In young and active patients, long head of biceps (LHB) tenodesis has become a common procedure for managing LHB pathology, but it remains unclear whether it is performed in isolation or along with other shoulder procedures and whether open and arthroscopic techniques produce different complications.
We sought to determine and compare open and arthroscopic LHB tenodesis in terms of (a) trends in overall use, (b) trends in use in isolation and in association with rotator cuff repair (RCR) and superior labral tear from anterior-to-posterior (SLAP) debridement/repair, and (c) the rates of post-operative complications.
We performed a retrospective analysis of data from an insurance database to identify LHB tenodesis procedures performed from 2011 to 2014. The overall annual rates of open and arthroscopic LHB tenodesis were determined and then stratified according to concurrent RCR and SLAP repair/debridement. A multivariate logistic regression analysis that controlled for patient demographics (age, sex, comorbidity) was performed.
Overall, 8547 patients underwent LHB tenodesis, of which 43.5% were open and 56.5% were arthroscopic procedures. There was a significant increase in the utilization of LHB tenodesis from 2011 to 2014. In isolation, open LHB tenodesis was the more common technique overall and by year. Arthroscopic LHB tenodesis was the most common tenodesis technique performed in conjunction with RCR and SLAP repair/debridement. The overall complication rate was 2.9%; only wound dehiscence demonstrated a difference between techniques.
The rates of open and arthroscopic LHB tenodesis procedures increased significantly from 2011 to 2014, with open techniques more common when LHB tenodesis is performed in isolation and arthroscopic techniques more common when performed as a concomitant procedure. Our use of a population database did not allow us to evaluate biomechanical or cost-related phenomena, and future research should examine these and other relevant differences between these two LHB tenodesis techniques.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Abraham VT, Tan BH, Kumar VP. Systematic review of biceps tenodesis: Arthroscopy versus open. Arthroscopy. 2016;32(2):365–371.
Arce G, Bak K, Bain G, Calvo E, Ejnisman B, Di Giacomo G, et al. Management of disorders of the rotator cuff: Proceedings of the ISAKOS upper extremity committee consensus meeting. Arthroscopy. 2013;29(11):1840–1850.
Beason DP, Shah JP, Duckett JW, Jost PW, Fleisig GS, Cain EL, Jr Torsional fracture of the humerus after subpectoral biceps tenodesis with an interference screw: A biomechanical cadaveric study. Clin Biomech (Bristol, Avon). 2015;30(9):915–920.
Bedard NA, Pugely AJ, Westermann RW, Duchman KR, Glass NA, Callaghan JJ. Opioid use after total knee arthroplasty: Trends and risk factors for prolonged use. J Arthroplasty. 2017;32(8):2390–2394
Chen CH, Hsu KY, Chen WJ, Shih CH. Incidence and severity of biceps long head tendon lesion in patients with complete rotator cuff tears. J Trauma. 2005;58(6):1189–1193.
Chiang FL, Hong CK, Chang CH, Lin CL, Jou IM, Su WR. Biomechanical comparison of all-suture anchor fixation and interference screw technique for subpectoral biceps tenodesis. Arthroscopy. 2016;32(7):1247–1252.
Dein EJ, Huri G, Gordon JC, McFarland EG. A humerus fracture in a baseball pitcher after biceps tenodesis. Am J Sports Med. 2014;42(4):877–879.
Erickson BJ, Basques BA, Griffin JW, Taylor SA, O’Brien SJ, Verma NN, et al. The effect of concomitant biceps tenodesis on reoperation rates after rotator cuff repair: A review of a large private-payer database from 2007 to 2014. Arthroscopy. 2017;33(7):1301–1307.
Euler SA, Smith SD, Williams BT, Dornan GJ, Millett PJ, Wijdicks CA. Biomechanical analysis of subpectoral biceps tenodesis: Effect of screw malpositioning on proximal humeral strength. Am J Sports Med. 2015;43(1):69–74.
Friedel R, Markgraf E, Schmidt I, Donicke T. Proximal humerus shaft fracture as a complication after keyhole-plasty. A case report. Unfallchirurgie. 1995;21(4):198–201.
Ge H, Zhang Q, Sun Y, Li J, Sun L, Cheng B. Tenotomy or tenodesis for the long head of biceps lesions in shoulders: A systematic review and meta-analysis. PLoS One. 2015;10(3):e0121286.
Gyulai M. Humeral fracture after keyhole tenodesis. Magy Traumatol Orthop Helyreallito Seb. 1990;33(3):234–236.
Nho SJ, Reiff SN, Verma NN, Slabaugh MA, Mazzocca AD, Romeo AA. Complications associated with subpectoral biceps tenodesis: Low rates of incidence following surgery. J Shoulder Elbow Surg. 2010;19(5):764–768.
Oflazoglu K, Menendez ME, Ring D, O’Brien TM, Archibald JD. Axillary artery injury associated with subpectoral biceps tenodesis: A case report. J Shoulder Elbow Surg. 2016;25(1):e25–28.
Provencher MT, LeClere LE, Romeo AA. Subpectoral biceps tenodesis. Sports Med Arthrosc. 2008;6(3):170–176.
Reiff SN, Nho SJ, Romeo AA. Proximal humerus fracture after keyhole biceps tenodesis. Am J Orthop (Belle Mead NJ). 2010;39(7):E61–63.
Rhee PC, Spinner RJ, Bishop AT, Shin AY. Iatrogenic brachial plexus injuries associated with open subpectoral biceps tenodesis: A report of 4 cases. Am J Sports Med. 2013;41(9):2048–2053.
Rios DM, Martetschlaeger F, Horan, MP, Millet, PJ. Complications following subpectoral biceps tenodesis with interference screw fixation. J Shoulder Elbow Surg. 2013;22:e26.
Sears BW, Spencer EE, Getz CL. Humeral fracture following subpectoral biceps tenodesis in 2 active, healthy patients. J Shoulder Elbow Surg. 2011;20(6):e7–11.
Vellios EE, Nazemi AK, Yeranosian MG, Cohen JR, Wang JC, McAllister DR, et al. Demographic trends in arthroscopic and open biceps tenodesis across the United States. J Shoulder Elbow Surg. 2015;24(10):e279–285.
Walch G, Edwards TB, Boulahia A, Nove-Josserand L, Neyton L, Szabo I. 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. 2005;4(3):238–246.
Werner BC, Brockmeier SF, Gwathmey FW. Trends in long head biceps tenodesis. Am J Sports Med. 2015;43(3):570–578.
Werner BC, Lyons ML, Evans CL, Griffin JW, Hart JM, Miller MD, et al. Arthroscopic suprapectoral and open subpectoral biceps tenodesis: A comparison of restoration of length-tension and mechanical strength between techniques. Arthroscopy. 2015;31(4):620–627.
Werner BC, Pehlivan HC, Hart JM, Carson EW, Diduch DR, Miller MD, et al. Increased incidence of postoperative stiffness after arthroscopic compared with open biceps tenodesis. Arthroscopy. 2014;30(9):1075–1084.
Wu PT, Jou IM, Yang CC, Lin CJ, Yang CY, Su FC, et al. The severity of the long head biceps tendinopathy in patients with chronic rotator cuff tears: Macroscopic versus microscopic results. J Shoulder Elbow Surg. 2014; 23(8):1099–1106.
Conflict of Interest
Timothy S. Leroux, MD; Eric J. Cotter, MD; Bryce Basques, MD; Justin Griffin, MD; and Rachel M. Frank, MD, declare that they have no conflicts of interest. Anthony A. Romeo, MD, reports board or committee membership at American Orthopaedic Society for Sports Medicine and American Shoulder and Elbow Surgeons; editorial or governing board membership at Orthopedics, Orthopedics Today, SAGE, and Wolters Kluwer Health; personal fees and governing board membership from SLACK Incorporated; personal fees from Arthrex, Inc., and Saunders/Mosby-Elsevier; and research support from DJO Surgical, Ossur, and Smith & Nephew, outside the submitted work. Bryan M. Saltzman, MD, reports personal fees from Nova Science Publishers and honoraria from Postgraduate Institute for Medicine, outside the submitted work. Nikhil N. Verma, MD, reports board or committee membership from American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, and Arthroscopy Association Learning center committee; personal fees and editorial or governing board membership from Arthroscopy and SLACK Incorporated; editorial or governing board membership from Journal of Knee Surgery; personal fees and research support from Arthrex, Inc., and Smith & Nephew; personal fees from Vindico Medical-Orthopedics Hyperguide, Minivasive, and Orthospace; and research support from Arthrosurface, Athletico, ConMEd Linvatec, Miomed, Mitek, and DJO Surgical, outside the submitted work.
Required Author Forms
Disclosure forms provided by the authors are available with the online version of this article.
Level of Evidence: Level III: Epidemiologic Study
About this article
Cite this article
Saltzman, B.M., Leroux, T.S., Cotter, E.J. et al. Trends in Open and Arthroscopic Long Head of Biceps Tenodesis. HSS Jrnl 16, 2–8 (2020). https://doi.org/10.1007/s11420-018-9645-1
- long head biceps