up period, procedure performed, surgical indications, and study design. Although indications were variable and often non-descriptive, of the 39 included studies, the most common indications for LHB tenodesis were partial tearing (51%), instability (49%), or tenosynovitis (44%), SLAP tear (28%), and positive clinical exam for LHB pain (26%). Most studies were of low quality of evidence, such as case series (33.0%) and retrospective studies (43.5%), and were of low-to-moderate methodological quality. Although indications used for LHB tenodesis are inconsistently reported, the most common indications include LHB tearing, instability, and tenosynovitis. Other indications include clinical exam indicating LHB pathology, SLAP tears and subjective shoulder pain. Rigorous reporting of indications and preoperative/operative findings should be emphasized in future studies, allowing surgeons to appropriately analyse outcomes of LHB tenodesis of different techniques within patient groups with distinct indications. Systematic review, Level IV.

A Systematic Review and Meta-analysis Comparing Clinical Outcomes After Concurrent Rotator Cuff Repair and Long Head Biceps Tenodesis or Tenotomy.

Context:A comparison of clinical outcomes after long head of biceps (LHB) tenotomy or tenodesis performed concurrently with rotator cuff repair (RCR) is of interest to physicians and patients.Objective:A systematic review of clinical outcome studies examining LHB tenotomy or tenodesis performed concurrently with RCR. Secondarily, perform a meta-analysis of data from comparative studies.Data Sources:MEDLINE (1946 to week 30 of 2013) and EMBASE (1980 to week 30 of 2013).Study Selection:Levels 1 through 4 studies reporting clinical outcomes of concurrent RCR and LHB tenotomy or tenodesis with minimum 1-year follow-up.Study Design:Systematic review and meta-analysis.Level of Evidence:Level 4.Data Extraction:Two independent reviewers identified eligible studies and applied the exclusion criteria. Clinical outcome data, including functional outcome score(s), biceps deformity and cramping, and patient satisfaction, were extracted. Clinical outcome data from included studies were pooled (weighted according to study size) and reported. A meta-analysis was performed only on outcomes extracted from comparative studies (α = 0.05).Results:Twelve studies (N = 565 patients; mean age, 61.3 years; 46.3% men) were included. Of these, 6 (N = 263) included RCR and LHB tenotomy and 9 (N = 302) included RCR and LHB tenodesis. A meta-analysis was performed on 3 comparative studies (levels 1 and 2), demonstrating that the postoperative Constant score at a mean follow-up of 25.5 months was significantly greater after tenodesis (92.8 [tenodesis] vs 90.6 [tenotomy], P < 0.01); however, this difference was less than the reported minimal clinically important difference of 10.4 points. Similarly, the rate of biceps deformity was significantly less after tenodesis (15.5% [tenotomy] vs 3.9% [tenodesis], P < 0.01); however, most patients were not bothered by it. There were no significant differences in the rate of biceps cramping or patient satisfaction.Conclusion:Although the postoperative Constant score and rate of biceps deformity favor LHB tenodesis statistically, the clinical significance appears negligible.

Biomechanical Comparison of Long Head of Biceps Tenodesis With Interference Screw and Biceps Sling Soft Tissue Techniques

The purpose of our study was to compare biomechanically a long head biceps tenodesis using an all soft tissue biceps sling technique versus an interference screw technique. Six paired fresh frozen shoulder specimens were separated into 2 groups. One group used an all soft tissue biceps sling technique for tenodesis. The other group used the interference screw technique for subpectoral tenodesis of the long head biceps tendon. Specimens in both groups were sequentially loaded for 200 cycles, and the difference between the initial and final displacements were recorded. Specimens were then loaded to failure. Load and mode of failure were recorded. The mean displacement of all specimens undergoing the sling technique was significantly less than that of the interference technique at 3.0 mm (±0.80) versus 5.0 mm (±1.08) (P < .05). The biceps sling technique had a higher mean ultimate failure load (UFL) than did the interference screw tenodesis (216.9 N ± 91.6 v 171.7 N ± 101.4), although this was not statistically significant (P= .63). In the interference screw technique, 4 specimens failed at the tenodesis site by either tearing or complete pullout, whereas 2 failed at the biceps myotendinous junction. In the sling technique, 4 specimens failed at the biceps myotendinous junction, whereas one specimen tore at the tenodesis site and one detached the pectoralis tendon insertion from the humerus. One specimen in the biceps sling technique and 2 specimens in the interference screw technique failed before completing all 200 cycles. The results of this biomechanical study show that the biceps sling technique has construct stability similar to that of the interference screw technique. The biceps sling may be a reasonable alternative for treating symptomatic pathologic conditions of the long head biceps tendon.

Biceps Tenodesis

Objectives:Long head biceps (LHB) tenodesis can be performed open or arthroscopically and can be positioned in a suprapectoral or subpectoral position. Suprapectoral tenodesis is easier to accomplish arthroscopically, whereas the subpectoral tenodesis is performed as an open procedure with a longitudinal skin incision at the lower border of the pectoralis major muscle. Numerous studies have investigated these tenodesis techniques, comparing them to tenotomy, and comparing fixation methods between techniques, however, no study has compared the actual postoperative clinical location of suprapectoral and subpectoral LHB tenodesis. The goal of this study is to compare the radiographic location of clinically-performed arthroscopic suprapectoral and open subpectoral biceps tenodesis.Methods: Study Design: Retrospective study. The charts of all patients who underwent arthroscopic or open biceps tenodesis in the past 5 years were reviewed. We routinely obtained post-operative x-rays in these patients and those with available x-rays and complete preoperative information were included in the study. Analysis: The location of all tenodesis sites were measured on x-rays as the distance from the top of the humeral head. Means and standard deviations were calculated and compared using Student’s t-test. Outliers were identified as patients with tenodesis locations greater than one standard deviation from the mean. Preoperative clinical characteristics of these patients were compared to the remaining tenodesis patients using Student’s t test for continuous variables and chi square tests for categorical variables.Results:We identified 158 patients who met inclusion criteria, which included 66 open subpectoral tenodeses and 92 arthroscopic tenodeses. Power analysis determined that 47 patients in each group (94 total) was the minimum number necessary to determine an 8 mm difference between groups. The average distance from the top of the humerus (TDH) in the arthroscopic suprapectoral group was 4.89 ± 0.8 cm, and in the open subpectoral group, 7.52 ± 1.2 cm. (Fig 1) This difference is statistically significant (p<0.0001). 12 (18%) distal outliers (more than one standard deviation distal) were found in the open subpectoral group. 11 (12%) proximal outliers were found in the arthroscopic suprapectoral group. Analysis determined that increased BMI and male gender were significant predictors for distal placement of an open tenodesis. No significant predictors of proximal arthroscopic tenodesis were found. Published cadaveric data localizes the proximal edge of the pectoralis major tendon to be 5.6 cm distal to the top of the humerus. Our data indicates that arthroscopic suprapectoral tenodesis results in a tenodesis location very near (within 0.7 cm on average) the proximal edge of pectoralis major tendon. Open subpectoral technique results in a truly subpectoral location, 1.9 cm distal to the proximal edge of the tendon, likely representing the clinical height of the pectoralis major tendon at the bicipital groove.Conclusion:Arthroscopic suprapectoral and open subpectoral techniques result in significantly different locations of biceps tenodesis. Surgeons experienced in these techniques can expect, on average, to localize their tenodesis just proximal to the pectoralis major tendon using an arthroscopic technique and just distal to the tendon using an open subpectoral technique. The clinical significance of these findings is currently being studied.

The loop-the-loop stitch technique for long head of biceps tenodesis

We present a simple, reproducible and quick method of securing the intra-articular portion of the long head of biceps in preparation for tenodesis. Securing the long head of biceps from the joint with per-tendinous suture or simple loop can result in loss of the tendon down the groove, which can be difficult to retrieve. Arthroscopic passage of the loop-the-loop suture provides dependable, reproducible control of the biceps, and can be prepared for tenodesis by whatever subsequent method.

Long head biceps tenotomy versus tenodesis: A cadaveric biomechanical analysis

Treatment of pathology of the long head biceps (LHB) tendon has become an area of renewed interest among orthopaedic surgeons in recent years. Numerous authors have recommended tenotomy, whereas others have recommended tenodesis to avoid distal migration of the LHB tendon stump and the associated cosmetic deformity that may develop. The purpose of the present study was to determine the likelihood of distal migration from the bicipital groove of the long head biceps tendon after tenotomy under physiologic loading conditions and the ultimate load to failure for tenotomized LHB tendons, and to compare these values with those present after tenodesis with an interference screw in a cadaveric model. Anatomic cadaveric biomechanical study. Cyclic loading was performed on 10 cadaveric shoulders through the LHB tendon on an MTS machine (Materials Testing System; MTS Systems Corp, Minneapolis, MN) at a peak force of 50 N (loading rate of 100 N/second) for 200 cycles. After cyclic loading, the specimens were tested to failure at a loading rate of 100 N/second. Failure was defined as migration of the biceps stump distal to the bicipital groove on the proximal humerus. The LHB tendon was then passed back up the bicipital groove and tenodesis was performed in the groove with a bioabsorbable interference screw according to a previously described technique (Arthrex, Naples, FL). Cyclic and load to failure testing were then repeated in similar fashion and the values were recorded and compared with those of the tenotomized subjects (n = 10 in each group). Four of 10 tenotomized specimens (40%) failed during cyclic loading, with the average number of cycles to failure being 35. The other 6 specimens passed the cyclic test. The average ultimate load to failure in these specimens was 110.7 N. After biceps tenodesis, all specimens passed the cyclic loading test. The average ultimate load to failure in these 10 specimens was 310.8 N. Compared with the 6 tenotomized specimens that passed the cyclic test, the specimens that underwent tenodesis had a significantly higher pullout strength (ultimate strength) with P = .001. These results show that, compared with tenodesis, biceps tenotomy results in a significant risk of distal LHB tendon migration and significantly lower load to failure. Cyclic loads similar to those produced by gentle active range of motion without resistance resulted in failure in 40% of specimens tested after an average of 35 cycles. Based on these results, the authors recommend that LHB tenodesis be considered in any patient who may object to the cosmetic deformity and associated dysfunction produced by distal LHB tendon migration after tenotomy. The findings of this study help determine whether to perform long head biceps tenotomy or tenodesis when dealing with long head biceps tendon pathology.