An arthroscopic technique for confirming intra-articular subluxation of the long head of the biceps tendon: The ramp test

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.

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Biceps tendinopathy

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114s00248 ◽

2014 ◽

Vol 2 (12_suppl4) ◽

pp. 2325967114S0024

Author(s):

Maximiliano Ibáñez ◽

Ana Belén Calvo ◽

Victoria Alvarez ◽

Salvador Lepore ◽

Federico Ibáñez ◽

...

Keyword(s):

Clinical Assessment ◽

Biceps Tendon ◽

Arthroscopic Technique ◽

Simple Shoulder Test ◽

Group A ◽

Long Head ◽

Group B ◽

Tendon Pathology ◽

Open Subpectoral Tenodesis

Introduction: Tenodesis is the preferred technique in the treatment of the long head of the biceps tendon pathology in younger people, athletes, workers, and those wishing to avoid any cosmetic deformity. The aim of our study was to compare a group of patients who underwent all arthroscopic biceps tenodesis with a group of patients who underwent an open subpectoral procedure. A clinical assessment was performed and we also registered the occurrence of complications. Materials and Methods: We retrospectively reviewed 90 patients with lesions in the long head of the biceps tendon treated at our institution between January 2009 and January 2012. Group A underwent an arthroscopic technique while Group B was treated in an open fashion. Clinical assessment included appropriate scores (ASES, Rowe, Simple Shoulder Test, Constant Murley), and we also evaluated pain with Visual Analogue Scale (VAS), and personal satisfaction in terms of aesthetics and local pain at the scar. Results: Group A: Rowe 86 points, ASES 81 points, SST 9 points, Constant and Murley 87 points. VAS 2/10. Regarding scars of the portals patients were satisfied. Group B: Rowe 85 points, ASES 82 points, SST 8.5 points, Constant and Murley 85 points. VAS 3/10 (greater at the site of subpectoral approach). Aesthetic concerns about the scar was observed in 4 cases (4 women). Arm deformity (sign of Popeye) was not observed at the latest follow-up. Discussion: No statistical significant differences were found in clinical assessment between both procedures. Arthroscopic tenodesis is technically more challenging and requires an initial longer learning curve in order to perform a successful procedure. Open subpectoral tenodesis despite being a faster and simpler procedure reports discomfort regarding the scar site.

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Using the Long Head of Biceps Tendon Autograft as an Anatomical Reconstruction of the Rotator Cable: An Arthroscopic Technique for Patients With Massive Rotator Cuff Tears

Arthroscopy Techniques ◽

10.1016/j.eats.2018.03.002 ◽

2018 ◽

Vol 7 (7) ◽

pp. e699-e703 ◽

Cited By ~ 4

Author(s):

Egbert J.D. Veen ◽

Cornelis T. Koorevaar ◽

Ronald L. Diercks

Keyword(s):

Rotator Cuff ◽

Biceps Tendon ◽

Rotator Cuff Tears ◽

Anatomical Reconstruction ◽

Arthroscopic Technique ◽

Massive Rotator Cuff Tears ◽

Rotator Cable ◽

Long Head Of Biceps ◽

Long Head ◽

Tendon Autograft

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Symptomatic Superior Labral Anterior Posterior Lesion With Absence of the Long Head of the Biceps Tendon: A Case Report

Yearbook of Sports Medicine ◽

10.1016/s0162-0908(08)70296-4 ◽

2006 ◽

Vol 2006 ◽

pp. 60-61

Author(s):

D.E. Feldman

Keyword(s):

Case Report ◽

Biceps Tendon ◽

Posterior Lesion ◽

Long Head ◽

Anterior Posterior

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Measurements of Tendon Movement Within the Bicipital Groove After Suprapectoral Intra-articular Biceps Tenodesis in a Cadaveric Model

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120977538 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097753

Author(s):

Brian J. Kelly ◽

Alan W. Reynolds ◽

Patrick J. Schimoler ◽

Alexander Kharlamov ◽

Mark Carl Miller ◽

...

Keyword(s):

Biceps Tendon ◽

Full Range ◽

Elbow Flexion ◽

Biceps Tenodesis ◽

Bicipital Groove ◽

Biceps Tenotomy ◽

Flexion Extension ◽

Before And After ◽

Long Head ◽

Scapular Motion

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.

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