scholarly journals Quantification of Long Head of the Biceps Tendon Motion After Loop ‘N’ Tack Suprapectoral Biceps Tenodesis

2017 ◽  
Vol 5 (7_suppl6) ◽  
pp. 2325967117S0039 ◽  
Author(s):  
Brian J. Kelly ◽  
Patrick J. Schimoler ◽  
Alexander Kharlamov ◽  
Mark Carl Miller ◽  
Sam Akhavan
Keyword(s):  
Biceps Tendon ◽  
Biceps Tenodesis ◽  
Long Head

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

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.

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

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.

scholarly journals Radiostereometric Analysis Of Biceps Tenodesis: A Comparison Of Techniques

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.

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

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.

scholarly journals Subpectoral versus suprapectoral biceps tenodesis yields similar clinical outcomes: a systematic review

2021 ◽  
pp. jisakos-2020-000543
Author(s):  
John W Belk ◽  
Stephen G Thon ◽  
John Hart ◽  
Eric C McCarty, Jr. ◽  
Eric C McCarty
Keyword(s):  
Systematic Review ◽  
Treatment Failure ◽  
Clinical Outcomes ◽  
Biceps Brachii ◽  
Biceps Tendon ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Biceps Tenodesis ◽  
Patient Reported ◽  
Long Head

ImportanceArthroscopic suprapectoral biceps tenodesis (ABT) and open subpectoral biceps tenodesis (OBT) are two surgical treatment options for relief of long head of the biceps tendon (LHBT) pathology and superior labrum anterior to posterior (SLAP) tears. There is insufficient knowledge regarding the clinical superiority of one technique over the other.ObjectiveTo systematically review the literature in order to compare the clinical outcomes and safety of ABT and OBT for treatment of LHBT or SLAP pathology.Evidence reviewA systematic review was performed by searching PubMed, the Cochrane Library and Embase to identify studies that compared the clinical efficacy of ABT versus OBT. The search phrase used was: (bicep OR biceps OR biceps brachii OR long head of biceps brachii OR biceps tendinopathy) AND (tenodesis). Patients were assessed based on the American Shoulder and Elbow Surgeons Score, the visual analogue scale, the Single Assessment Numeric Evaluation, Constant-Murley Score, clinical failure, range of motion, bicipital groove pain and strength. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and both the Cochrane Collaboration’s and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) risk of bias tools were used to evaluate risk of bias.FindingsEight studies (one level I, seven level III) met inclusion criteria, including 326 patients undergoing ABT and 381 patients undergoing OBT. No differences were found in treatment failure rates or patient-reported outcome scores between groups in any study. One study found OBT patients to experience significantly increased range of shoulder forward flexion when compared with ABT patients (p=0.049). Two studies found ABT patients to experience significantly more postoperative stiffness when compared with OBT patients (p<0.05).ConclusionsPatients undergoing ABT and OBT can be expected to experience similar improvements in clinical outcomes at latest follow-up without differences treatment failure or functional performance. ABT patients may experience an increased incidence of stiffness in the early postoperative period.Level of evidenceIII.

scholarly journals Rates and Risk Factors for Revision Open and Arthroscopic Proximal Biceps Tenodesis

2019 ◽  
Vol 7 (2) ◽  
pp. 232596711882547 ◽  
Author(s):  
Brian Forsythe ◽  
Avinesh Agarwalla ◽  
Richard N. Puzzitiello ◽  
Randy Mascarenhas ◽  
Brian C. Werner
Keyword(s):  
Risk Factors ◽  
Rotator Cuff ◽  
Protective Factors ◽  
Biceps Tendon ◽  
Rotator Cuff Tears ◽  
Biceps Tenodesis ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Male Sex ◽  
Long Head

Background: Biceps tenodesis may be performed for symptomatic tendinopathy or tearing of the long head of the biceps tendon. Biceps tenodesis is also commonly performed as an adjunctive procedure. However, the indications and prevalence of biceps tenodesis have expanded. Purpose: To establish the incidence and risk factors for revision biceps tenodesis. Study Design: Case-control study; Level of evidence, 2. Methods: The PearlDiver database of Humana patient data was queried for patients undergoing arthroscopic or open biceps tenodesis (Current Procedural Terminology [CPT] 29828 and CPT 23430, respectively) from 2008 through the first quarter of 2017. Patients without a CPT laterality modifier were excluded from analysis. Revision biceps tenodesis was defined as patients who underwent subsequent ipsilateral open or arthroscopic biceps tenodesis. The financial impact of revision biceps tenodesis was also calculated. Multivariate binomial logistic regression was performed to identify risk factors for revision biceps tenodesis, such as patient demographics as well as concomitant procedures and diagnoses. Odds ratios (ORs) and 95% CIs were calculated, and all statistical comparisons with P < .05 were considered significant. Results: There were 15,257 patients who underwent biceps tenodesis. Of these, 9274 patients (60.8%) underwent arthroscopic biceps tenodesis, while 5983 (39.2%) underwent open biceps tenodesis. A total of 171 patients (1.8%) and 111 patients (1.9%) required revision biceps tenodesis after arthroscopic and open biceps tenodesis, respectively ( P = .5). Male sex (OR, 1.38 [95% CI, 1.04-1.85]; P = .02) was the only independent risk factor for revision biceps tenodesis after the index open biceps tenodesis. After arthroscopic biceps tenodesis, age >45 years (OR, 0.58 [95% CI, 0.39-0.89]; P = .01) and concomitant rotator cuff tear (OR, 0.58 [95% CI, 0.47-0.71]; P < .001) were independent protective factors for revision biceps tenodesis. The total cost of revision biceps tenodesis after open and arthroscopic biceps tenodesis was US$3427.95 and US$2174.33 per patient, respectively. Conclusion: There was no significant difference in the revision rate between arthroscopic and open biceps tenodesis. Risk factors for revision surgery included male sex for open biceps tenodesis, while age >45 years and rotator cuff tears were protective factors for arthroscopic biceps tenodesis.

Clinical outcome comparison of suprapectoral and subpectoral tenodesis of the long head of the biceps with concomitant rotator cuff repair: A systematic review

2021 ◽  
pp. 175857322198908
Author(s):  
Selim Ergün ◽  
Yiğit Umur Cırdı ◽  
Said Erkam Baykan ◽  
Umut Akgün ◽  
Mustafa Karahan
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Case Reports ◽  
Biceps Tendon ◽  
Case Series ◽  
Biceps Tenodesis ◽  
Long Head Of Biceps ◽  
Long Head ◽  
Cuff Repair ◽  
Popeye Deformity

Background Simultaneous repairs of rotator cuff and biceps tenodesis can be managed by tenodesis of long head of biceps tendon to a subpectoral or suprapectoral area. This review investigated long head of biceps tendon tenodesis with concomitant rotator cuff repair and evaluated the clinical outcomes and incidences of complications based on tenodesis location. Methods Medline, Cochrane, and Embase databases were searched for published, randomized or nonrandomized controlled studies and prospective or retrospective case series with the phrases “suprapectoral,” “subpectoral,” “tenodesis,” and “long head of biceps tendon”. Those with a clinical evidence Level IV or higher were included. Non-English manuscripts, review articles, commentaries, letters, case reports, and sole long head of biceps tendon tenodesis articles were excluded. Results From 481 studies, 13 were chosen. In total, 1194 subpectoral and 2520 suprapectoral tenodesis cases were investigated. Postoperative Constant-Murley and American Shoulder and Elbow Surgeons mean scores showed similar good results. In terms of complication incidences, while transient nerve injuries were more commonly seen in patients with subpectoral tenodesis, persistent bicipital pain and Popeye deformity are mostly seen in patients with suprapectoral tenodesis. Discussion Biceps tenodesis to suprapectoral or subpectoral area with concomitant rotator cuff repair demonstrated similar outcomes. Popeye deformity and persistent bicipital pain were higher in suprapectoral area and transient neuropraxia was found to be higher in subpectoral area. Level of evidence: IV.

Chronic rupture of the long head of the biceps tendon: comparison of 2-year results following primary versus revision open subpectoral biceps tenodesis

2016 ◽  
Vol 136 (5) ◽  
pp. 657-663 ◽  
Author(s):  
Simon A. Euler ◽  
Marilee P. Horan ◽  
Michael B. Ellman ◽  
Joshua A. Greenspoon ◽  
Peter J. Millett
Keyword(s):  
Biceps Tendon ◽  
Biceps Tenodesis ◽  
Chronic Rupture ◽  
Long Head ◽  
Subpectoral Biceps Tenodesis

Biceps Tenodesis Versus Tenotomy in the Treatment of Lesions of the Long Head of the Biceps Tendon in Patients Undergoing Arthroscopic Shoulder Surgery: A Prospective Double-Blinded Randomized Controlled Trial

2020 ◽  
Vol 48 (6) ◽  
pp. 1439-1449 ◽  
Author(s):  
Peter MacDonald ◽  
Fleur Verhulst ◽  
Sheila McRae ◽  
Jason Old ◽  
Greg Stranges ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Randomized Controlled Trial ◽  
Magnetic Resonance ◽  
Biceps Tendon ◽  
Controlled Trial ◽  
Scientific Quality ◽  
Biceps Tenodesis ◽  
Resonance Imaging ◽  
Randomized Controlled ◽  
Long Head

Background: The biceps tendon is a known source of shoulder pain. Few high-level studies have attempted to determine whether biceps tenotomy or tenodesis is the optimal approach in the treatment of biceps pathology. Most available literature is of lesser scientific quality and shows varying results in the comparison of tenotomy and tenodesis. Purpose: To compare patient-reported and objective clinical results between tenotomy and tenodesis for the treatment of lesions of the long head of the biceps brachii. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients aged ≥18 years undergoing arthroscopic surgery with intraoperative confirmation of a lesion of the long head of the biceps tendon were randomized. The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) score, while secondary outcomes included the Western Ontario Rotator Cuff Index (WORC) score, elbow and shoulder strength, operative time, complications, and the incidence of revision surgery with each procedure. Magnetic resonance imaging was performed at postoperative 1 year to evaluate the integrity of the procedure in the tenodesis group. Results: A total of 114 participants with a mean age of 57.7 years (range, 34 years to 86 years) were randomized to undergo either biceps tenodesis or tenotomy. ASES and WORC scores improved significantly from pre- to postoperative time points, with a mean difference of 32.3% ( P < .001) and 37.3% ( P < .001), respectively, with no difference between groups in either outcome from presurgery to postoperative 24 months. The relative risk of cosmetic deformity in the tenotomy group relative to the tenodesis group at 24 months was 3.5 (95% CI, 1.26-9.70; P = .016), with 4 (10%) occurrences in the tenodesis group and 15 (33%) in the tenotomy group. Pain improved from 3 to 24 months postoperatively ( P < .001) with no difference between groups. Cramping was not different between groups, nor was any improvement in cramping seen over time. There were no differences between groups in elbow flexion strength or supination strength. Follow-up magnetic resonance imaging at postoperative 12 months showed that the tenodesis was intact for all patients. Conclusion: Tenotomy and tenodesis as treatment for lesions of the long head of biceps tendon both result in good subjective outcomes but there is a higher rate of Popeye deformity in the tenotomy group. Registration: NCT01747902 ( ClinicalTrials.gov identifier)

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