Skip to main content

Arthroscopic tenodesis versus tenotomy of the long head of biceps tendon in simultaneous rotator cuff repair



Full thickness rotator cuff tears are a common cause of shoulder pain and disability. While the role of the rotator cuff seems to be well known, the clinical significance of the biceps tendon for shoulder function has still been a subject of controversy. The aim of this study was to evaluate differences between tenodesis or tenotomy in simultaneous rotator cuff repair.


For this retrospective study 53 consecutive patients (25f/28m, Ø age 58 years) undergoing arthroscopic double row rotator cuff reconstruction and suture bridge repair were included. The LHB was treated with tenodesis (n = 24) or tenotomy (n = 29). Clinical examination was carried out for all patients after an average of 34 months (range 27–38) following arthroscopic surgery. The Constant score, level of pain, range of motion in flexion and abduction, and isometric force for the operated and healthy shoulder in flexion and abduction were recorded.


Patients in the tenodesis and tenotomy group reached similar good result regarding the Constant score (86.6 ± 11.9 vs. 81.3 ± 12.2; P = 0.120), pain (median 0, range 0–8 vs. Median 0, range 0–10; P = 0.421), and range of motion (flexion: median 180°, range 90°–180° vs. median 180°, range 90°–180°; P = 0.833; abduction: median 180°, range 90°–180° vs. median 180°, range 120°–180°; P = 0.472). Postoperative popeye sign was found only in one patient (1.9 %). At the time of postoperative follow-up, no patient reported cramping of the biceps. Isometric forces in abduction of the tenotomy group (mean 4.7 ± 2.9 kg; maximum 5.5 ± 2.8 kg) was significant lower compared to the tenodesis group (mean 6.6 ± 3.0 kg, P = 0.019; maximum 7.7 ± 2.9 kg, P = 0.007) and compared to healthy shoulders (mean 6.1 ± 3.0 kg P = 0.004; maximum 7.4 ± 3.1 kg, P = 0.001), all other measurements were similar.


According to our results arthroscopic biceps tenodesis and tenotomy are valuable procedures in simultaneous rotator cuff repair regarding function, pain, and range of motion. However, the tenotomy group showed reduced strength in abduction.

Level of evidence

Level IV, retrospective case series.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Andrews JR, Carson WG Jr, McLeod WD (1985) Glenoid labrum tears related to long head of the biceps. Am J Sports Med 13:337–341

    PubMed  CAS  Article  Google Scholar 

  2. Bennet WF (2003) Arthroscopic repair of isolated subscapularis tears: a prospective cohort with 2- to 4-year follow-up. Arthroscopy 19(2):131–143. doi:10.1053/jars.2003.50053

    Article  Google Scholar 

  3. Boileau P, Baqué 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(4):747–757. doi:10.2106/JBJS.E.01097

    PubMed  Article  Google Scholar 

  4. Boileau P, Krishan SG, Coste JS, Walch G (2002) Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation. Arthroscopy 18(9):1002–1012. doi:10.1053/jars.2002.36488

  5. Cofield RH (1985) Rotator cuff disease oft he shoulder. J Bone Joint Surg Am 67(6):974–979

    PubMed  CAS  Google Scholar 

  6. De Carli A, Vadalà A, Zanzotto E, Zampar G, 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(12):2553–2558. doi:10.1007/s00167-012-1918-5 (Epub 2012 Feb 15)

    PubMed  Article  Google Scholar 

  7. Edwards TB, Walch G, Sirveaux F, Molé D, Nové-Josserand L, Boulahia A, Neyton L, Szabo I, Lindgren B (2005) Repair of tears of the subscapularis. J Bone Joint Surg Am 87(4):725–730. doi:10.2106/JBJS.D.02051

    PubMed  Article  Google Scholar 

  8. Frost A, Zafar MS, Maffulli N (2009) Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii. Am J Sports Med 37(4):828–833. doi:10.1177/0363546508322179 (Epub 2008 Sep 1)

    PubMed  Article  Google Scholar 

  9. Habermeyer P, Magosch P, Pritsch M, Scheibel MT, Lichtenberg S (2004) Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elbow Surg 13(1):5–12. doi:10.1016/j.jse.2003.09.013

  10. Itoi E, Kuechle DK, Newman SR, Morrey BF, An KN (1993) Stabilising function of the biceps in stable and unstable shoulders. J Bone Joint Surg Br 75:546–550

    PubMed  CAS  Google Scholar 

  11. Jones CK, Savoie FH 3rd (2003) Arthroscopic repair of large and massive rotator cuff tears. Arthroscopy 19(6):564–571. doi:10.1016/S0749-8063(03)00169-5

  12. Kido T, Itoi E, Konno N, Sano A, Urayama M, Sato K (2000) The depressor function of biceps on the head of the humerus in shoulders with tears of the rotator cuff. J Bone Joint Surg Br 82:416–419

    PubMed  CAS  Article  Google Scholar 

  13. Kho KH, Ahn SH, 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(8):1584–1590. doi:10.1177/0363546510364053. (Epub 2010 Jun 15)

  14. Kumar VP, Satku K, Balasubramaniam P (1989) The role of the long head of the biceps brachii in the stabilization of the head of the humerus. Clin Orthop Relat Res 244:172–175

    PubMed  Google Scholar 

  15. Lee HI, Shon MS, Koh KH, Lim TK, Heo J, Yoo JC (2014) Clinical and radiologic results of arthroscopic biceps tenodesis with suture anchor in the setting of rotator cuff tear. J Shoulder Elbow Surg 23(3):e53–e60. doi:10.1016/j.jse.2013.06.004 (Epub 2013 Sep 8)

  16. Lyons TR, Savoie FH 3rd, Field LD (2001) Arthroscopic repair of partial-thickness tears of the rotator cuff. Arthroscopy 17(2):219–223

    PubMed  CAS  Article  Google Scholar 

  17. Millet PJ, Mazzocca A, Guanche CA (2004) Mattress double anchor footprint repair: a novel, arthroscopic rotator cuff repair technique. Arthroscopy 20(8):875–879. doi:10.1016/j-arthro.2004.07.015

  18. Pagnani MJ, Deng XH, Warren RF, Torzilli PA, O’Brien SJ (1996) Role of the long head of the biceps brachii in glenohumeral stability: a biomechanical study in cadavera. J Shoulder Elbow Surg 5(4):255–262

    PubMed  CAS  Article  Google Scholar 

  19. Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res (254):81–86

  20. Scheibel M, Schröder 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(5):1046–1052. doi:10.1177/0363546510390777 (Epub 2011 Jan 21)

    PubMed  Article  Google Scholar 

  21. Sentürk I, Ozalay M, Akpinar S, Leblebici B, Cinar BM, Tuncay C (2011) Clinical and isokinetik comparison between tenotomy and tenodesis in biceps pathologies. Acta Orthop Traumatol Turc 45(1):41–46. doi:10.3944/AOTT.2011.2308 (Epub 2010 Jun 15)

    PubMed  Article  Google Scholar 

  22. Severud EL, Ruotolo C, Abbott DD, Nottage WM (2003) All-arthroscopic versus mini-open rotator cuff repair: a long term retrospective outcome comparison. Arthroscopy 19(3):234–238. doi:10.1053/jars.2003.50036

    PubMed  Article  Google Scholar 

  23. Shank JR, Singleton SB, Hawkins J, Decker MJ, Torry MR (2006) A comparison of supination and elbow flexion strength in patients either proximal biceps release or tenodesis. Presented at the Meeting of the American Orthopedic Society for Sports Medicine, Hershey

  24. Walch G, Edwards TB, Boulahia A, Nové-Josserand L, Neyton L, Szabo I (2005) Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg 14(3):238–246. doi:10.1016/j.jse.2004.07.008

    PubMed  Article  Google Scholar 

  25. Warner JJ, MCMahon PJ (1995) The role of the long head of the biceps brachii in superior stability of the glenohumeral joint. J Bone Joint Surg Am 77:366–372

    PubMed  CAS  Google Scholar 

  26. Kany J, Guinand R, Amaravathi RS, Alassaf I (2015) The keyhole technique for arthroscopic tenodesis of the long head of the biceps tendon. In vivo prospective study with a radio-opaque marker. Orthop Traumatol Surg Res 101(1):31–34. doi:10.1016/j.otsr.2014.10.016 (Epub 2015 Jan 8)

  27. Zhang Q, Zhou J, Ge H, Cheng B (2015) Tenotomy or tenodesis for long head biceps lesions in shoulders with reparable rotator cuff tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 23(2):464–469. doi:10.1007/s00167-013-2587-8 (Epub 2013 Jul 5)

    PubMed  Article  Google Scholar 

  28. Duff SJ, Campbell PT (2012) Patient acceptance of long head of biceps brachii tenotomy. J Shoulder Elbow Surg 21(1):61–65. doi:10.1016/j.jse.2011.01.014 (Epub 2011 Mar 30)

    PubMed  Article  Google Scholar 

  29. Wittstein JR, Queen R, Abbey A, Toth A, Moorman CT 3rd (2011) Isokinetic strength, endurance, and subjective outcomes after biceps tenotomy versus tenodesis: a postoperative study. Am J Sports Med 39(4):857–865. doi:10.1177/0363546510387512 (Epub 2010 Dec 28)

    PubMed  Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Dominik Meraner.

Ethics declarations

Conflict of interest


Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Meraner, D., Sternberg, C., Vega, J. et al. Arthroscopic tenodesis versus tenotomy of the long head of biceps tendon in simultaneous rotator cuff repair. Arch Orthop Trauma Surg 136, 101–106 (2016).

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI:


  • Tenotomy
  • Tenodesis
  • Biceps tendon
  • Shoulder arthroscopy