AOSSM/AANA Specialty Day 2020-Handout - Biceps Tenodesis_ How I Do This and Why

Handout - Biceps Tenodesis_ How I Do This and Why_

Pdf Summary

This presentation by Dr. Alan S. Curtis from Boston Sports and Shoulder discusses biceps tenodesis, focusing on the reasons, timing, and surgical locations for the procedure.<br /><br />The long head of the biceps (LHB) tendon is about 9 cm long and 6-8 mm in diameter, located intra-articularly but extra-synovial, running through a bicipital groove approximately 31 mm long and 7 mm wide. The LHB is prone to repetitive trauma leading to tenosynovitis, SLAP lesions, instability, and structural failure.<br /><br />Rotator cuff (RC) pathology is commonly associated with biceps tendon problems. Lafosse (2007) noted that 45% of LHB issues include instability and tears that can increase biceps pathology.<br /><br />The goal of tenodesis is to eliminate painful joint and groove motion of the LHB. Surgical options include arthroscopic tenodesis at the groove or supra-pectoral region using suture anchors or interference screws, often combined with rotator cuff repair, versus open sub-pectoral tenodesis.<br /><br />Several studies (Werner 2014; Green 2017; Forsythe 2020; Brady 2015) examined if tenodesis location matters. McCrum et al. (2019) found no significant difference in complications based on location, fixation, or indication, though persistent anterior shoulder pain (ASP) occurred in 10-12%. Forsythe et al. (2019) reported no difference in revision rates between open and arthroscopic techniques, with rotator cuff repair and age under 45 being protective factors.<br /><br />Suture techniques vary depending on the integrity of the rotator cuff. The presentation also touched on salvage options combining tenodesis with rotator cuff repair and the use of superior capsular reconstruction (SCR) using LHB autograft in irreparable supraspinatus tears (El-Shaar 2018; Han 2019).<br /><br />In summary, biceps tenodesis is an effective procedure to address LHB pathology with no clear superiority between open and arthroscopic approaches or fixation methods, often performed with rotator cuff repair, and used innovatively in SCR for irreparable cuff tears.

Keywords

biceps tenodesis

long head of biceps tendon

rotator cuff pathology

arthroscopic tenodesis

open sub-pectoral tenodesis

suture anchors

interference screws

anterior shoulder pain

superior capsular reconstruction

rotator cuff repair