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Long head of the biceps tendon versatility in reconstructive shoulder surgery: a narrative review of arthroscopic techniques and their biomechanical principles with video presentation

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Abstract

The management of the long head of the biceps tendon (LHBT) during shoulder arthroscopy has been a subject of controversy for many years, with evolving discussions and trends. Despite long-standing debate, the nature of the surgical indication regarding how to treat concomitent LHBT injuries has undergone changes in recent years. It now extends beyond the timing of tenotomy to encompass considerations of alternative methods for preserving the LHBT, along with an ongoing exploration of how it can be effectively utilized in reconstructive shoulder surgery. Recent techniques describe approaches to using LHBT in a wide range of procedures, from shoulder instability to rotator cuff tears. Additionally, LHBT-based reconstructive techniques have surfaced for addressing what were formerly denoted as irreparable rotator cuff tears. While current literature provides detailed anatomical descriptions of the LHBT and many reports of novel, advanced techniques, there is still much debate regarding the decision-making process in each case. Because of the growing number of emerging techniques and the escalating debate in the subsequent paper, a decision has been made to present the current literature review concerning the potential utilization of LHBT in shoulder arthroscopy. In a dedicated video, we demonstrate the main arthroscopic techniques employed by the authors in their daily practice.

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Acknowledgements

The authors wish to express their gratitude to Alexandra Sermier for her assistance in creating the figures. Diana-Cosmina Neculau and George Mihai Avram have contributed equally to this work, thus sharing the first authorship.

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Authors and Affiliations

  1. Romanian Shoulder Institute, ORTOPEDICUM - Orthopaedic Surgery & Sports Clinic, Bucharest, Romania

    Diana-Cosmina Neculau, George Mihai Avram & Ion-Andrei Popescu

  2. SportsOrtho Department, Zetta Hospital, Bucharest, Romania

    Diana-Cosmina Neculau, George Mihai Avram & Ion-Andrei Popescu

  3. Orthopaedics and Traumatology Department, Regio Clinic Elmshorn, Elmshorn, Germany

    Diana-Cosmina Neculau

  4. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Bruderholz, Switzerland

    George Mihai Avram

  5. Orthopaedics and Traumatology Department, Central Military Emergency Hospital Dr. Carol Davila, 010825, Bucharest, Romania

    George Mihai Avram

  6. Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Łódź, Lodz, Poland

    Adam Kwapisz

  7. Clinique Chirurgicale St. Michel, Groupe ELSAN, Toulon, France

    Marius M. Scarlat

  8. Orthopaedic Traumatology Department, Emergency Clinical County Hospital, Constanta, Romania

    Bogdan Obada

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  1. Diana-Cosmina Neculau
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Contributions

Diana-Cosmina Neculau: conceptualization, data curation, formal analysis, investigation, methodology, writing-original draft, writing—review and editing; George Mihai Avram: conceptualization, data curation, formal analysis, investigation, methodology, writing—original draft, writing—review and editing; Adam Kwapisz: data curation, visualization, writing—review and editing; Marius M Scarlat: data curation, visualization, writing—review and editing; Bogdan Obada: resources, visualization, writing—review and editing; Ion-Andrei Popescu: project administration, resources, supervision, visualization, writing—review, text and video editing.

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Correspondence to Ion-Andrei Popescu.

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Supplementary file1 Video: LHBT augmentation in rotator cuff repair: Introduction (00:00–00:56); (1) The 360° lasso loop (00:57–01:39); (2) supraspinatus repair augmented with the tenotomized LHBT-tenotenodesis (01:40–02:48); (3) SCR using LHBT (distal tenotomy) with side to side suturing to the anteriorly advanced postero-superior rotator cuff (02:49–07:21); (4) Bio-SCR with posteriorly displaced LHBT-without tenotomy (07:22–08:57); (5) PASTA Repair augmented with the LHBT-tenotenodesis (08:59–11:55) (MP4 392750 KB)

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Neculau, DC., Avram, G.M., Kwapisz, A. et al. Long head of the biceps tendon versatility in reconstructive shoulder surgery: a narrative review of arthroscopic techniques and their biomechanical principles with video presentation. International Orthopaedics (SICOT) 48, 1249–1256 (2024). https://doi.org/10.1007/s00264-024-06126-3

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