Crossfire: Tenotomy Versus Tenodesis # Pro Tenodesis

  • Mike H. BaumsEmail author


While tenotomy and tenodesis both have been advocated to create good clinical outcome, a discussion remained over the favored treatment option in lesions of the biceps pulley system (BPS) and the long head of the biceps tendon (LHB). LHB tenodesis can avoid the three major complaints after tenotomy: (1) distalization of the biceps muscle belly resulting in a so-called “popeye” deformity, (2) cramping and soreness of the biceps muscle belly, and (3) fatigue discomfort and loss of flexion/supination strength in the elbow. These disorders play an important role in the young and active patient. Therefore, tenodesis should be preferred in younger patients who are involved in sports activities and in manually laboring employees. No general recommendation about the technique for tenodesis could be given that is mostly up to the preference of the surgeon.


Biceps pulley system Long head of the biceps Pulley lesion Biceps tendon instability Biceps tenodesis 


  1. 1.
    Kelly AM, Drakos MC, Fealy S, et al. Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results. Am J Sports Med. 2005;33:208–13.CrossRefGoogle Scholar
  2. 2.
    Walch G, Edwards TB, Boulahia A, et al. 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 Elb Surg. 2005;14:238–46.CrossRefGoogle Scholar
  3. 3.
    Shank JR, Singleton SB, Braun S, et al. A comparison of forearm supination and elbow flexion strength in patients with long head of the biceps tenotomy or tenodesis. Arthroscopy. 2011;27:9–16.CrossRefGoogle Scholar
  4. 4.
    Wittstein JR, Queen R, Abbey A, et al. Isokinetic strength, endurance, and subjective outcomes after biceps tenotomy versus tenodesis: a postoperative study. Am J Sports Med. 2011;39:857–65.CrossRefGoogle Scholar
  5. 5.
    Galdi B, Southren DL, Brabston EW, et al. Patients have strong preferences and perceptions for biceps tenotomy versus tenodesis. Arthroscopy. 2016;32:2444–50.CrossRefGoogle Scholar
  6. 6.
    Mellano C, Franks RM, Shin J, et al. Subpectoral biceps tenodesis with PEEK interference screw: a biomechanical analysis of humeral fracture risk. Arthroscopy. 2018;34:806–13.CrossRefGoogle Scholar
  7. 7.
    Tahal DS, Katthagen JC, Vap AR, et al. Subpectoral biceps tenodesis for tenosynovitis of the long head of the biceps in active patients younger than 45 years old. Arthroscopy. 2017;33:1124–30.CrossRefGoogle Scholar
  8. 8.
    Vap AR, Katthagen JC, Tahal DS, et al. Isolated biceps reflection pulley tears treated with subpectoral biceps tenodesis: minimum 2-year outcomes. Arthroscopy. 2017;33:1788–94.CrossRefGoogle Scholar
  9. 9.
    Chalmers PN, Erickson BJ, Verma NN, et al. Incidence and return to play after biceps tenodesis in professional baseball players. Arthroscopy. 2018;34:747–51.CrossRefGoogle Scholar

Copyright information

© ISAKOS 2019

Authors and Affiliations

  1. 1.Department of Orthopaedics, Trauma Surgery and Sports Traumatology, St. Elizabeth-HospitalAcademic Training Hospital of Westphalian-Wilhelms-University MünsterDorstenGermany

Personalised recommendations