Arthroscopic Biceps Tenodesis: Technique and Results in Six Dogs

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.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00193 ◽

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.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120975354 ◽

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.

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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.

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Clinical Outcomes after Subpectoral Biceps Tenodesis with an Interference Screw

The American Journal of Sports Medicine ◽

10.1177/0363546508318192 ◽

2008 ◽

Vol 36 (10) ◽

pp. 1922-1929 ◽

Cited By ~ 153

Author(s):

Augustus D. Mazzocca ◽

Mark P. Cote ◽

Cristina L. Arciero ◽

Anthony A. Romeo ◽

Robert A. Arciero

Keyword(s):

Rotator Cuff ◽

Clinical Outcome ◽

Physical Examination ◽

Outcome Measures ◽

Interference Screw ◽

Biceps Tenodesis ◽

Rotator Cuff Lesion ◽

The Mean ◽

Subpectoral Biceps Tenodesis

Background Subpectoral biceps tenodesis with an interference screw has been shown to be an effective procedure from both an anatomic and biomechanical perspective. There have been no clinical outcome data on this procedure to date. Hypothesis Subpectoral biceps tenodesis is an effective procedure in eliminating biceps tendinosis symptoms. Study Design Case series; Level of evidence, 4. Methods Patients who underwent subpectoral biceps tenodesis with a minimum follow-up of 1 year were evaluated using a battery of clinical outcome measures, biceps apex difference, and pain scores. A diagnosis of biceps tendinosis was made using a specific diagnostic protocol coupled with observation of biceps tendon fraying and increased erythema on dry arthroscopy. Results Between November 2002 and August 2005, 50 patients underwent subpectoral biceps tenodesis. Complete follow-up examinations were performed in 41 of 50 (82%). There were 16 women and 25 men (mean age, 50 years). Follow-up averaged 29 months (range, 12–49 months). The mean scores were 86, Rowe; 81, American Shoulder and Elbow Surgeons (ASES); 9, Simple Shoulder Test (SST); 87, Constant Murley; and 84, Single Assessment Numeric Evaluation (SANE). There was 1 failure as demonstrated by pull-out of the tendon from the bone tunnel resulting in a “Popeye” deformity on physical examination. The mean value for biceps apex distance was 0.15 cm, with 35 of 41 patients demonstrating no difference on physical examination. Twenty-three of 41 patients had complete preoperative and postoperative examinations. All clinical outcome measures demonstrated a statistically significant improvement at follow-up when compared with the preoperative scores. Thirty-one patients had identified lesions of the rotator cuff at time of arthroscopy. The mean ASES score in patients without rotator cuff lesion (89.2 ± 10.3) was significantly greater than the mean ASES for those with rotator cuff lesion (78.0 ± 21.0) ( P = .0324). The mean SST score in patients without rotator cuff lesion (10.6 ± 1.5) was significantly greater than the mean ASES score for those with rotator cuff lesion (8.8 ± 2.7) ( P = .0132). Conclusion Subpectoral biceps tenodesis with an interference screw is a viable treatment option for patients with symptomatic biceps tendinosis. Anterior shoulder pain and biceps symptoms were resolved with this technique. Patients with coexistent rotator cuff lesion had less favorable outcomes.

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A Combined Technique for Distal Biceps Repair Using a Soft Tissue Button and Biotenodesis Interference Screw

The American Journal of Sports Medicine ◽

10.1177/0363546508330130 ◽

2009 ◽

Vol 37 (5) ◽

pp. 989-994 ◽

Cited By ~ 49

Author(s):

Andrew D. Heinzelmann ◽

Felix H. Savoie ◽

J. Randall Ramsey ◽

Larry D. Field ◽

Augustus D. Mazzocca

Keyword(s):

Soft Tissue ◽

Biceps Tendon ◽

Interference Screw ◽

Distal Biceps Tendon ◽

Distal Biceps ◽

Early Return ◽

Accelerated Rehabilitation ◽

Tendon Ruptures ◽

Anterior Incision

Background There are many techniques described to repair acute distal biceps tendon ruptures. The authors’ objective is to report the results of a single-incision technique using a combination of a soft tissue button and biotenodesis interference screw with accelerated rehabilitation. Hypothesis Dual fixation of a distal biceps rupture will allow for early return to function. Study Design Case series; Level of evidence, 4. Methods From February 2004 to July 2007, 41 elbows in 40 patients had repair of an acute distal biceps tendon rupture (<6 weeks) through an anterior incision using a soft tissue button and interference screw combined technique. The patients were evaluated pre- and postoperatively with a physical examination, radiographs, and the Andrews-Carson elbow score. Nine patients were unavailable for follow-up. The remaining 31 patients (32 elbows) were contacted for a telephone interview at an average of 24 months postoperatively. Results The preoperative Andrews-Carson score averaged 168 and the postoperative Andrews-Carson score averaged 196 points at final clinical follow-up. There was a statistically significant difference between the pre- and postoperative Andrews-Carson scores (P < .001). One patient had heterotopic ossification associated with decreased pronation and supination. Two superficial radial nerve palsies completely resolved by final follow-up. The average postoperative time to resume normal activities or return to work was 6.5 weeks. Conclusion Repair of acute distal biceps tendon ruptures using a soft tissue button and interference screw technique through a limited anterior incision can allow for accelerated rehabilitation and early return to function.

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

Orthopedics ◽

10.3928/01477447-20150105-04 ◽

2015 ◽

Vol 38 (1) ◽

pp. 37-41 ◽

Cited By ~ 14

Author(s):

Patrick Kane ◽

Philip Hsaio ◽

Bradford Tucker ◽

Kevin B. Freedman

Keyword(s):

Biceps Tendon ◽

Biceps Tenodesis ◽

Tendon Pathology ◽

Subpectoral Biceps Tenodesis

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Clinical Evaluation of an Arthroscopic Knotless Suprapectoral Biceps Tenodesis Technique: Loop ’n’ Tack Tenodesis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118779786 ◽

2018 ◽

Vol 6 (6) ◽

pp. 232596711877978 ◽

Cited By ~ 5

Author(s):

Robert A. Duerr ◽

Darin Nye ◽

James M. Paci ◽

Sam Akhavan

Keyword(s):

Los Angeles ◽

Shoulder Pain ◽

Biceps Tendon ◽

Demographic Data ◽

Case Series ◽

High Rate ◽

Biceps Tenodesis ◽

Excellent Outcome ◽

Shoulder Score

Background: Pathology of the long head of the biceps tendon is a well-known cause of shoulder pain that is commonly managed with arthroscopic suprapectoral biceps tenodesis when conservative treatment fails. Purpose: To present an arthroscopic knotless suprapectoral biceps tenodesis technique known as “Loop ’n’ Tack” tenodesis and to report the clinical outcomes of patients with a minimum 2 years of follow-up. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review of all patients who had undergone Loop ’n’ Tack tenodesis between January 2009 and May 2014 was completed. Charts were reviewed, and patients were contacted for demographic data, time from surgery, concomitant procedures, and workers’ compensation status, as well as visual analog scale for pain, American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, and University of California, Los Angeles (UCLA) scores. Results: Complete follow-up evaluations were performed for 59 of 68 patients (87%). Mean follow-up was 43 months. A majority (88%) of patients had at least 1 additional procedure performed at the time of biceps tenodesis. The mean ASES shoulder score improved from 42.6 preoperatively to 91.0 postoperatively ( P < .001), and 54 of 59 patients (91.5%) had a good/excellent outcome, with a UCLA shoulder score >27 and ASES shoulder score >70. Three patients (5%) reported biceps cramping pain with overuse, and 2 (3.3%) reported intermittent anterior shoulder pain. No patients had developed a “Popeye” deformity at final clinical examination, and 97% reported that they were overall satisfied with the procedure. Conclusion: The Loop ’n’ Tack tenodesis technique results in a high rate of patient satisfaction, significant improvement in shoulder outcome scores, and a low incidence of postoperative pain, with no reoperations for biceps-related pathology.

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