In-office Shoulder Arthroscopy and Tenotomy of the Long Head of the Biceps Tendon-a Cadaveric Feasibility Study

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2019 Aug 3

PMID 31372811

Citations 4

Authors

Ion-Andrei Popescu

Frederic Teboul

Jean-Noel Goubier

Amir Ghazanfari

Affiliations

Soon will be listed here.

Abstract

Purpose: Studies have shown that isolated tenotomy of the long head of the biceps (LHB) improves significantly pain scores, active range of motion and Constant score in elderly patients with massive and irreparable cuff tears with no osteoarthritis. This cadaveric study was performed to assess the feasibility of a tenotomy of the LHB and subacromial corticosteroid injection using a minimally invasive in-office setting under local anaesthesia on awake patients.

Materials And Methods: Twenty scare-free shoulders were included in the study. We performed the procedure in an in-office setting using a wrist arthroscope with no fluid, connected to wireless camera and light source. A standard shoulder arthroscopy was finally performed in order to analyse the tenotomy quality and detect possible iatrogenic lesions.

Results: The LHB tendon was cut fully in all cases, the mean length of the proximal stump of the LHB was 0.4 cm (range, 0.3-0.7 mm) and the mean duration of the surgery was 3.5 minutes (range, 2.43-3.86 min). No iatrogenic lesion occurred during the in-office procedure.

Conclusion: This cadaveric study suggests that it is feasible and safe to perform, under local anaesthesia, a minimally invasive arthroscopic tenotomy of the LHB and subacromial injection using an in-office setting. Further clinical studies are needed to confirm the reliability, indication and effectiveness of this technique.

Citing Articles

Superior capsular reconstruction with the long head of the biceps tendon achieves excellent clinical results and low rotator cuff rerupture rates one year after cuff repair surgery.

Pastor P, Ramos M, Roig A, Safont J Int Orthop. 2024; 48(8):2121-2128.

PMID: 38796811 DOI: 10.1007/s00264-024-06223-3.

Long head of the biceps tendon versatility in reconstructive shoulder surgery: a narrative review of arthroscopic techniques and their biomechanical principles with video presentation.

Neculau D, Avram G, Kwapisz A, Scarlat M, Obada B, Popescu I Int Orthop. 2024; 48(5):1249-1256.

PMID: 38413413 DOI: 10.1007/s00264-024-06126-3.

Dynamic Anterior Stabilization with Hill-Sachs Remplissage Can be Employed in Skeletally Immature Patients-Operative Technique.

Neculau D, Avram G, Simion C, Predescu V, Obada B, Popescu I Orthop Surg. 2024; 16(3):745-753.

PMID: 38238248 PMC: 10925509. DOI: 10.1111/os.13989.

Partial Articular Supraspinatus Tendon Avulsion Repair and Patch: A Technical Note for Augmenting the Supraspinatus Reinsertion with the Long Head of the Biceps Tendon.

Avram G, Neculau D, Obada B, Pomenta Bastidas M, Popescu D, Fiodorovas M Orthop Surg. 2023; 15(8):2174-2180.

PMID: 37587547 PMC: 10432445. DOI: 10.1111/os.13856.

References

Atlan F, Werthel J . Ultrasound-guided intra-articular tenotomy of the long head of the biceps: a cadaveric feasibility study. Int Orthop. 2016; 40(12):2567-2573. DOI: 10.1007/s00264-016-3231-2. View

Hsu A, Ghodadra N, Provencher M, Lewis P, Bach B . Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results. J Shoulder Elbow Surg. 2010; 20(2):326-32. DOI: 10.1016/j.jse.2010.08.019. View

Boileau P, Ahrens P, Hatzidakis A . Entrapment of the long head of the biceps tendon: the hourglass biceps--a cause of pain and locking of the shoulder. J Shoulder Elbow Surg. 2004; 13(3):249-57. DOI: 10.1016/j.jse.2004.01.001. View

Rol M, Favard L, Berhouet J . Diagnosis of long head of biceps tendinopathy in rotator cuff tear patients: correlation of imaging and arthroscopy data. Int Orthop. 2017; 42(6):1347-1355. DOI: 10.1007/s00264-017-3616-x. View

Castricini R, Familiari F, De Gori M, Riccelli D, De Benedetto M, Orlando N . Tenodesis is not superior to tenotomy in the treatment of the long head of biceps tendon lesions. Knee Surg Sports Traumatol Arthrosc. 2017; 26(1):169-175. DOI: 10.1007/s00167-017-4609-4. View

Cheng N, Pan W, Vally F, le Roux C, Richardson M . The arterial supply of the long head of biceps tendon: Anatomical study with implications for tendon rupture. Clin Anat. 2010; 23(6):683-92. DOI: 10.1002/ca.20992. View

Kerschbaum M, Maziak N, Scheuermann M, Scheibel M . [Arthroscopic tenodesis or tenotomy of the long head of the biceps tendon in preselected patients : Does it make a difference?]. Orthopade. 2016; 46(3):215-221. DOI: 10.1007/s00132-016-3358-2. View

Meeks B, Meeks N, Froehle A, Wareing E, Bonner K . Patient Satisfaction After Biceps Tenotomy. Orthop J Sports Med. 2017; 5(5):2325967117707737. PMC: 5448732. DOI: 10.1177/2325967117707737. View

Maynou C, Mehdi N, Cassagnaud X, Audebert S, Mestdagh H . [Clinical results of arthroscopic tenotomy of the long head of the biceps brachii in full thickness tears of the rotator cuff without repair: 40 cases]. Rev Chir Orthop Reparatrice Appar Mot. 2005; 91(4):300-6. DOI: 10.1016/s0035-1040(05)84327-2. View

10.

Greditzer 4th H, Kaplan L, Lesniak B, Jose J . Ultrasound-guided percutaneous long head of the biceps tenotomy: a novel technique with case report. HSS J. 2014; 10(3):240-4. PMC: 4171451. DOI: 10.1007/s11420-014-9397-5. View

11.

Andrin J, Pottecher P, Viard B, Baulot E, Trouilloud P, Martz P . Linear relationship between lateralization of the bicipital groove and humeral retroversion and its link with the biepicondylar humeral line. Anatomical study of seventy cadaveric humerus scans. Int Orthop. 2017; 41(7):1431-1434. DOI: 10.1007/s00264-017-3495-1. View

12.

Boileau P, Baque 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(4):747-57. DOI: 10.2106/JBJS.E.01097. View

13.

Walch G, Edwards T, 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; 14(3):238-46. DOI: 10.1016/j.jse.2004.07.008. View

14.

Pander P, Sierevelt I, Pecasse G, van Noort A . Irreparable rotator cuff tears: long-term follow-up, five to ten years, of arthroscopic debridement and tenotomy of the long head of the biceps. Int Orthop. 2018; 42(11):2633-2638. DOI: 10.1007/s00264-018-3991-y. View

15.

Ahrens P, Boileau P . The long head of biceps and associated tendinopathy. J Bone Joint Surg Br. 2007; 89(8):1001-9. DOI: 10.1302/0301-620X.89B8.19278. View

16.

Levy B, Ducat A, Gaudin P, Maqdes A, Brasseur J, Klouche S . Ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon: a non-reliable technique. Knee Surg Sports Traumatol Arthrosc. 2011; 20(6):1027-30. DOI: 10.1007/s00167-011-1671-1. View

17.

Szabo I, Boileau P, Walch G . The proximal biceps as a pain generator and results of tenotomy. Sports Med Arthrosc Rev. 2008; 16(3):180-6. DOI: 10.1097/JSA.0b013e3181824f1e. View

18.

Galdi B, Southren D, Brabston E, Popkin C, Jobin C, Levine W . Patients Have Strong Preferences and Perceptions for Biceps Tenotomy Versus Tenodesis. Arthroscopy. 2016; 32(12):2444-2450. DOI: 10.1016/j.arthro.2016.04.022. View

19.

Wu P, Jou I, Yang C, Lin C, Yang C, Su F . 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):1099-106. DOI: 10.1016/j.jse.2013.11.013. View