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Surgical indications for long head biceps tenodesis: a systematic review

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Tenodesis as a treatment for a symptomatic long head of biceps (LHB) tendon is becoming more prevalent and new techniques exist which are purported to make the procedure faster and more effective. The determination of appropriate surgical indications for the procedure will facilitate proper analysis and comparisons of the varied techniques. This review analyses the reported indications in the literature in an attempt to guide future research and treatment.

Methods

The EMBASE and MEDLINE databases were searched to identify surgical studies that report indications for LHB tenodesis. After title, abstract searches, and full-text reviews, 39 studies were included. Study information was extracted including author, publication date, patient numbers, patient age, follow-up period, procedure performed, surgical indications, and study design.

Results

Although indications were variable and often non-descriptive, of the 39 included studies, the most common indications for LHB tenodesis were partial tearing (51 %), instability (49 %), or tenosynovitis (44 %), SLAP tear (28 %), and positive clinical exam for LHB pain (26 %). Most studies were of low quality of evidence, such as case series (33.0 %) and retrospective studies (43.5 %), and were of low-to-moderate methodological quality.

Conclusion

Although indications used for LHB tenodesis are inconsistently reported, the most common indications include LHB tearing, instability, and tenosynovitis. Other indications include clinical exam indicating LHB pathology, SLAP tears and subjective shoulder pain. Rigorous reporting of indications and preoperative/operative findings should be emphasized in future studies, allowing surgeons to appropriately analyse outcomes of LHB tenodesis of different techniques within patient groups with distinct indications.

Level of evidence

Systematic review, Level IV.

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Author information

Authors and Affiliations

  1. Division of Orthopedic Surgery, Department of Clinical Epidemiology and Biostatistics, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada

    Michael J. Creech, Marco Yeung, Matthew Denkers, Nicole Simunovic & Olufemi R. Ayeni

  2. Biomechanics Laboratory, Roth McFarlane Hand and Upper Limb Center, St Joseph’s Health Care, 268 Grosvenor Street, London, ON, N6A 4V2, Canada

    George S. Athwal

Authors
  1. Michael J. Creech
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  2. Marco Yeung
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  3. Matthew Denkers
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  4. Nicole Simunovic
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  5. George S. Athwal
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  6. Olufemi R. Ayeni
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Corresponding author

Correspondence to Olufemi R. Ayeni.

Appendices

Appendix 1: List of Included Studies in Systematic Review

  1. 1.

    Abrams JS. (2007) Arthroscopic biceps tenodesis: Direct suturing and results. Oper Tech Sports Med 15:10–15.

  2. 2.

    Berlemann U, Bayley I. (1995) Tenodesis of the long head of biceps brachii in the painful shoulder: Improving results in the long term. J Shoulder Elbow Surg 4(6):429–435.

  3. 3.

    Boileau P, Ahrens PM, Hatzidakis AM. (2004) Entrapment of the long head of the biceps tendon: The hourglass biceps - A cause of pain and locking of the shoulder. J Shoulder Elbow Surg 13:249–257.

  4. 4.

    Boileau P, Baque F, Valerio L, Ahrens P, Chuinard C, Trojani C. (2007) Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am 89:747–757.

  5. 5.

    Boileau P, Krishnan SG, Coste J, Walch G. (2002) Arthroscopic biceps tenodesis: A new technique using bioabsorbable interference screw fixation. Arthroscopy 18:1002–1012.

  6. 6.

    Boileau P, Neyton L. (2005) Arthroscopic tenodesis for lesions of the long head of the biceps. Oper Orthop Tramatol 17:601–623.

  7. 7.

    Boileau P, Parratte S, Chuinard C, Roussanne Y, Shia D, Bicknell R. (2009) Arthroscopic treatment of isolated type II SLAP lesions: Biceps tenodesis as an alternative to reinsertion. Am J Sports Med 37:929–936.

  8. 8.

    Checchia SL, Doneux PS, Miyazaki AN, Silva LA, Fregoneze M, Ossada, A, Tsuitida CY, Masiole C. (2005) Biceps tenodesis associated with arthroscopic repair of rotator cuff tears. J Shoulder Elbow Surg 14:138–144.

  9. 9.

    de Carli A, Vadala A, Zanzotto E, Zampar E, Vetrano M, Iorio R, Ferretti A. (2012) Reparable rotator cuff tears with concomitant long-head biceps lesions: Tenotomy or tenotomy/tenodesis?. Knee Surg Sports Traumatol Arthrosc 20:2553–2558.

  10. 10.

    Delle Rose G, Borroni M, Silvestro A, Garofalo R, Cont M, De Nittis P, Castagna A. (2012) The long head of biceps as a source of pain in active population: Tenotomy or tenodesis? A comparison of 2 case series with isolated lesions. Musculoskelet Surg 96(Suppl 1):S47–52.

  11. 11.

    Drakos MC, Verma NN, Gulotta LV, Potucek F, Taylor S, Fealy S, Selby RM,O’Brien SJ. (2008) Arthroscopic transfer of the long head of the biceps tendon: Functional outcome and clinical results. Arthroscopy. 24:217–223.

  12. 12.

    Edwards TB, Walch G, Sirveaux F, Mole D, Nove-Josserand L, Boulahia A, Neyton L, Szabo I, Lindgren B. (2005) Repair of tears of the subscapularis. J Bone Joint Surg Am 87:725–730.

  13. 13.

    Elkousy HA, Fluhme DJ, O’Connor DP, Rodosky MW. (2005) Arthroscopic biceps tenodesis using the percutaneous, intra-articular trans-tendon technique: Preliminary results. Orthopedics 28:1316–1319.

  14. 14.

    Fama G, Edwards TB, Boulahia A, Kempf JF, Boileau P, Nemoz C, Walch G. (2004) The role of concomitant biceps tenodesis in shoulder arthroplasty for primary osteoarthritis: Results of a multicentric study. Orthopedics 27:401–405.

  15. 15.

    Franceschi F, Longo UG, Ruzzini L, Papalia R, Rizzello G, Denaro V. (2007) To detach the long head of the biceps tendon after tenodesis or not: Outcome analysis at the 4-year follow-up of two different techniques. Int Orthop 31:537–545.

  16. 16.

    Gumina S, Carbone S, Perugia D, Perugia L, Postacchini F. (2011) Rupture of the long head biceps tendon treated with tenodesis to the coracoid process. Results at more than 30 years. Int Orthop 35:713–716.

  17. 17.

    Jancosko JJ, Duggan DP, Nottage WM. (2013) Arthroscopically assisted mini-open transdeltoid biceps tenodesis: Surgical technique and preliminary results. Tech Shoulder Elbow Surg 14:69–72.

  18. 18.

    Kim DY, Yoo YS, Lee SS, Seo EM, Hwang JT, Kwon SC, Lee JW. (2012) Arthroscopic percutaneous repair of anterosuperior rotator cuff tear including biceps long head: A 2-year follow-up. Clin in Orthop Surg 4:284–292.

  19. 19.

    Koh KH, Ahn JH, Kim SM, Yoo JC. (2010) Treatment of biceps tendon lesions in the setting of rotator cuff tears: Prospective cohort study of tenotomy versus tenodesis. Am J Sports Med 38:1584–1590.

  20. 20.

    Lutton DM, Gruson KI, Harrison AK, Gladstone JN, Flatow EL. (2011) Where to tenodese the biceps: Proximal or distal?. Clin Orthop 469:1050–1055.

  21. 21.

    Maier D, Jaeger M, Suedkamp NP, Koestler W. (2007) Stabilization of the long head of the biceps tendon in the context of early repair of traumatic subscapularis tendon tears. J Bone Joint Surg Am 89:1763–1769.

  22. 22.

    Mazzocca AD, Cote MP, Arciero CL, Romeo AA, Arciero RA. (2008) Clinical outcomes after subpectoral biceps tenodesis with an interference screw. Am J Sports Med 36:1922–1929.

  23. 23.

    Millett PJ, Sanders B, Gobezie R, Braun S, Warner JJP. (2008) Interference screw vs. suture anchor fixation for open subpectoral biceps tenodesis: Does it matter? BMC Musculoskelet Disord 9:121.

  24. 24.

    Namdari S, Henn III RF, Green A. (2008) Traumatic anterosuperior rotator cuff tears: The outcome of open surgical repair. J Bone Joint Surg Am. 90:1906–13.

  25. 25.

    Nho SJ, Frank RM, Reiff SN, Verma NN, Romeo AA. (2010) Arthroscopic repair of anterosuperior rotator cuff tears combined with open biceps tenodesis. Arthroscopy. 26:1667–1674.

  26. 26.

    Nho SJ, Reiff SN, Verma NN, Slabaugh MA, Mazzocca AD, Romeo AA. (2010) Complications associated with subpectoral biceps tenodesis: Low rates of incidence following surgery. J Shoulder Elbow Surg 19:764–768.

  27. 27.

    Nord KD, Smith GB, Mauck BM. (2005) Arthroscopic biceps tenodesis using suture anchors through the subclavian portal. Arthroscopy 21:248–252.

  28. 28.

    Osbahr DC, Diamond AB, Speer KP. (2002) The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis. Arthroscopy 18:483–487.

  29. 29.

    Paulos LE, Mendez KT, Berg T. (2007) A novel approach to arthroscopic biceps tenodesis. Oper Tech Sports Med 15:27–34.

  30. 30.

    Price MD, Anstey DE, Carroll K, Gill TJ. (2011) Arthroscopically-assisted biceps tenodesis using a suture anchor. Curr Orthop Pract 22:524–528.

  31. 31.

    Sanders B, Lavery KP, Pennington S, Warner JJP. (2012) Clinical success of biceps tenodesis with and without release of the transverse humeral ligament. J Shoulder Elbow Surg 21:66–71.

  32. 32.

    Scheibel M, Schroder RJ, Chen J, Bartsch M. (2011) Arthroscopic soft tissue tenodesis versus bony fixation anchor tenodesis of the long head of the biceps tendon. Am J Sports Med 39:1046–1052.

  33. 33.

    Senturk I, Ozalay M, Akpinar S, Leblebici B, Murat cinar B, Tuncay C. (2011) Clinical and isokinetic comparison between tenotomy and tenodesis in biceps pathologies. Acta Orthop Traumatol Turc 45:41–46.

  34. 34.

    Shank JR, Singleton SB, Braun S, et al. (2011) A comparison of forearm supination and elbow flexion strength in patients with long head of the biceps tenotomy or tenodesis. Arthroscopy 27:9–16.

  35. 35.

    Simmen BR, Bachmann LM, Drerup S, Schwyzer HK, Burkhart A, Flury MP, Goldhahn J. (2008) Usefulness of concomitant biceps tenodesis in total shoulder arthroplasty: A prospective cohort study. J Shoulder Elbow Surg 17:921–924.

  36. 36.

    Soliman OA, Koptan WMT. Proximal humeral fractures treated with hemiarthroplasty: Does tenodesis of the long head of the biceps improve results?. Injury. 2013;44:461–464.

  37. 37.

    Wahl CJ, MacGillivray JD. (2007) Three congenital variations in the long head of the biceps tendon: a review of pathoanatomic considerations and case reports. J Shoulder Elbow Surg Nov-Dec;16(6):e25–30.


  38. 38.

    Warner JJ, Higgins L, Parsons IM 4th, Dowdy P. (2001) Diagnosis and treatment of anterosuperior rotator cuff tears. Journal of Shoulder and Elbow Surgery 10:37–46.

  39. 39.

    Zhang Q, Zhou J, Cheng B. (2013) Tenotomy or tenodesis for long head biceps lesions in shoulders with reparable rotator cuff tears: A prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 1–6.

Appendix 2

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Creech, M.J., Yeung, M., Denkers, M. et al. Surgical indications for long head biceps tenodesis: a systematic review. Knee Surg Sports Traumatol Arthrosc 24, 2156–2166 (2016). https://doi.org/10.1007/s00167-014-3383-9

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