Advertisement

Complications in Biceps Tendon Management: Long Head of Biceps Tenotomy and Tenodesis

  • Johannes Plath
Chapter

Abstract

Tenotomy and tenodesis of the long head of biceps (LHB) are very common procedures in shoulder surgery.

While tenotomy is an easy and very effective procedure, “popeye deformity” and biceps muscle-belly cramping are potential drawbacks. To reduce the risk of these side-effects, many surgeons perform a biceps tenodesis, with many technical options described in the literature. While complications in biceps tendon management are generally low, each specific tenodesis technique carries its own potential risks.

In this chapter we will discuss complications of LHB tendon tenotomy and tenodesis and will give tips and tricks to avoid them.

Keyword

Complications Long head of the biceps Tenotomy Tenodesis Popeye deformity 

References

  1. 1.
    Werner BC, Brockmeier SF, Gwathmey FW. Trends in long head biceps tenodesis. Am J Sports Med. 2015;43:570–8.  https://doi.org/10.1177/0363546514560155.CrossRefPubMedGoogle Scholar
  2. 2.
    AlQahtani SM, Bicknell RT. Outcomes following long head of biceps tendon tenodesis. Curr Rev Musculoskelet Med. 2016;9:378–87.  https://doi.org/10.1007/s12178-016-9362-7.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Patel KV, Bravman J, Vidal A, Chrisman A, McCarty E. Biceps tenotomy versus tenodesis. Clin Sports Med. 2016;35:93–111.  https://doi.org/10.1016/j.csm.2015.08.008.CrossRefPubMedGoogle Scholar
  4. 4.
    Holzapfel K, Waldt S, Bruegel M, Paul J, Heinrich P, Imhoff AB, Rummeny EJ, Woertler K. Inter- and intraobserver variability of MR arthrography in the detection and classification of superior labral anterior posterior (SLAP) lesions: evaluation in 78 cases with arthroscopic correlation. Eur Radiol. 2009;20:666–73.  https://doi.org/10.1007/s00330-009-1593-1.CrossRefPubMedGoogle Scholar
  5. 5.
    Razmjou H, Fournier-Gosselin S, Christakis M, Pennings A, ElMaraghy A, Holtby R. Accuracy of magnetic resonance imaging in detecting biceps pathology in patients with rotator cuff disorders: comparison with arthroscopy. J Shoulder Elbow Surg. 2016;25:38–44.  https://doi.org/10.1016/j.jse.2015.06.020.CrossRefPubMedGoogle Scholar
  6. 6.
    Zappia M, Reginelli A, Russo A, D’Agosto GF, Di Pietto F, Genovese EA, Coppolino F, Brunese L. Long head of the biceps tendon and rotator interval. Musculoskelet Surg. 2013;97(Suppl 2):S99–108.  https://doi.org/10.1007/s12306-013-0290-z.CrossRefPubMedGoogle Scholar
  7. 7.
    Armstrong A, Teefey SA, Wu T, Clark AM, Middleton WD, Yamaguchi K, Galatz LM. The efficacy of ultrasound in the diagnosis of long head of the biceps tendon pathology. J Shoulder Elbow Surg. 2006;15:7–11.  https://doi.org/10.1016/j.jse.2005.04.008.CrossRefPubMedGoogle Scholar
  8. 8.
    Godenèche A, Nové-Josserand L, Audebert S, Toussaint B, Denard PJ, French Society for Arthroscopy (SFA), Lädermann A. Relationship between subscapularis tears and injuries to the biceps pulley. Knee Surg Sports Traumatol Arthrosc. 2017;25:2114–20.  https://doi.org/10.1007/s00167-016-4374-9.CrossRefPubMedGoogle Scholar
  9. 9.
    Moon SC, Cho NS, Rhee YG. Analysis of “hidden lesions” of the extra-articular biceps after subpectoral biceps tenodesis: the subpectoral portion as the optimal tenodesis site. Am J Sports Med. 2015;43:63–8.  https://doi.org/10.1177/0363546514554193.CrossRefPubMedGoogle Scholar
  10. 10.
    Taylor SA, Khair MM, Gulotta LV, Pearle AD, Baret NJ, Newman AM, Dy CJ, O’Brien SJ. Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex. Arthroscopy. 2015;31:215–24.  https://doi.org/10.1016/j.arthro.2014.10.017.CrossRefPubMedGoogle Scholar
  11. 11.
    Holtby R, Razmjou H. Accuracy of the Speed’s and Yergason’s tests in detecting biceps pathology and SLAP lesions: comparison with arthroscopic findings. Arthroscopy. 2004;20:231–6.  https://doi.org/10.1016/j.arthro.2004.01.008.CrossRefPubMedGoogle Scholar
  12. 12.
    Erickson BJ, Basques BA, Griffin JW, Taylor SA, O’Brien SJ, Verma NN, Romeo AA. 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;33:1301–1307.e1.  https://doi.org/10.1016/j.arthro.2017.01.030.CrossRefPubMedGoogle Scholar
  13. 13.
    Godenèche A, Kempf J-F, Nové-Josserand L, Michelet A, Saffarini M, Hannink G, Collin P. Tenodesis renders better results than tenotomy in repairs of isolated supraspinatus tears with pathologic biceps. J Shoulder Elbow Surg. 2018;27:1939–45.  https://doi.org/10.1016/j.jse.2018.03.030.CrossRefPubMedGoogle Scholar
  14. 14.
    Saccomanno MF, Sircana G, Cazzato G, Donati F, Randelli P, Milano G. Prognostic factors influencing the outcome of rotator cuff repair: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2016;24:3809–19.  https://doi.org/10.1007/s00167-015-3700-y.CrossRefPubMedGoogle Scholar
  15. 15.
    Castricini R, Familiari F, De Gori M, Riccelli DA, De Benedetto M, Orlando N, Galasso O, Gasparini G. Tenodesis is not superior to tenotomy in the treatment of the long head of biceps tendon lesions. Knee Surg Sports Traumatol Arthrosc. 2018;26:169–75.  https://doi.org/10.1007/s00167-017-4609-4.CrossRefPubMedGoogle Scholar
  16. 16.
    De Carli A, Vadalà A, Zanzotto E, Zampar G, Vetrano M, Iorio R, Ferretti A. Reparable rotator cuff tears with concomitant long-head biceps lesions: tenotomy or tenotomy/tenodesis? Knee Surg Sports Traumatol Arthrosc. 2012;20:2553–8.  https://doi.org/10.1007/s00167-012-1918-5.CrossRefPubMedGoogle Scholar
  17. 17.
    Frost A, Zafar MS, Maffulli N. Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii. Am J Sports Med. 2009;37:828–33.  https://doi.org/10.1177/0363546508322179.CrossRefPubMedGoogle Scholar
  18. 18.
    Gurnani N, Deurzen DFP, Janmaat VT, Bekerom den MPJ. Tenotomy or tenodesis for pathology of the long head of the biceps brachii: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2015;24:3765–71.  https://doi.org/10.1007/s00167-015-3640-6.CrossRefPubMedGoogle Scholar
  19. 19.
    Hsu AR, Ghodadra NS, Provencher MT, Lewis PB, Bach BR. Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results. J Shoulder Elbow Surg. 2011;20:326–32.  https://doi.org/10.1016/j.jse.2010.08.019.CrossRefPubMedGoogle Scholar
  20. 20.
    Slenker NR, Lawson K, Ciccotti MG, Dodson CC, Cohen SB. Biceps tenotomy versus tenodesis: clinical outcomes. Arthroscopy. 2012;28:576–82.  https://doi.org/10.1016/j.arthro.2011.10.017.CrossRefPubMedGoogle Scholar
  21. 21.
    Friedman JL, FitzPatrick JL, Rylander LS, Bennett C, Vidal AF, McCarty EC. Biceps tenotomy versus tenodesis in active patients younger than 55 years: is there a difference in strength and outcomes? OJSM. 2015;3:1–6.  https://doi.org/10.1177/2325967115570848.CrossRefGoogle Scholar
  22. 22.
    García-Rellán JE, Sánchez-Alepuz E, Mudarra-García J. Increased fatigue of the biceps after tenotomy of the long head of biceps tendon. Knee Surg Sports Traumatol Arthrosc. 2018;89:1001.  https://doi.org/10.1007/s00167-018-5007-2.CrossRefGoogle Scholar
  23. 23.
    Bigliani LU, Dalsey RM, McCann PD, April EW. An anatomical study of the suprascapular nerve. Arthroscopy. 1990;6:301–5.CrossRefGoogle Scholar
  24. 24.
    Lafosse L, Shah AA, Butler RB, Fowler RL. Arthroscopic biceps tenodesis to supraspinatus tendon: technical note. Am J Orthop. 2011;40:345–7.PubMedGoogle Scholar
  25. 25.
    Gombera MM, Kahlenberg CA, Nair R, Saltzman MD, Terry MA. All-arthroscopic suprapectoral versus open subpectoral tenodesis of the long head of the biceps brachii. Am J Sports Med. 2015;43:1077–83.  https://doi.org/10.1177/0363546515570024.CrossRefPubMedGoogle Scholar
  26. 26.
    Knudsen ML, Hibbard JC, Nuckley DJ, Braman JP. The low-anterolateral portal for arthroscopic biceps tenodesis: description of technique and cadaveric study. Knee Surg Sports Traumatol Arthrosc. 2014;22:462–6.  https://doi.org/10.1007/s00167-013-2444-9.CrossRefPubMedGoogle Scholar
  27. 27.
    Werner BC, Evans CL, Holzgrefe RE, Tuman JM, Hart JM, Carson EW, Diduch DR, Miller MD, Brockmeier SF. Arthroscopic suprapectoral and open subpectoral biceps tenodesis: a comparison of minimum 2-year clinical outcomes. Am J Sports Med. 2014;42:2583–90.  https://doi.org/10.1177/0363546514547226.CrossRefPubMedGoogle Scholar
  28. 28.
    Dickens JF, Kilcoyne KG, Tintle SM, Giuliani J, Schaefer RA, Rue J-P. Subpectoral biceps tenodesis: an anatomic study and evaluation of at-risk structures. Am J Sports Med. 2012;40:2337–41.  https://doi.org/10.1177/0363546512457654.CrossRefPubMedGoogle Scholar
  29. 29.
    Jarrett CD, McClelland WB, Xerogeanes JW. Minimally invasive proximal biceps tenodesis: an anatomical study for optimal placement and safe surgical technique. J Shoulder Elbow Surg. 2011;20:477–80.  https://doi.org/10.1016/j.jse.2010.08.002.CrossRefPubMedGoogle Scholar
  30. 30.
    Abtahi AM, Granger EK, Tashjian RZ. Complications after subpectoral biceps tenodesis using a dual suture anchor technique. Int J Shoulder Surg. 2014;8:47–50.  https://doi.org/10.4103/0973-6042.137527.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Ma H, Van Heest A, Glisson C, Patel S. Musculocutaneous nerve entrapment: an unusual complication after biceps tenodesis. Am J Sports Med. 2009;37:2467–9.  https://doi.org/10.1177/0363546509337406.CrossRefPubMedGoogle Scholar
  32. 32.
    McCormick F, Nwachukwu BU, Solomon D, Dewing C, Golijanin P, Gross DJ, Provencher MT. The efficacy of biceps tenodesis in the treatment of failed superior labral anterior posterior repairs. Am J Sports Med. 2014;42:820–5.  https://doi.org/10.1177/0363546513520122.CrossRefPubMedGoogle Scholar
  33. 33.
    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;19:764–8.  https://doi.org/10.1016/j.jse.2010.01.024.CrossRefPubMedGoogle Scholar
  34. 34.
    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;41:2048–53.  https://doi.org/10.1177/0363546513495646.CrossRefPubMedGoogle Scholar
  35. 35.
    Koch BS, Burks RT. Failure of biceps tenodesis with interference screw fixation. Arthroscopy. 2012;28:735–40.  https://doi.org/10.1016/j.arthro.2012.02.019.CrossRefPubMedGoogle Scholar
  36. 36.
    Saithna A, Chizari M, Morris G, Anley C, Wang B, Snow M. An analysis of the biomechanics of interference screw fixation and sheathed devices for biceps tenodesis. Clin Biomech (Bristol, Avon). 2015;30:551–7.  https://doi.org/10.1016/j.clinbiomech.2015.04.006.CrossRefGoogle Scholar
  37. 37.
    Denard PJ, Dai X, Hanypsiak BT, Burkhart SS. Anatomy of the biceps tendon: implications for restoring physiological length-tension relation during biceps tenodesis with interference screw fixation. Arthroscopy. 2012;28:1352–8.  https://doi.org/10.1016/j.arthro.2012.04.143.CrossRefPubMedGoogle Scholar
  38. 38.
    Werner BC, Lyons ML, Evans CL, Griffin JW, Hart JM, Miller MD, Brockmeier SF. Arthroscopic suprapectoral and open subpectoral biceps tenodesis: a comparison of restoration of length-tension and mechanical strength between techniques. Arthroscopy. 2015;31:620–7.  https://doi.org/10.1016/j.arthro.2014.10.012.CrossRefPubMedGoogle Scholar
  39. 39.
    Gottschalk MB, Karas SG, Ghattas TN, Burdette R. Subpectoral biceps tenodesis for the treatment of type II and IV superior labral anterior and posterior lesions. Am J Sports Med. 2014;42:2128–35.  https://doi.org/10.1177/0363546514540273.CrossRefPubMedGoogle Scholar
  40. 40.
    Brady PC, Narbona P, Adams CR, Huberty D, Parten P, Hartzler RU, Arrigoni P, Burkhart SS. Arthroscopic proximal biceps tenodesis at the articular margin: evaluation of outcomes, complications, and revision rate. Arthroscopy. 2015;31:470–6.  https://doi.org/10.1016/j.arthro.2014.08.024.CrossRefPubMedGoogle Scholar
  41. 41.
    Lutton DM, Gruson KI, Harrison AK, Gladstone JN, Flatow EL. Where to tenodese the biceps: proximal or distal? Clin Orthop Relat Res. 2011;469:1050–5.  https://doi.org/10.1007/s11999-010-1691-z.CrossRefPubMedGoogle Scholar
  42. 42.
    Sanders B, Lavery KP, Pennington S, Warner JJP. Clinical success of biceps tenodesis with and without release of the transverse humeral ligament. J Shoulder Elbow Surg. 2012;21:66–71.  https://doi.org/10.1016/j.jse.2011.01.037.CrossRefPubMedGoogle Scholar
  43. 43.
    Millett PJ, Sanders B, Gobezie R, Braun S, Warner JJ. Interference screw vs. suture anchor fixation for open subpectoral biceps tenodesis: does it matter? BMC Musculoskelet Disord. 2008;9:121.  https://doi.org/10.1186/1471-2474-9-121.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Kelly AM, Drakos MC, Fealy S, Taylor SA, O’Brien SJ. Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results. Am J Sports Med. 2005;33:208–13.  https://doi.org/10.1177/0363546504269555.CrossRefPubMedGoogle Scholar
  45. 45.
    Kilicoglu O, Koyuncu O, Demirhan M, Esenyel CZ, Atalar AC, Ozsoy S, Bozdag E, Sunbuloglu E, Bilgic B. Time-dependent changes in failure loads of 3 biceps tenodesis techniques: in vivo study in a sheep model. Am J Sports Med. 2005;33:1536–44.  https://doi.org/10.1177/0363546505274716.CrossRefPubMedGoogle Scholar
  46. 46.
    Mazzocca AD, Bicos J, Santangelo S, Romeo AA, Arciero RA. The biomechanical evaluation of four fixation techniques for proximal biceps tenodesis. Arthroscopy. 2005;21:1296–306.  https://doi.org/10.1016/j.arthro.2005.08.008.CrossRefPubMedGoogle Scholar
  47. 47.
    Patzer T, Kircher J, Krauspe R. All-arthroscopic suprapectoral long head of biceps tendon tenodesis with interference screw–like tendon fixation after modified lasso-loop stitch tendon securing. Arthrosc Tech. 2012;1:e53–6.  https://doi.org/10.1016/j.eats.2012.01.003.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Richards DP, Burkhart SS. A biomechanical analysis of two biceps tenodesis fixation techniques. Arthroscopy. 2005;21:861–6.  https://doi.org/10.1016/j.arthro.2005.03.020.CrossRefPubMedGoogle Scholar
  49. 49.
    Sethi PM, Rajaram A, Beitzel K, Hackett TR, Chowaniec DM, Mazzocca AD. Biomechanical performance of subpectoral biceps tenodesis: a comparison of interference screw fixation, cortical button fixation, and interference screw diameter. J Shoulder Elbow Surg. 2012;22:451–7.  https://doi.org/10.1016/j.jse.2012.03.016.CrossRefPubMedGoogle Scholar
  50. 50.
    Park JS, Kim SH, Jung HJ, Lee YH, Oh JH. A prospective randomized study comparing the interference screw and suture anchor techniques for biceps tenodesis. Am J Sports Med. 2017;45:440–8.  https://doi.org/10.1177/0363546516667577.CrossRefPubMedGoogle Scholar
  51. 51.
    Boileau P, Baqué F, Valerio L, Ahrens P, Chuinard C, Trojani C. Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am. 2007;89:747–57.  https://doi.org/10.2106/JBJS.E.01097.CrossRefPubMedGoogle Scholar
  52. 52.
    Boileau P, Krishnan SG, Coste J-S, Walch G. Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation. Arthroscopy. 2002;18:1002–12.CrossRefGoogle Scholar
  53. 53.
    Walch G, Edwards TB, Boulahia A, Nové-Josserand L, Neyton L, Szabó 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;14:238–46.  https://doi.org/10.1016/j.jse.2004.07.008.CrossRefPubMedGoogle Scholar
  54. 54.
    Werner BC, Pehlivan HC, Hart JM, Carson EW, Diduch DR, Miller MD, Brockmeier SF. Increased incidence of postoperative stiffness after arthroscopic compared with open biceps tenodesis. Arthroscopy. 2014;30:1075–84.  https://doi.org/10.1016/j.arthro.2014.03.024.CrossRefPubMedGoogle Scholar
  55. 55.
    Sears BW, Spencer EE, Getz CL. Humeral fracture following subpectoral biceps tenodesis in 2 active, healthy patients. J Shoulder Elbow Surg. 2011;20:e7–11.  https://doi.org/10.1016/j.jse.2011.02.020.CrossRefPubMedGoogle Scholar
  56. 56.
    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;43:69–74.  https://doi.org/10.1177/0363546514554563.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Johannes Plath
    • 1
  1. 1.Department of Trauma, Orthopaedic, Hand and Plastic SurgeryUniversity Hospital of AugsburgAugsburgGermany

Personalised recommendations