Open Subpectoral Biceps Tenodesis: Reliable Treatment for All Biceps Tendon Pathology

Orthopedics ◽  
2015 ◽  
Vol 38 (1) ◽  
pp. 37-41 ◽  
Author(s):  
Patrick Kane ◽  
Philip Hsaio ◽  
Bradford Tucker ◽  
Kevin B. Freedman
Keyword(s):  
Biceps Tendon ◽  
Biceps Tenodesis ◽  
Tendon Pathology ◽  
Subpectoral Biceps Tenodesis

Arthroscopic Biceps Tenodesis: Technique and Results in Six Dogs

2005 ◽  
Vol 41 (2) ◽  
pp. 121-127 ◽  
Author(s):  
James L. Cook ◽  
Keith Kenter ◽  
Derek B. Fox
Keyword(s):  
Surgical Management ◽  
Biceps Tendon ◽  
Interference Screw ◽  
Cannulated Screw ◽  
Biceps Tenodesis ◽  
Fixation Methods ◽  
Feasible Option ◽  
Successful Outcomes ◽  
Tendon Pathology

Biceps tenodesis was performed using an arthroscopic-assisted technique on six dogs diagnosed with chronic bicipital tendon pathology. The technique was performed using two different fixation methods (i.e., cannulated interference screw, cannulated screw and tissue washer). All six dogs had successful outcomes in terms of return to full function at a mean follow-up time of 11.7 months after surgery. Arthroscopic biceps tenodesis is a feasible option for surgical management of biceps tendon pathology, and it may have advantages over open tenodesis and open or arthroscopic tenotomy. Further study is needed before definitive recommendations regarding indications, complications, and prognosis associated with arthroscopic biceps tenodesis can be made.

scholarly journals Radiostereometric Analysis of Subpectoral versus Suprapectoral Biceps Tenodesis with Interference Screw Fixation

2019 ◽  
Vol 7 (3_suppl2) ◽  
pp. 2325967119S0019
Author(s):  
Richard N. Puzzitiello ◽  
Avinesh Agarwalla ◽  
Joseph N. Liu ◽  
Gregory L. Cvetanovich ◽  
Anirudh K. Gowd ◽  
...  
Keyword(s):  
Screw Fixation ◽  
Average Distance ◽  
Biceps Tendon ◽  
Interference Screw ◽  
Biceps Tenodesis ◽  
Radiostereometric Analysis ◽  
Distal Migration ◽  
Interference Screw Fixation ◽  
Subpectoral Biceps Tenodesis

Objectives: Biceps tenodesis is performed with increasing frequency for various pathologies of the long head biceps tendon (LHBT). Multiple surgical techniques and devices for tenodesis have been described with favorable outcomes. The subpectoral approach provides adequate clinical outcomes; furthermore, recent research suggests that similar outcomes can be achieved via arthroscopic suprapectoral biceps tenodesis. Previous studies have compared the biomechanical profile of suprapectoral and subpectoral biceps tenodesis. There is a paucity of data regarding the biomechanical behavior and construct stability of suprapectoral and subpectoral biceps tenodesis in vivo. The purpose of this investigation is to quantify and compare the behavior of the biceps tenodesis construct in arthroscopic suprapectoral (ASPBT) and open subpectoral (OSPBT) techniques, with radiostereometric analysis (RSA). Methods: This is a prospective cohort study comparing migration of the biceps tendon after suprapectoral and subpectoral biceps tenodesis with Polyetheretherketone (PEEK) interference screw fixation. Thirty consecutive patients were allocated to the subpectoral group, follow by thirty consecutive patients to the suprapectoral group. Patients aged 18-65 years with symptomatic biceps tendinopathy, anterior intertubercular groove tenderness, and positive biceps tension tests were included in the investigation. Patients undergoing revision biceps tenodesis, shoulder arthroplasty, or ruptured LHBT were excluded. A mini skin staple, functioning as a radiostereometric marker, was placed longitudinally within the tendon prior to final fixation with interference screw. Staple stability was confirmed with a hemostat to gravity. The distance from the most proximal portion of the mini skin staple and the most proximal aspect of the humeral head was measured. Following final fixation with an interference screw, AP radiographs were obtained intraoperatively. Follow-up radiographs were one week and 12 weeks post-operatively. A paired and non-paired students t-test were utilized to assess for intra-group and inter-group changes, respectively. Results: A total of 60 consecutive patients (30 per group) were enrolled and available for follow-up imaging at 1 and 12 weeks postoperatively. The average age was 43.5±10.5 years, average BMI was 28.3±5.4, and 50% of the patients were females. Groups were similar with respect to patient demographics and concomitant procedures (P>.05). In the OSPBT group, the average distance of the radiostereometic marker to the proximal humeral head increased on by 26.0 mm (SD, 15.7) from the immediate post-operative radiograph to 3 months postoperatively (P=0.002). In the ASPBT group, the average distance also significantly increased by 24.7 mm (SD, 14.9) from the immediate post-operative radiograph to 3-months postoperatively (P=0.001). The change in distal migration between the ASPBT and OSPBT was not found to be statistically significant (P> 0.05). Conclusion: Biceps tenodesis performed with a PEEK tenodesis screw results in significant distal migration of the biceps tendon by 3 months post-operatively; however, there was no significant difference in distal migration between the OSPBT and ASPBT groups.

scholarly journals Biomechanical Comparison of Subpectoral Biceps Tenodesis Onlay Techniques

2019 ◽  
Vol 7 (10) ◽  
pp. 232596711987627 ◽  
Author(s):  
Lucca Lacheta ◽  
Samuel I. Rosenberg ◽  
Alex W. Brady ◽  
Grant J. Dornan ◽  
Peter J. Millett
Keyword(s):  
Cyclic Loading ◽  
Suture Anchor ◽  
Biceps Tendon ◽  
Suture Anchors ◽  
Biceps Tenodesis ◽  
Fixation Technique ◽  
Ultimate Failure ◽  
Suture Anchor Fixation ◽  
Anchor Fixation ◽  
Subpectoral Biceps Tenodesis

Background: Subpectoral biceps tenodesis can be performed with cortical fixation using different repair techniques. The goal of this technique is to obtain a strong and stable reduction of biceps tendon in an anatomic position. Purpose/Hypothesis: The purpose of this study was to compare (1) displacement during cyclic loading, (2) ultimate load, (3) construct stiffness, and (4) failure mode of the biceps tenodesis fixation methods using onlay techniques with an all-suture anchor versus an intramedullary unicortical button. It was hypothesized that fixation with all-suture anchors using a Krackow stitch would exhibit biomechanical characteristics similar to those exhibited by fixation with unicortical buttons. Study Design: Controlled laboratory study. Methods: Ten pairs of fresh-frozen cadaveric shoulders (N = 20) were dissected to the humerus, leaving the biceps tendon-muscle unit intact for testing. A standardized subpectoral biceps cortical (onlay) tenodesis was performed using either an all-suture anchor or a unicortical button. The biceps tendon was initially cycled from 5 to 70 N at a frequency of 1.5 Hz. The force on the tendon was then returned to 5 N, and the tendon was pulled until ultimate failure of the construct. Displacement during cyclic loading, ultimate failure load, stiffness, and failure modes were assessed. Results: Cyclic loading resulted in a mean displacement of 12.5 ± 2.5 mm for all-suture anchor fixation and 29.2 ± 9.4 mm for unicortical button fixation ( P = .005). One all-suture anchor fixation and 2 unicortical button fixations failed during cyclic loading. The mean ultimate failure load was 170.4 ± 68.8 N for the all-suture anchor group and 125.4 ± 44.6 N for the unicortical button group ( P = .074), with stiffness 59.3 ± 11.6 N/mm and 48.6 ± 6.8 N/mm ( P = .091), respectively. For the unicortical button, failure occurred by suture tearing through tendon in 100% of the specimens. For the all-suture anchor, failure occurred by suture tearing through tendon in 56% and knot failure in 44% of the specimens. Conclusion: The all-suture anchor fixation using a Krackow stitch for subpectoral biceps tenodesis provided ultimate load and stiffness similar to unicortical button fixation using a nonlocking whipstitch. The all-suture anchor fixation technique was shown to be superior in terms of displacement during cyclic loading when compared with the unicortical button fixation technique. However, the results of this study help to show that the fixation method used on the humeral side is less implicative of the overall construct strength than stitch location and technique, as the biceps tendon tissue and stitch configuration seem to be the limiting factor in subpectoral onlay tenodesis techniques. Clinical Relevance: All-suture anchors have a smaller diameter than traditional suture anchors, can be inserted through curved guides, and preserve humeral bone stock without compromising postoperative imaging. This study supports use of the all-suture anchor fixation technique for subpectoral biceps tenodesis, with high biomechanical fixation strength and low displacement, as an alternative to the subpectoral onlay biceps tenodesis technique.

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

scholarly journals Proximal Biceps Tenodesis Incorporated into Supraspinatus Repair: A Case Series and Technical Description

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097535
Author(s):  
Joshua M. Veenstra ◽  
Andrew G. Geeslin ◽  
Christopher W. Uggen
Keyword(s):  
Rotator Cuff ◽  
Biceps Tendon ◽  
Tendon Repair ◽  
Case Series ◽  
Supraspinatus Tendon ◽  
Biceps Tenodesis ◽  
Arm Pain ◽  
Patient Reported ◽  
Tendon Pathology

Background: Biceps tendon pathology is commonly associated with rotator cuff tears. A multitude of different biceps tenodesis techniques have been studied, with limited clinical data on arthroscopic biceps tenodesis techniques incorporated into rotator cuff repairs. Purpose: To evaluate the outcomes of an arthroscopic biceps tenodesis incorporated into a supraspinatus tendon repair. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing surgical treatment of supraspinatus tendon tears with concomitant biceps tendon pathology were prospectively enrolled from 2014 to 2015. A total of 32 patients underwent combined biceps tenodesis and rotator cuff repair; of these, 19 patients were evaluated for a mean of 2.0 years. The primary outcome measures were the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES; patient self-report and physician assessment sections), visual analog scale (VAS) pain score, responses to specific biceps-related assessments, and biceps specific physical exam findings. Results: Patient-reported ASES scores improved from 45.9 preoperatively to 91.6 at the 2-year follow-up ( P < .001). Pain VAS scores improved from 5.2 preoperatively to 0.7 at the 2-year follow-up ( P < .001). Preoperatively, 18 patients had a positive Speed test; all were negative at 5 months postoperatively, and 21 patients had bicipital groove tenderness preoperatively, which resolved in all 21 patients at 5 months postoperatively. At the 2-year follow-up, 2 patients had cramping arm pain and 4 patients noticed a change in arm contour. There were no reoperations. No complications occurred in the study group. Conclusion: Arthroscopic biceps tenodesis incorporated into a supraspinatus tendon repair was a safe and reliable option for biceps pathology with a concomitant rotator cuff tear.

scholarly journals Arthroscopic Onlay Articular Margin Biceps Tenodesis for Long Head of the Biceps Tendon Pathology

2020 ◽  
Vol 9 (7) ◽  
pp. e959-e963
Author(s):  
Paul J. Cagle ◽  
Ryley K. Zastrow ◽  
Jimmy J. Chan ◽  
Akshar V. Patel ◽  
Bradford O. Parsons
Keyword(s):  
Biceps Tendon ◽  
Biceps Tenodesis ◽  
Long Head ◽  
Tendon Pathology

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.

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