Arthroscopic Tenodesis for Lesions of the Long Head of the Biceps

Abstract Objective: Resection of the intraarticular part of the long head of the biceps and tenodesis to decrease shoulder pain due to a pathologically altered biceps tendon and to improve shoulder function. Indications: Tenosynovitis. State of prerupture. Instability (subluxation or dislocation of tendon from intertubercular groove). Intraarticular entrapment secondary to hypertrophy of the long head of the biceps in the presence of an intact cuff. To be performed during arthroscopic cuff repair or during debridement of an irreparable cuff tear. Contraindications: Very thin, frayed, almost ruptured biceps tendon.Complete rupture of the long head of the biceps. Surgical Technique: Standard arthroscopy with 30° scope inserted through the posterior portal. Detachment of the long head from the glenoid origin. Longitudinal opening of the bicipital groove. Exteriorization and doubling of the tendon. Drilling of a socket starting in the groove but perforating the posterior cortex only with a guide wire. Passing of the tendon in an anteroposterior direction and securing the anchorage with a bioresorbable PLA interference screw. Results: Between 1997 and 1999, an arthroscopic tenodesis was performed in 43 patients. Minimum follow-up 2 years. The absolute Constant Score improved from 43 points preoperatively to 79 points at the time of follow-up. No loss of elbow extension or flexion; power of biceps after tenodesis 90% of opposite side. Early on, two failures of tenodesis occurred. The following is a reprint from Operat Orthop Traumatol 2005:17 601–23 and continues the new series of articles at providing continuing education on operative techniques to the European trauma community. Reprint from: Oper Orthop Traumatol 2005;17:601–23 DOI 10.1007/s00064-005-1154-y     

Arthroscopic Percutaneous Repair of Anterosuperior Rotator Cuff Tear Including Biceps Long Head: A 2-Year Follow-up

Background

To report the results of an arthroscopic percutaneous repair technique for partial-thickness tears of the anterosuperior cuff combined with a biceps lesion.

Methods

The inclusion criteria were evidence of the upper subscapularis tendon tear and an articular side partial-thickness tear of the supraspinatus tendon, degeneration of the biceps long head or degenerative superior labrum anterior-posterior, above lesions treated by arthroscopic percutaneous repair, and follow-up duration > 24 months after the operation. American Shoulder and Elbow Surgeons (ASES) score, constant score, the pain level on a visual analogue scale, ranges of motion and strength were assessed.

Results

The mean (± standard deviation) age of the 20 enrolled patients was 56.0 ± 7.7 years. The forward flexion strength increased from 26.3 ± 6.7 Nm preoperatively to 38.9 ± 5.1 Nm at final follow-up. External and internal rotation strength was also significantly increased (14.2 ± 1.7 to 19.1 ± 3.03 Nm, 12.3 ± 3.2 to 18.1 ± 2.8 Nm, respectively). Significant improvement was observed in ASES and constant scores at 3 months, 1 year and the time of final follow-up when compared with preoperative scores (p < 0.001). The mean subjective shoulder value was 86% (range, 78% to 97%).

Conclusions

The implementation of complete rotator cuff repair with concomitant tenodesis of the biceps long head using arthroscopic percutaneous repair achieved full recovery of normal rotator cuff function, maximum therapeutic efficacy, and patient satisfaction.     

Trends in Open and Arthroscopic Long Head of Biceps Tenodesis

Background

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.

Questions/Purposes

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.

Methods

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.

Results

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.

Conclusions

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.

     

Medial Dislocation of the Tendon of the Long Head of the Biceps Brachii

Medial displacement of the long tendon of the biceps brachii muscle is a rare condition associated with degenerative or traumatic ruptures of the rotator cuff. This condition was recorded in nine shoulders during 45 reconstructive procedures on the rotator cuff. Five of the displacements were complete, leaving the tendon medially displaced in a fascial sling; four were incomplete, allowing a to-and-fro medial displacement of the tendon out of the intertubercular groove.

Anatomical dissections on eight shoulders showed that the coracohumeral ligament is the key ligament which keeps the biceps tendon aligned in the sulcus: transection of the medial part of the ligament allows the tendon to be medially displaced.

There was no pathognomonic clinical sign of the luxation or subluxation. Since abnormal movement of the tendon in the sulcus may be an important cause of shoulder pain, the condition should be carefully looked for during reconstructive procedures on the rotator cuff. Tenodesis of the displaced tendon is recommended, either as the sole procedure or in combination with other reconstructive measures.     

Evaluation of the Effusion within Biceps Long Head Tendon Sheath Using Ultrasonography

Background

Many shoulder diseases are related to glenohumeral joint synovitis and effusion. The purpose of the present study is to detect effusion within the biceps long head tendon sheath as the sign of glenohumeral joint synovitis using ultrasonography, and to evaluate the clinical meaning of effusion within the biceps long head tendon sheath.

Methods

A consecutive series of 569 patients who underwent ultrasonography for shoulder pain were reviewed retrospectively and ultimately, 303 patients were included. The authors evaluated the incidence and amount of the effusion within the biceps long head tendon sheath on the ultrasonographic short axis view. Furthermore, the authors evaluated the correlation between the amount of effusion within the biceps long head tendon sheath and the range of motion and the functional score.

Results

The effusion within the biceps long head tendon sheath was detected in 58.42% of the patients studied: 69.23% in adhesive capsulitis, 56.69% in rotator cuff tear, 41.03% in calcific tendinitis, and 33.33% in biceps tendinitis. The average amount of the effusion within the biceps long head tendon sheath was 1.7 ± 1.6 mm, and it was measured to be the largest in adhesive capsulitis. The amount of effusion within biceps long head tendon sheath showed a moderate to high degree of correlation with the range of motion, and a low degree of correlation with the functional score and visual analogue scale for pain in each type of shoulder disease.

Conclusions

The effusion within the biceps long head tendon sheath is closely related to the range of motion and clinical scores in patients with painful shoulders. Ultrasonographic detection of the effusion within the biceps long head tendon sheath might be a simple and easy method to evaluate shoulder function.     

Treatment of Insertional Peroneus Brevis Tendinopathy by Ultrasound-Guided Percutaneous Ultrasonic Needle Tenotomy: A Case Report

Insertional peroneus brevis tendinopathy is uncommon and treatment options for recalcitrant insertional lesions are rarely described in the literature. Ultrasound-guided percutaneous ultrasonic needle tenotomy has been described for the treatment of recalcitrant tendinopathy in the elbow, knee, and plantar fascia, but has not been described for the treatment of peroneal tendinopathy. We report a case of recalcitrant insertional peroneus brevis tendinopathy successfully treated with an ultrasound-guided percutaneous ultrasonic needle tenotomy. The treatment resulted in a rapid recovery, and the patient remained asymptomatic at the 6-month follow up. No complications were observed during follow up and the minimally invasive percutaneous procedures offers clear advantage over open techniques.     

带线锚钉治疗肱二头肌长头腱断裂

目的 探讨带线锚钉治疗肱二头肌长头腱断裂的临床疗效.方法 对我院收治的肱二头肌长头腱断裂患者5例.均采用DePuy Mitek FASTIN RC螺纹钛合金带线锚钉固定于喙突或结节间沟.结果 本组患者随访时间为6～18个月,平均11.6个月.采用美国肩肘关节医师协会肩关节评估表对肩关节进行术后功能评估:优3例,良2例.结论 带线锚钉治疗肱二头肌长头腱断裂具有创伤小、操作便捷、固定可靠、康复迅速、并发症少、无需二次手术等优点.