All-Arthroscopic Long Head of the Biceps Transfer: An Optional Technique for Soft-Tissue Biceps Tenodesis

Background: Lesions of the long head of the biceps can be successfully treated with biceps tenotomy or tenodesis when surgical management is elected. The advantage of a tenodesis is that it prevents the potential development of a cosmetic deformity or cramping muscle pain. Proponents of a subpectoral tenodesis believe that “groove pain” may remain a problem after suprapectoral tenodesis as a result of persistent motion of the tendon within the bicipital groove. Purpose/Hypothesis: To evaluate the motion of the biceps tendon within the bicipital groove before and after a suprapectoral intra-articular tenodesis. The hypothesis was that there would be minimal to no motion of the biceps tendon within the bicipital groove after tenodesis. Study Design: Controlled laboratory study. Methods: Six fresh-frozen cadaveric arms were dissected to expose the long head of the biceps tendon as well as the bicipital groove. Inclinometers and fiducials (optical markers) were used to measure the motions of the scapula, forearm, and biceps tendon through a full range of shoulder and elbow motions. A suprapectoral biceps tenodesis was then performed, and the motions were repeated. The motion of the biceps tendon was quantified as a function of scapular or forearm motion in each plane, both before and after the tenodesis. Results: There was minimal motion of the native biceps tendon during elbow flexion and extension but significant motion during all planes of scapular motion before tenodesis, with the most motion occurring during shoulder flexion-extension (20.73 ± 8.21 mm). The motion of the biceps tendon after tenodesis was significantly reduced during every plane of scapular motion compared with the native state ( P < .01 in all planes of motion), with a maximum motion of only 1.57 mm. Conclusion: There was a statistically significant reduction in motion of the biceps tendon in all planes of scapular motion after the intra-articular biceps tenodesis. The motion of the biceps tendon within the bicipital groove was essentially eliminated after the suprapectoral biceps tenodesis. Clinical Relevance: This arthroscopic suprapectoral tenodesis technique can significantly reduce motion of the biceps tendon within the groove in this cadaveric study, possibly reducing the likelihood of groove pain in the clinical setting.

Download Full-text

Suprapectoral vs. Intra Articular Biceps Tenodesis: A Comparison of Clinical Outcomes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00108 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0010

Author(s):

Brian M. Godshaw ◽

Nicholas Kolodychuk ◽

Benjamin Bryan Browning ◽

Gerard Williams ◽

Rachel Burdette ◽

...

Keyword(s):

Clinical Outcomes ◽

Outcome Measures ◽

Glenohumeral Joint ◽

Short Form ◽

Biceps Tendon ◽

Biceps Tenodesis ◽

Measured Time ◽

Long Head ◽

Distally Based

Objectives: The long head of the biceps tendon is a frequent pain generator within the shoulder. It is subjected to trauma and wear within the glenohumeral joint and within the intertubercular groove. Tenodesis of this tendon is a common treatment option for patients experiencing biceps tendon related pain. There are several different techniques to perform this procedure. Proximal intra-articular tenodesis can be performed but leaves the tendon within the intertubercular groove. Alternatively, suprapectoral tenodesis can be performed removing the tendon from the bicipital groove and sheath while avoiding conversion to an open procedure. Further, suprapectoral tenodesis limits complications associated with an open distally based incision. Several studies have compared these techniques to tenotomy or open-subpectoral tenodesis. This is the first study to directly compare patient outcomes between intra-articular and suprapectoral bicep tenodeses. Methods: Retrospective review of patients undergoing intra-articular or suprapectoral arthroscopic biceps tenodesis from 2010 - 2015. Clinical outcomes were measured at set intervals post-operatively (3 months, 6 months, and 12 months) and compared to pre-operative scores. Outcome measures included short form-12, both physical (PSF) and mental (MSF) component scores, and the American Shoulder and Elbow Surgeons score (ASES). Results: A total of 96 patients were available for this study, 43 had intra-articular tenodesis and 56 had suprapectoral tenodesis. There was no difference in functional outcomes between intra and extra articular biceps tenodesis at 1-year post-operative. The intra-articular group had a quicker improvement in scores with the greatest increase at 3 months post-operatively, specifically in PSF group (p=0.016): however, this difference leveled off at 1-year follow up (p=0.238). The intra-articular group had greater absolute scores at all measured time points, but not significantly. Both groups showed improvement in all outcome measures and there was found to be no difference in changes for ASES, PSF, or MSF (p=0.262, p=0.489, and p=0.907 respectively). Conclusion: This study demonstrates that both intra-articular and surpapectoral techniques are acceptable options for biceps tenodesis. Despite leaving the biceps tendon within the glenohumeral joint and intertubercular groove, the intra-articular technique offers similar improvement in outcome measures to the suprapectoral technique.

Download Full-text

Radiostereometric Analysis Of Biceps Tenodesis: A Comparison Of Techniques

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00122 ◽

2020 ◽

Vol 8 (3_suppl2) ◽

pp. 2325967120S0012

Author(s):

Kelechi Okoroha ◽

Brandon J. Manderle ◽

Alexander Beletsky ◽

Adam Blair Yanke ◽

Brian J. Cole ◽

...

Keyword(s):

Screw Fixation ◽

Biceps Tendon ◽

Similar Amount ◽

X Rays ◽

Biceps Tenodesis ◽

Radiostereometric Analysis ◽

Arthroscopic Technique ◽

Distal Migration ◽

Long Head ◽

Anchor Fixation

Objectives: Arthroscopic biceps tenodesis (BT) is a common surgical procedure for treatment of anterior shoulder pain due to long head of the biceps pathology. BT can be accomplished via several different techniques. There continues to be a paucity of literature comparing the different techniques and fixation devices. The purpose of this study was to compare 4 different techniques for accomplishing a BT utilizing radiostereometric analysis. Methods: This study was a prospectively enrolled non-randomized trial of patients undergoing BT. All patients were treated at a single institution by 1 of 4 surgeons. Four different techniques were analyzed, 1) open BT with screw fixation, 2) open BT with single anchor fixation, 3) arthroscopic BT with screw fixation, and 4) arthroscopic BT with two suture anchor fixation. After the BT was completed a tantalum bead was sewn to the long head of the biceps tendon. This bead acted as a marker of the position of the biceps tendon. X-rays were taken during surgery while the patient remained sedated to establish time zero bead position. Follow up x-rays were completed at the patients 1st post-operative visit and 12 week post-operative visit. Position of the bead was measured at each time point in mm from the proximal most point of the humerus to its position distally. Results: A total of 60 patients were included in the analysis, with 15 patients in each of the 4 groups. Final bead position differed significantly for the open and arthroscopic techniques (107.35±20.39mm, 65.64±23.69mm, p<0.001), but did not differ significantly between the two open techniques and the two arthroscopic technique (p>0.05). The open technique resulted in 7.69±5.98mm of distal migration while the arthroscopic technique resulted in a similar amount of distal migration, 8.93±2.71mm. Conclusion: Short-term radiographic outcomes following open and arthroscopic biceps tenodesis revealed that each technique results in stable fixation of the tendon with minimal migration. Although a statistically significant migration occurred, this is likely clinically insignificant. This initial migration observed could be due to increased tensioning of the tendon when the patient is awake versus sedated.

Download Full-text

Arthroscopic Biceps Tenodesis: Soft Tissue versus Bone Fixation

The Korean Journal of Sports Medicine ◽

10.5763/kjsm.2014.32.2.133 ◽

2014 ◽

Vol 32 (2) ◽

pp. 133

Author(s):

Young-Kyu Kim ◽

Kyu-Hak Jung ◽

Dong-Hyun Kim

Keyword(s):

Soft Tissue ◽

Biceps Tenodesis ◽

Bone Fixation

Download Full-text

Type 2 Superior Labral Anterior Posterior (SLAP) Tear in 55-Year-Old Male with Concomitant Full-Thickness Rotator Cuff Tear Treated with Long Head of the Biceps Tenodesis and Rotator Cuff Repair

The Biceps and Superior Labrum Complex ◽

10.1007/978-3-319-54934-7_12 ◽

2017 ◽

pp. 159-172

Author(s):

Robert A. Duerr ◽

Darren A. Frank

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Full Thickness ◽

Biceps Tenodesis ◽

Cuff Tear ◽

Long Head ◽

Slap Tear ◽

Cuff Repair ◽

Anterior Posterior

Download Full-text

Nerve Injury with Long Head of the Biceps Tenodesis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00397 ◽

2017 ◽

Vol 5 (7_suppl6) ◽

pp. 2325967117S0039

Author(s):

Christopher L. McCrum ◽

Ram Kirin Alluri ◽

Raffy Mirzayan

Keyword(s):

Nerve Injury ◽

Biceps Tenodesis ◽

Long Head

Download Full-text

Characterization of the Proximal Long Head of Biceps Tendon Anatomy Using Magnetic Resonance Imaging: Implications for Biceps Tenodesis

The American Journal of Sports Medicine ◽

10.1177/0363546520976630 ◽

2020 ◽

pp. 036354652097663

Author(s):

Eugene T. Ek ◽

Andrew J. Philpott ◽

Jennifer N. Flynn ◽

Nada Richards ◽

Andrew J. Hardidge ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Biceps Tendon ◽

Proton Density ◽

Biceps Tenodesis ◽

Resonance Imaging ◽

Wide Variability ◽

Shoulder Mri ◽

Long Head ◽

Superior Border

Background: Biceps tenodesis is a common treatment for proximal long head of biceps (LHB) tendon pathology. To maintain biceps strength and contour and minimize cramping, restoration of muscle-length tension and appropriate positioning of the tenodesis is key. Little is known about the biceps musculotendinous junction (MTJ) anatomy, especially in relation to the overlying pectoralis major tendon (PMT), which is a commonly used landmark for tenodesis positioning. Purpose: To characterize the in vivo topographic anatomy of the LHB tendon, in particular the MTJ relative to the PMT, using a novel axial proton-density magnetic resonance imaging (MRI) sequence. Study Design: Descriptive laboratory study. Methods: In total, 45 patients having a shoulder MRI for symptoms unrelated to their biceps tendon or rotator cuff were prospectively recruited. There were 33 men and 12 women, with a mean age of 37 ± 13 years (range, 18-59 years). All patients underwent routine shoulder MRI scans with an additional axial proton density sequence examining the LHB tendon and its MTJ. Three independent observers reviewed each MRI scan, and measurements were obtained for (1) MTJ length, (2) the distance between the proximal MTJ and the superior border of the PMT (MTJ-S), (3) the distance between the distal MTJ to the inferior border of the PMT, and (4) the width of the PMT. Results: The average position of the MTJ-S was 5.9 ± 10.8 mm distal to the superior border of the PMT. The mean MTJ length was 32.5 ± 8.3 mm and the width of the PMT was 28.0 ± 7.3 mm. We found no significant correlation between patient age, height, sex, or body mass index and any of the biceps measurements. We observed wide variability of the MTJ-S position and identified 3 distinct types of biceps MTJ: type 1, MTJ-S above the PMT; type 2, MTJ-S between 0 and 10 mm below the superior border of the PMT; and type 3, MTJ-S >10 mm distal to the superior PMT. Conclusion: In this study, the in vivo anatomy of the LHB tendon is characterized relative to the PMT using a novel MRI sequence. The results demonstrate wide variability in the position of the MTJ relative to the PMT, which can be classified into 3 distinct subtypes or zones relative to the superior border of the PMT. Understanding this potentially allows for accurate and anatomic placement of the biceps tendon for tenodesis. Clinical Relevance: To our knowledge, this is the first study to radiologically analyze the in vivo topographic anatomy of the LHB tendon and its MTJ. The results of this study provide more detailed understanding of the variability of the biceps MTJ, thus allowing for more accurate placement of the biceps tendon during tenodesis.

Download Full-text