Abstract
Background:
Management of symptomatic long head of biceps tendon (LHBT) pathology remains a source of debate.
Questions/Purposes:
The purpose of this study was to identify consensus trends for the treatment of LHBT pathology among specialists.
Methods:
A survey was distributed to members of the American Shoulder and Elbow Society (ASES), consisting of three sections—demographics, case scenarios, and general LHBT pathology management. Cases presented common clinical scenarios, and surgeons reported their management preferences. Consensus responses were defined as > 50% of participants giving a single response.
Results:
One hundred and forty-two of 417 (34%) surgeons completed surveys. Forty-seven percent of questions reached a consensus answer. Biceps tenodesis was the overwhelmingly preferred technique in cases demonstrating LHBT pathology, as compared to tenotomy. No consensus, however, was reached regarding a specific surgical technique for biceps tenodesis. The two most popular techniques were arthroscopic tenodesis to bone and open subpectoral biceps tenodesis. Fellowship-trained arthroscopic surgeons and surgeons with a largely arthroscopic practice were more likely to perform tenodesis arthroscopically.
Conclusion:
ASES members favored biceps tenodesis over tenotomy for surgical management of LHBT pathology, without consensus regarding a specific surgical technique.
Get full access to this article
View all access options for this article.
References
1.
Acevedo DC, Paxton ES, Williams GR, Abboud JA. A survey of expert opinion regarding rotator cuff repair. J Bone Joint Surg Am. 2014;96(14):e123. 10.2106/JBJS.M.00399
2.
Ahrens PM, Boileau P. The long head of biceps and associated tendinopathy. J. Bone Joint Surg Br. 2007;89(8):1001–9. 10.1302/0301-620X.89B8.19278
3.
Baggio M, Martinelli F, Netto MB, Martins RO, da Cunha RC, Stipp WN. Evaluation of the results from arthroscopic tenodesis of the long head of the biceps brachii on the tendon of the subscapularis muscle. Rev Bras Ortop. 2016;51(2):157–62. 10.1016/j.rboe.2016.01.006
4.
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.;89(4):747–57. 10.2106/JBJS.E.01097
5.
Creech MJ, Yeung M, Denkers M, Simunovic N, Athwal GS, Ayeni OR. Surgical indications for long head biceps tenodesis: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2016;24(7):2156–66. 10.1007/s00167-014-3383-9
6.
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? Orthop. J Sport Med. 2015;3(2):2325967115570848. 10.1177/2325967115570848
7.
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(4):828–33. 10.1177/0363546508322179
8.
Galdi B, Southren DL, Brabston EW, Popkin CA, Jobin CM, Levine WN, et al. Patients have strong preferences and perceptions for biceps tenotomy versus tenodesis. Arthroscopy. 2016. 10.1016/j.arthro.2016.04.022
9.
Garcia GH, Taylor SA, Fabricant PD, Dines JS. Shoulder instability management: a survey of the American shoulder and elbow surgeons. Am J Orthop. 2016;45(3):E91–7.
10.
Gill TJ, McIrvin E, Mair SD, Hawkins RJ. Results of biceps tenotomy for treatment of pathology of the long head of the biceps brachii. J Shoulder Elbow Surg. 2001;10(3):247–9. 10.1067/mse.2001.114259
11.
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(2):326–32. 10.1016/j.jse.2010.08.019
12.
Johannsen AM, Macalena JA, Carson EW, Tompkins M. Anatomic and radiographic comparison of arthroscopic suprapectoral and open subpectoral biceps tenodesis sites. Am J Sports Med. 2013; 41 (12):2919–24. 10.1177/0363546513503812.
13.
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(2):208–13.
14.
Nair R, Kahlenberg CA, Patel RM, Knesek M, Terry MA. All-arthroscopic suprapectoral biceps tenodesis. Arthrosc Tech. 2015;4(6):e855–61. 10.1016/j.eats.2015.08.010.
15.
Nho SJ, Strauss EJ, Lenart BA, Provencher MT, Mazzocca AD, Verma NN, et al. Long head of the biceps tendinopathy: diagnosis and management. J Am Acad Orthop Surg. 2010;18(11):645–56.
16.
Osbahr DC, Diamond AB, Speer KP. The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis. Arthroscopy. 2002;18(5):483–7. 10.1053/jars.2002.32233
17.
Patel K V, Bravman J, Vidal A, Chrisman A, McCarty E. Biceps tenotomy versus tenodesis. Clin Sports Med. 2016;35(1):93–111. 10.1016/j.csm.2015.08.008
18.
Randelli P, Arrigoni P, Cabitza F, Ragone V, Cabitza P. Current practice in shoulder pathology: results of a web-based survey among a community of 1, 084 orthopedic surgeons. Knee Surg Sports Traumatol Arthrosc. 2012;20(5):803–15. 10.1007/s00167-011-1673-z
19.
Raziano DB, Jayadevappa R, Valenzula D, Weiner M, Lavizzo-Mourey R. E-mail versus conventional postal mail survey of geriatric chiefs. Gerontologist. 2001;41(6):799–804.
20.
Redfern J, Burks R. 2009 survey results: surgeon practice patterns regarding arthroscopic surgery. Arthroscopy. 2009;25(12):1447–52. 10.1016/j.arthro.2009.07.013
21.
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(1):66–71. 10.1016/j.jse.2011.01.037
22.
Sethi N, Wright R, Yamaguchi K. Disorders of the long head of the biceps tendon. J Shoulder Elbow Surg. 1999;8(6):644–54.
23.
Slenker NR, Lawson K, Ciccotti MG, Dodson CC, Cohen SB. Biceps tenotomy versus tenodesis: clinical outcomes. Arthroscopy. 2012;28(4):576–82. 10.1016/j.arthro.2011.10.017
24.
Taylor SA, Fabricant PD, Bansal M, Khair MM, McLawhorn A, DiCarlo EF, et al. The anatomy and histology of the bicipital tunnel of the shoulder. J Shoulder Elbow Surg. 2015;24(4):511–9. 10.1016/j.jse.2014.09.026
25.
Taylor SA, Khair MM, Gulotta L V, Pearle AD, Baret NJ, Newman AM, et al. Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex. Arthroscopy. 2015;31(2):215–24. 10.1016/j.arthro.2014.10.017
26.
Taylor SA, Newman AM, Dawson C, Gallagher KA, Bowers A, Nguyen J, et al. The “3-Pack” examination is critical for comprehensive evaluation of the biceps-labrum complex and the bicipital tunnel: a prospective study. Arthroscopy. 2016. 10.1016/j.arthro.2016.05.015
27.
Taylor SA, Ramkumar PN, Fabricant PD, Dines JS, Gausden E, White A, et al. The clinical impact of bicipital tunnel decompression during long head of the biceps tendon surgery: a systematic review and meta-analysis. Arthroscopy. 2016;32(6):1155–64. 10.1016/j.arthro.2016.02.020
28.
Verma NN, Drakos M, O'Brien SJ. Arthroscopic transfer of the long head biceps to the conjoint tendon. Arthroscopy. 2005;21(6):764. 10.1016/j.arthro.2005.03.032
29.
Voss A, Cerciello S, Yang J, Beitzel K, Cote MP, Mazzocca AD. Open subpectoral tenodesis of the proximal biceps. Clin Sports Med. 2016;35(1):137–52. 10.1016/j.csm.2015.08.007