Long Head Of The Biceps Tendon Tenodesis Research Articles

Return to Sports and Clinical Results After All-Arthroscopic Biceps Tenodesis Using a 2.7-mm Knotless PEEK Suture Anchor.

The long head of the biceps tendon (LHBT) is a well-known source of pain in the shoulder, especially in active patients. To evaluate the outcomes and return-to-sports rate after all-arthroscopic suprapectoral tenodesis of the LHBT using a small knotless anchor. Case series; Level of evidence, 4. In this retrospective study, 27 patients-who underwent all-arthroscopic tenodesis of the LHBT using a 2.7-mm knotless polyether ether ketone anchor-were evaluated. Sports activities, the return-to-sports rate, and other sports-related parameters (eg, pain during sports, level of sports) were examined. Sports-related data, the Constant score with isometric force (at 90° of abduction in the scapular plane), the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST) score, the visual analog scale (VAS) score for satisfaction, range of motion, and the presence of a Popeye deformity were assessed at a mean follow-up of 15.3 ± 8.7 months. The data were initially analyzed using descriptive statistics. The postoperative ASES, Constant, and SST scores were 81.61, 85.74 and 8.85, respectively. Of the 27 patients, 4 patients (14.8%) showed a Popeye deformity. Preoperatively, 25 patients (92.6%) participated regularly in some type of sports activity. All 25 patients (100.0%) were able to return to sports activities after surgery. 24 (96.0%) returned to the same level preoperatively, with 88.0% (22/25) within 6 months. Patient satisfaction with the outcome was high (VAS score: 2.15 ± 2.78). Neither bicipital groove pain nor cramping was reported. There were no signs of osteolytic bone around the anchor or a fracture of the humeral bone. Our clinical results after using a 2.7-mm knotless anchor for LHBT tenodesis as well as the return-to-sports rate were satisfying. Using an anchor this size can lower the risk of cortical bone damage and therefore the risk of fractures of the humeral head while still enabling patients to perform at a high level.

Long Head of the Biceps Pediculated Autograft Augmentation of Arthroscopic Subscapularis Repair

Subscapularis (SSc) repairs are not free of failure and continues to pose a challenging problem. Although various biological and structural augmentation methods are available for the posterosuperior rotator cuff, few options have been explored for the anterior one. In the Technical Note, we describe an all-arthroscopic technique in which we use the long head of the biceps tendon (LHBT) as a pediculated autograft to reinforce an SSc repair. After SSc repair and LHBT tenodesis, the intra-articular portion of the LHBT is placed on the upper part of the SSc tendon at the rotator interval. Repurposing the otherwise-discarded tendon brings several biological and mechanical advantages at a lower cost without donor-site morbidity.

Arthroscopic Pan-Capsular and Transverse Humeral Ligament Release with Biceps Tenodesis for Patients with Refractory Frozen Shoulder.

Arthroscopic capsular release allows direct visualization and release of inflamed tissues in refractory frozen shoulder. The reticular neural network in the long head of the biceps tendon (LHBT) and nerve endings of the transverse humeral ligament (THL) might be responsible for shoulder pain. We hypothesized that patients with painful refractory frozen shoulder benefited from pan-capsular release, THL release, and LHBT tenodesis. The LHBT tenodesis decreased the possibility of LHBT instability. The balance of the shoulder joint was maintained after such extensive release. From October 2013 to June 2019, patients with painful refractory frozen shoulder were enrolled consecutively at the same institute. All patients received arthroscopic pan-capsular, THL release, and suprapectoral LHBT tenodesis with a minimum of 2-year follow-up. Preoperative and postoperative shoulder range of motion (ROM), pain visual analog scale (PVAS), subjective shoulder value (SSV), constant score, LHBT score, acromio-humeral distance (AHD), and critical shoulder angle (CSA) were recorded. In total, 35 patients with an average age of 53.1 ± 9 years were enrolled. The average follow-up period was 24 ± 1.5 months. Forward elevation improved from 105.1° ± 17° to 147° ± 12° (p < 0.001), external rotation improved from 24.1° ± 13.3° to 50.9° ± 9.7° (p < 0.001), and internal rotation improved from L3 to T9 (p < 0.001), respectively, at final follow-up. PVAS improved from 7.3 ± 1.1 to 1.8 ± 0.6 (p < 0.001), constant score from 23.4 ± 11 to 80.7 ± 5.2 (p < 0.001), and SSV from 27.7 ± 10.5 to 77.4 ± 3.8, respectively, at follow-up. No differences were found in AHD and CSA after surgery (p = 0.316, and p = 0.895, respectively). Patients with painful refractory frozen shoulder benefited from pan-capsular and THL release. A radiographically balanced shoulder joint was maintained even after such extensive release.

Rotator cuff repair with or without proximal end detachment for long head of the biceps tendon tenodesis.

BackgroundRotator cuff tears cause pathologies of the long head of the biceps tendon (LHBT). One of the surgical treatments for such a tear is LHBT tenodesis to the humerus. This study aims to compare simultaneous rotator cuff repair and LHBT tenodesis with or without detachment of the proximal end of the LHBT (PELHBT) from its site of adhesion to the glenoid.MethodsThis retrospective study involved patients affected by LHBT pathology with rotator cuff tear. The patients were divided into two groups, with or without PELHBT detachment from the glenoid. Therapeutic outcomes were investigated by evaluation of patient satisfaction, pain based on visual analog scale, shoulder function based on Constant score and simple shoulder test, and biceps muscle strength based on the manual muscle testing grading system before surgery, at 6 months, and at the final visit after surgery.ResultsGroups 1 and 2 comprised 23 and 26 patients, respectively, who showed no significant differences in demographic characteristics (p>0.05). Shoulder function, biceps muscle strength, pain, and satisfaction rate improved over time (p<0.05) but were not significantly different between the two groups (p>0.05). No post-surgical complication was found in either group.ConclusionsThere was no difference in final outcomes of tenodesis with or without detachment of the PELHBT from the supraglenoid tubercle. Such tendon detachment is not necessary.

Assessment of the Preserved Biceps Tendon After Arthroscopic Rotator Cuff Repair in Patients ≤ 55 Years

PurposeWe assessed hypertrophy of preserved long head of the biceps tendon (LHBT) and vascularity in the bicipital groove after arthroscopic rotator cuff repair in ≤55-year-old patients and compared postoperative pain between shoulders with or without vascularity in the bicipital groove.MethodsPatients who underwent arthroscopic rotator cuff repair between 2015 and 2017 were reviewed. Inclusion criteria were arthroscopic rotator cuff repair and ≤55 years old. Exclusion criteria were a history of contralateral rotator cuff repair, revision surgery, partial repair or superior capsular reconstruction, shoulder dislocation or fracture, torn LHBT at surgery, LHBT tenodesis, retears, <1-year follow-up, and incomplete follow-up data. Cross-sectional area (CSA) of the LHBT and vascularity in the bicipital groove were examined preoperatively and 1 year after surgery using ultrasonography. Shoulder pain at postoperative 1 year was assessed using the pain subscore of the University of California at Los Angeles scale. The data were compared between shoulders with negative and positive vascularity.ResultsFifty-seven shoulders were included in this study. There was no side-to-side difference in preoperative CSA. No difference was found between preoperative and postoperative CSA in the affected shoulders. Postoperative vascularity was identified in 28 (49%) shoulders. Mean pain score was significantly higher in the negative vascularity group than the positive vascularity group (9 and 8, respectively; P = .002).ConclusionsThe preserved LHBT did not show hypertrophy 1 year after arthroscopic repair of medium-sized or smaller posterosuperior rotator cuff tear in ≤55-year-old patients. However, 49% of the shoulders postoperatively demonstrated lower-grade vascularity in the bicipital groove. Healthy LHBT can be preserved in ≤55-year-old patients with posterosuperior medium-sized or smaller rotator cuff tears.Level of EvidenceIII, retrospective comparative prognostic trial

Adhesion of the Long Head of the Biceps Tendon: A Case Series

PurposeTo present the clinical and imaging findings and results of treatment in patients with intra-articular long head of the biceps tendon (LHBT) adhesion to the undersurface of the rotator cuff found incidentally during shoulder arthroscopy.MethodsPatients with intra-articular LHBT adhesion to the undersurface of the rotator cuff found incidentally during arthroscopy were included with a minimal 2-year follow-up. Demographic data, images, and physical examinations were recorded. LHBT release, tenotomy, or tenodesis were performed according to the patient’s age and surgeon’s preference.ResultsTwelve patients were included in the study. All of them presented with chronic anterior shoulder pain and positive Speed and O’Brien tests. The average age was 46.8 ± 17 years (range 20-79 years) and the pain sustained from 6 to 96 (average 25.5 ± 28.6) months. Before the operation, 6 patients had a positive Jobe’s test, 1 had a positive lift-off test, and all had positive O’Brien and Speed tests and tenderness over the LHBT. Three release, 4 tenotomy, and 5 LHBT tenodesis were done in addition to other procedures if needed. All range of motion except external rotation, pain visual analog score, and functional outcome scores showed significant improvement at 6 months after surgery. There were no significant differences in range of motion and functional scores between 6 months and 12 months postoperatively. No difference was found in LHBT scores at 6 and 12 months after the operation. Magnetic resonance imaging revealed thickened coracohumeral ligament overlying the LHBT.ConclusionsPatients who had intra-articular LHBT adhesion to the undersurface of the rotator cuff and underwent release of the adhesion around LHBT, tenotomy, or tenodesis all had good clinical outcomes. The lesion was observed in 2.2% of all shoulder arthroscopies. Although difficult to diagnose before surgery, surgeons should be aware of this unusual condition in patients with chronic and insidious anterior shoulder pain.Level of EvidenceLevel IV, Therapeutic case series.

Risk Factors and Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon.

Background:Controversy exits regarding performing a tenotomy versus a tenodesis of the long head of the biceps tendon (LHBT).Purpose:To evaluate the complications after arthroscopic tenotomy of the LHBT and characterize the incidence of cosmetic deformity, cramping, subjective weakness, and continued anterior shoulder pain (ASP). Additionally, to identify patient-related factors that may predispose a patient to these complications.Study Design:Case-control study; Level of evidence, 3.Methods:Records of patients who underwent an arthroscopic LHBT tenotomy at an integrated health care system under the care of 55 surgeons were retrospectively reviewed. Exclusion criteria included LHBT tenodesis, arthroplasty, neoplastic, or fracture surgery; age younger than 18 years; incomplete documentation of physical examination; or incomplete operative reports. Characteristic data, concomitant procedures, LHBT morphology, and postoperative complications were recorded. Patients with and without postoperative complications—including cosmetic deformity, subjective weakness, continued ASP, and cramping—were analyzed by age, sex, dominant arm, body mass index (BMI), smoking status, workers’ compensation status, and intraoperative LHBT morphology to identify risk factors for developing these postoperative complications.Results:A total of 192 patients who underwent LHBT tenotomy were included in the final analysis. Tenotomy was performed with concomitant shoulder procedures in all but 1 individual. The mean ± SD patient age was 60.6 ± 9.5 years, and 55% were male. The overall complication rate was 37%. The most common postoperative complications include cosmetic (Popeye) deformity (14.1%), subjective weakness (10.4%), cramping (10.4%), and continued postoperative ASP over the bicipital groove (7.8%). Every 10-year increase in age was associated with 0.52 (95% CI, 0.28-0.94) times the odds of continued ASP and 0.59 (95% CI, 0.36-0.98) times the odds of cramping pain. Male patients had 3.9 (95% CI, 1.4-10.8) times the odds of cosmetic (Popeye) deformity. Patients who had active workers’ compensation claims had 12.5 (95% CI, 2.4-63.4) times the odds of having continued postoperative ASP. Tenotomy on the dominant arm, BMI, and active smoking status demonstrated no statistically significant association with postoperative complications.Conclusion:Patients experiencing complications after tenotomy were significantly younger and more likely to be male and to have a workers’ compensation injury. LHBT tenotomy may best be indicated for elderly patients, female patients, and those without active workers’ compensation claims.

Arthroscopic All-Inside Biceps Tenodesis: Technique and Outcomes

The long head of the biceps tendon (LHBT) is a frequent source of disorders and pathology in the shoulder. Significant evidence is available on the management of disorders of the LHBT in the literature, and the LHBT is frequently addressed intraoperatively when involved in shoulder pathology. An all-arthroscopic, intra-articular biceps tenodesis with suture anchor fixation has several advantages that have not been well described previously, and it does not add significant morbidity to arthroscopic surgery to treat the rotator cuff or other sources of pain. Intra-articular LHBT tenodesis in the bicipital groove thus has advantages of less surgical time and a decreased bone footprint.

Complications of biceps tenodesis based on location, fixation, and indication: a review of 1526 shoulders

Long head of the biceps tendon (LHBT) tenodesis is predominantly performed for 2 reasons: anterior shoulder pain (ASP) or structural reasons (partial tear, dislocation). Between 2006 and 2014, all cases of primary LHBT tenodesis performed at an integrated health care system were retrospectively reviewed. Complications were analyzed by tenodesis location (below or out of the groove [OOG] vs leaving tendon in the groove [ITG]), fixation method (soft tissue vs implant), and indication (preoperative ASP vs structural). Among 1526 shoulders, persistent ASP did not differ by fixation method (11.0% for implant vs 12.8% for soft tissue, P = .550) or location (10.8% for OOG vs 12.9% for ITG, P = .472). Soft-tissue tenodesis cases had more frequent new-onset ASP (11.9% vs 2.6%, P < .001) and subjective weakness (8.50% vs 3.92%, P < .001) but less frequent revisions (0% vs 1.19%, P = .03) than implant tenodesis cases. No difference was found between ITG and OOG for persistent ASP (12.9% vs 10.8%, P = .550), new-onset ASP (6.5% vs 2.8%, P = .339), cramping (1.70% vs 2.31%, P = .737), deformity (4.72% vs 4.62%, P = .532), or subjective weakness (6.23% vs 4.32%, P = .334), but ITG cases had more revisions (1.51% vs 0.60%, P = .001). Among implant tenodesis cases, 1 shoulder (0.085%) sustained a fracture. The overall complication rate of LHBT tenodesis was low. Of the shoulders, 10.8% to 12.9% continued to have ASP, regardless of whether the LHBT was left ITG. Soft-tissue tenodesis cases had higher rates of new-onset ASP and subjective weakness. No significant difference for tenodesis ITG or OOG was found in biceps-related complications.

Risk Factors for Biceps Related Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon

Objectives:Our objective was to evaluate complications after arthroscopic tenotomy of the long head of the biceps tendon (LHBT) and identify patient-related factors associated with postoperative cosmetic (Popeye) deformity, subjective weakness, and residual anterior shoulder pain.Methods:After obtaining IRB approval, the records of patients who underwent an arthroscopic LHBT tenotomy, between 2008 and 2015, at an integrated multi-center (14) and multi-surgeon (55) were retrospectively reviewed. Exclusion criteria included LHBT tenodesis, arthroplasty, neoplastic, or fracture surgery, age below 18, or indata. Demographic data, concomitant procedures, the appearance of the biceps tendon (presence or absence of hypertrophy) at time of arthroscopy, and postoperative complications were recorded. The development of each postoperative complication was compared by age, gender, hand dominance, workers’ compensation status, and intra-operative LHBT morphology.Results:192 patients met our inclusion criteria. The average age was 60.6 ± 9.5 years and 55% were male. Average follow-up was 10.6 ± 13.6 months. The most common concomitant procedures were subacromial decompression (82%), rotator cuff repair (72%), distal clavicle resection (26%), and glenohumeral debridement (18%). LHBT morphology based on arthroscopic images was as follows: normal (56%), mildly hypertrophic (24%), severely hypertrophic (20%). Postoperative complications cosmetic deformity (14%), subjective weakness (10.4%), persistent (residual) anterior shoulder pain (7.8%), conversion to tenodesis (3.6%), venous thromboembolism (1%). Seven (3.6%) patients underwent a revision surgery to convert the LHBT tenotomy to a tenodesis, most commonly for postoperative cosmetic deformity (6 patients, 86%). Male gender was significantly associated with the development of postoperative cosmetic deformity (Odds Ratio of 3.21, P<0.05). Biceps tenotomy on the dominant shoulder was significantly associated with postoperative subjective weakness (Odds Ratio 3.17, P<0.05). Patients with workers’ compensation injuries were more likely to have continued postoperative anterior shoulder pain (6.57, P<0.05). A full list of individual patient-related factors association with postoperative complications is presented in Table 1.Conclusion:In our series, in patients undergoing LHBT tenotomy, 14% developed a cosmetic deformity, 10% subjective reported weakness and 8% had persistent (residual) anterior shoulder pain. Male gender was associated with developing a cosmetic deformity, the dominant shoulder was associated with postoperative subjective weakness, and workers’ compensation status was associated with residual anterior shoulder pain. Older age and a hypertrophic biceps tendon demonstrated decreased odds of developing a postoperative cosmetic deformity but did not reach statistical significance. Surgeons who perform LHBT tenotomy should take these risk factors under consideration to minimize complications.Table 1Association of Patient-Related Characteristics with Postoperative Complications.Postoperative ComplicationPatient-Related CharacteristicDevelopment of Cosmetic DeformityReported Subjective WeaknessResidual Anterior Shoulder PainAverage AgeYes= 58 years oldYes= 59.6 years oldYes= 56.64No= 61 years oldNo= 60.7 years oldNo= 60.99P= 0.120P= 0.316P= 0.100GenderMale= 19%Male= 11%Male= 6.7%Female= 6.9%Female= 9.2%Female= 9.2%P= 0.013*P= 0.614P= 0.528Dominant ArmYes= 16.9%Yes= 14.2%Yes= 7.2%No=10%No= 5.0%No= 8.6%P= 0.171P= 0.038*P= 0.696Workers' CompensationYes= 28%Yes= 0%Yes= 42.8%No=13%No= 10.8%No= 6.5%P= 0.261P= 0.358P= 0.001*Biceps Tendon HypertrophyYes= 0%Yes= 0%Yes= 0%No= 19.4%No= 11.1%No= 8.3%P= 0.150P= 0.294P= 0.370* Indicates statistical significance

Nerve Injury with Long Head of the Biceps Tenodesis

Objectives:Surgical treatment of long head of the biceps tendon (LHBT) lesions is controversial. Nerve injury is a potentially devastating complication following tenodesis of the LHBT, particularly with regard to tenodesis distal to the biceps groove. The axillary, musculocutaneous, ulnar, radial, and median nerves are all within close proximity of the tenodesis site and are susceptible to injury via retraction of the soft tissues or drilling. The purpose of this study is to characterize the rate of nerve injury during tenodesis of the LHBT, specifically with regard to subpectoral tenodesis.Methods:Following IRB approval, the records of patients who underwent a LHBT tenotomy +/- tenodesis at an integrated health care system by 84 surgeons, from 2006 to 2014, were retrospectively analyzed. Inclusion criteria were patients who underwent a shoulder arthroscopy where the LHBT underwent tenodesis. Exclusion criteria included revision tenodesis, arthroplasty, neoplastic, or fracture surgery, age below 18, or indata. Fixation methods, location of tenodesis were recorded. Descriptive statistics were employed, and odds ratios with 95% confidence intervals were calculated to evaluate the association between variables, with significance evaluated with chi-square for categorical variables.Results:A total of 1524 patients were included in this study. The average patient age was 53.7 ± 10.2 years, which was not significantly different between patients who did and did not experience a nerve complication (p=0.97). There were 1076 males and 445 females included. Subpectoral techniques were performed on 997 cases, while the tendon was tenodesed in the groove on 527 cases. Of the subpectoral LHBT tenodesis, 103 were drilled bicorically, while 682 were drilled unicortically. A total of 16 nerve injuries were encountered, and all nerve injuries were neuropraxias and recovered at terminal follow up. The musculocutaneous nerve was most often injured during subpectoral tenodesis (0.6% of cases), followed by the axillary nerve (0.3% of cases), and finally the radial, median, and ulnar nerves (0.2% of cases each). Significantly more nerve injuries were encountered for subpectoral techniques (15 of 982 cases, 1.53%) than suprapectoral techniques (1 of 526 cases, 0.19%) (OR 8.03, 95% CI 1.06-61, p=0.02). There was no difference between drilling unicortically versus bicortically with regard to nerve injury (OR 1.43, 95% CI 0.40-5.07, p=0.57). There was no difference in nerve injury between males and females (p=0.85).Conclusion:Both suprapectoral and subpectoral LHBT are safe procedures, although nerve injury is a rarely encountered. Nerve injury occurred at a significantly higher rate for subpectoral LHBT tenodesis and tenodesis within the bicipital groove, although all nerve function did recover. However, neither number of cortices drilled nor patient gender influenced nerve injury frequencies. This data suggests that care should be taken while drilling and placing and holding retractors, especially during subpectoral tenodesis.

Tenodesis of long biceps tendon in it’s pathology

One of the causes of pain and dysfunction of the shoulder joint may be inflammation or injury of intraarticular or extraarticular part of long head of the biceps (LHB). Different versions ofLHB pathology are the indication for surgical treatment, namely to tenodesis or tenotomy of LHB. There are many methods and locations for LHB tendon fixation, but consensus on their use is absent.Objective: To determine the best method and location for LHB fixation taking into considerations types of it’s pathology. Methods: A retrospective analysis of treatment in 37 patients (26 men, 11 women from 18 to 79 years) with various types of LHB tendon pathology in the period from 2009 to 2015.In the preoperative period, in all patients clinical loading provocative Speed, O'Brien, Yergasson test provided, humeral joint radiography and MRI studies performed. Options for surgical treatment were: tenotomy, tenodesis with anchor fixation, tenodesis with interferential screws, subpectoral fixation using Endobutton system and subpectoral tenodesiswith transposal fixation. Results: performing choice of surgical treatment in biceps pathology, besides the morphology of LHB tendon injury, one must take into consideration the patient’s age, level of physical activity and work, and the associated pathology of humeral joint. Application of biceps tenotomy in patients older than 50 years with low physical activity and non intensive the labor activity allows to reduce the operation time, intraoperative injury and to get good results without significant reduction in functional outcomes. Application of subpectoral tenodesis of LHB tendon with Endobutton system and transossal fixation results in the best functional outcome.

Outcomes of tenodesis of the long head of the biceps tendon more than three months after rupture.

To demonstrate that long head of the biceps tendon (LHBT) tenodesis is possible more than 3 mo after rupture. From September 2009 to January 2012 we performed tenodesis of the LHBT in 11 individuals (average age 56.9 years, range 42 to 73) more than 3 mo after rupture. All patients were evaluated by Disabilites of the Arm Shoulder and Hand (DASH) and Mayo outcome scores at an average follow-up of 19.1 mo. We similarly evaluated 5 patients (average age 58.2 years, range 45 to 64) over the same time treated within 3 mo of rupture with an average follow-up of 22.5 mo. Tenodesis with an interference screw was possible in all patients more than 3 mo after rupture and 90% had good to excellent outcomes but two had recurrent rupture. All of those who had tenodesis less than 3 mo after rupture had good to excellent outcomes and none had recurrent rupture. No statistical difference was found for DASH and Mayo outcome scores between the two groups (P <0.05). Tenodesis of LHBT more than 3 mo following rupture had outcomes similar to tenodesis done within 3 mo of rupture but recurrent rupture occurred in 20%.

Outcomes of Primary Biceps Sub-pectoral Tenodesis in an Active Population: A prospective Evaluation of 101 Patients

Objectives:SLAP tears and tendonitis disorders of the long head of the biceps tendon (LHBT) remain a challenge to treat in an active population. The purpose of this study is to prospectively compare the surgical outcomes of a primary biceps tenodesis for SLAP tears and biceps tenosynovitis in a young active population.Methods:Over a 6-year period, 125 patients with mean age of 42.6 (range, 26.3 to 56.5) with a diagnosis of LHBT were prospectively evaluated. Inclusion criteria included patients with a clinical diagnosis of a type II SLAP or anterior shoulder pain who failed conservative management and underwent a diagnostic shoulder arthroscopy. Patients were excluded for full-thickness rotator cuff tears, AC joint pathology, and labral pathology outside of the SLAP lesion. Patients with an arthroscopically confirmed labral tear or biceps tendonopathy underwent a mini-open subpectoral tenodesis with interference screw and were independently evaluated with patient reported outcome measurements (SANE, WORC), and a biceps position examination. Statistical analysis was via Student’s t-test and significance set at p <.05.Results:101 of 125 patients (81%) completed the study requirements at a mean of 2.75 years (range 1.5 to 5.7 years). 50 Patients were diagnosed with SLAP II tears (40%) and 75 patients with biceps tendonitis (60%), 28 (22%) underwent a rotator cuff debridement for a concomitant low-grade partial rotator cuff tear and LHBT instability. There was a clinically and statistical improvement in patient outcomes scores: (WORC=54%, SANE=58) improved to (WORC=89%, SANE=89.5, p<0.01). 82% of patients returned to work and full activity at a mean of 4.1 months. The biceps muscle measured relative to the antecubital fossa of operative (mean 3.20 cm) versus non-operative (3.11 cm) was not clinically different (p=0.57), except in the 3 that failed tenodesis fixation. There was an 8% complication rate: 3 patients sustained failure of the LHBT tenodesis requiring revision; 2 superficial infections treated with antibiotics; and 3 transient musculoskeletal neruopraxias.Conclusion:A primary biceps tenodesis for pathology of the LHBT provides a clinical and statistically significant improvement in shoulder outcomes with a reliable and efficient return to previous activity level and low risk for surgical complications. However, additional work is necessary to define optimal primary treatment of LHB disorders.

A Comparison of Forearm Supination and Elbow Flexion Strength in Patients With Long Head of the Biceps Tenotomy or Tenodesis

The purpose of this study was to compare the forearm supination and elbow flexion strength of the upper extremity in patients who have had an arthroscopic long head of the biceps tendon (LHBT) release with patients who have had an LHBT tenodesis. Cybex isokinetic strength testing (Cybex Division of Lumex, Ronkonkoma, NY) was performed on 17 patients who underwent arthroscopic LHBT tenotomy, 19 patients who underwent arthroscopic LHBT tenodesis, and 31 age-, gender-, and body mass index-matched control subjects. Subjects were considered fully recovered from shoulder surgery, were released for unrestricted activities, and were at least 6 months after surgery before testing. Subjects were tested for forearm supination and elbow flexion strength of both arms by use of a Cybex II NORM isokinetic dynamometer at 60°/s and 120°/s. Testing was performed on injured and uninjured arms as well as dominant and nondominant arms in control subjects. Both forearm supination and elbow flexion strength values were recorded. Comparison between the involved and uninvolved upper extremities within each group by use of a paired t test showed a 7% increase in elbow flexion strength when the dominant and nondominant arms were compared at 60°/s. Neither the tenotomy nor tenodesis groups exhibited elbow flexion strength differences at 120°/s (all P ≥ .147). Comparison between groups by use of 2 × 3 analysis of variance (speed × group) showed no statistical difference in either forearm supination or elbow flexion strength when we compared the tenotomy, tenodesis, and control groups. In asymptomatic patients who have had biceps tenotomy or tenodesis, no statistically significant forearm supination or elbow flexion strength differences existed in the involved extremity between the 2 study groups. Level III, case-control study.

Soft tissue tenodesis of the long head of the biceps tendon associated to the Roman Bridge repair

BackgroundRotator cuff tears are frequently associated with pathologies of the long head of the biceps tendon (LHBT). Tenotomy and tenodesis of the LHBT are commonly used to manage disorders of the LHBT.MethodsWe present an arthroscopic soft tissue LHBT tenodesis associated with a Roman Bridge (double pulley – suture bridges) repairResultsTwo medial row 5.5-mm Bio-Corkscrew suture anchors (Arthrex, Naples, FL), double-loaded with No. 2 FiberWire sutures (Arthrex, Naples, FL), are placed in the medial aspect of the footprint. A shuttle is passed through an anterior point of the rotator cuff and through the LHBT by means of a Penetrator or a BirdBeak suture passer (Arthrex, Naples, FL). A tenotomy of the LHBT is performed. All the sutures from the anteromedial anchor are passed through a single anterior point in the rotator cuff using a shuttle technique. All the sutures from the posteromedial anchor are passed through a single posterior point in the rotator cuff. The sutures in the medial row are tied using the double pulley technique. A suture limb is retrieved from each of the medial anchors and manually tied as a six-throw surgeon's knot over a metal rod. The two free suture limbs are pulled to transport the knot over the top of the tendon bridge. The two free suture limbs are then used to produce suture bridges over the tendon, using a Pushlock (Arthrex, Naples, FL), placed 1 cm distal to the lateral edge of the footprint. The same double pulley – suture bridges technique is repeated for the other two suture limbs from the two medial anchors.ConclusionThis technique allows to perform a double pulley – suture bridges repair for a rotator cuff tear, associated with a soft tissue tenodesis for the management of LHBT pathology. The tenodesis of the LHBT is performed just with the passage of a shuttle inside the LHBT, after passing it through the anterior portion of the rotator cuff, with successive detachment of the LHBT from the glenoid. It is a technically easy procedure which can be performed relatively quickly, and does not require additional fixation.