Top

International Orthopaedics

Published in:

01-10-2019 | Painful Arc | Original Paper

In-office shoulder arthroscopy and tenotomy of the long head of the biceps tendon—a cadaveric feasibility study

Authors: Ion-Andrei Popescu, Frédéric Teboul, Jean-Nöel Goubier, Amir Ghazanfari

Published in: International Orthopaedics | Issue 10/2019

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.

Szabó I, Boileau P, Walch G (2008) The proximal biceps as a pain generator and results of tenotomy. Sports Med Arthrosc. https://doi.org/10.1097/JSA.0b013e3181824f1e CrossRef

Meeks BD, Meeks NM, Froehle AW et al (2017) Patient satisfaction after biceps tenotomy. Orthop J Sport Med 5:232596711770773. https://doi.org/10.1177/2325967117707737 CrossRef

Walch G, Edwards TB, Boulahia A et al (2005) 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. https://doi.org/10.1016/j.jse.2004.07.008 CrossRef

Wu P-T, Jou I-M, Yang C-C et al (2014) The severity of the long head biceps tendinopathy in patients with chronic rotator cuff tears: macroscopic versus microscopic results. J Shoulder Elb Surg 23:1099–1106. https://doi.org/10.1016/j.jse.2013.11.013 CrossRef

Ahrens PM, Boileau P (2007) The long head of biceps and associated tendinopathy. J Bone Jt Surg - Br. https://doi.org/10.1302/0301-620X.89B8.19278 CrossRef

Maynou C, Mehdi N, Cassagnaud X et al (2005) 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. https://doi.org/10.1016/s0035-1040(05)84327-2 CrossRef

Galdi B, Southren DL, Brabston EW et al (2016) Patients have strong preferences and perceptions for biceps tenotomy versus tenodesis. Arthrosc J Arthrosc Relat Surg 32:2444–2450. https://doi.org/10.1016/j.arthro.2016.04.022 CrossRef

Rol M, Favard L, Berhouet J (2018) Diagnosis of long head of biceps tendinopathy in rotator cuff tear patients: correlation of imaging and arthroscopy data. Int Orthop 42:1347–1355. https://doi.org/10.1007/s00264-017-3616-x CrossRefPubMed

Castricini R, Familiari F, De Gori M et al (2018) Tenodesis is not superior to tenotomy in the treatment of the long head of biceps tendon lesions. Knee Surg Sport Traumatol Arthrosc 26:169–175. https://doi.org/10.1007/s00167-017-4609-4 CrossRef

10.

Kerschbaum M, Maziak N, Scheuermann M, Scheibel M (2017) Arthroskopische Tenodese oder Tenotomie der langen Bizepssehne bei vorselektionierten Patienten. Orthopade 46:215–221. https://doi.org/10.1007/s00132-016-3358-2 CrossRefPubMed

11.

Hsu AR, Ghodadra NS, Provencher CMT et al (2011) Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results. J Shoulder Elb Surg 20:326–332. https://doi.org/10.1016/j.jse.2010.08.019 CrossRef

12.

Boileau P, Baqué F, Valerio L et al (2007) Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Jt Surg - Ser A. https://doi.org/10.2106/JBJS.E.01097

13.

Pander P, Sierevelt IN, Pecasse GABM, van Noort A (2018) 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 42:2633–2638. https://doi.org/10.1007/s00264-018-3991-y CrossRefPubMed

14.

Greditzer HG, Kaplan LD, Lesniak BP, Jose J (2014) Ultrasound-guided percutaneous long head of the biceps tenotomy: a novel technique with case report. HSS J. https://doi.org/10.1007/s11420-014-9397-5 CrossRef

15.

Atlan F, Werthel JD (2016) Ultrasound-guided intra-articular tenotomy of the long head of the biceps: a cadaveric feasibility study. Int Orthop 40:2567–2573. https://doi.org/10.1007/s00264-016-3231-2 CrossRefPubMed

16.

Lévy B, Ducat A, Gaudin P et al (2012) Ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon: a non-reliable technique. Knee Surg Sport Traumatol Arthrosc. https://doi.org/10.1007/s00167-011-1671-1 CrossRef

17.

Cheng NM, Pan WR, Vally F et al (2010) The arterial supply of the long head of biceps tendon: anatomical study with implications for tendon rupture. Clin Anat. https://doi.org/10.1002/ca.20992 CrossRef

18.

Andrin J, Pottecher P, Viard B et al (2017) 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 41(7):1431–1434. https://doi.org/10.1007/s00264-017-3495-1 CrossRefPubMed

19.

Boileau P, Ahrens PM, Hatzidakis AM (2004) Entrapment of the long head of the biceps tendon: the hourglass biceps--a cause of pain and locking of the shoulder. J Shoulder Elb Surg 13(3):249–257. https://doi.org/10.1016/S1058274604000187 CrossRef

Title: In-office shoulder arthroscopy and tenotomy of the long head of the biceps tendon—a cadaveric feasibility study
Authors: Ion-Andrei Popescu
Frédéric Teboul
Jean-Nöel Goubier
Amir Ghazanfari
Publication date: 01-10-2019
Publisher: Springer Berlin Heidelberg
Keywords: Painful Arc
Local Anesthesia in Dentistry
Shoulder Arthroscopy
Arthroscopy
Arthroscopy
Published in: International Orthopaedics / Issue 10/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-019-04377-z

At a glance: The STEP trials

Springer Medicine

In-office shoulder arthroscopy and tenotomy of the long head of the biceps tendon—a cadaveric feasibility study

Abstract

Purpose

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2019

Below- vs above-elbow cast for distal radius fractures: is elbow immobilization really effective for reduction maintenance?

“More accurate correction using “patient-specific” cutting guides in opening wedge distal femur varization osteotomies

Cementless revision femoral stems application of press-fit principles and clinical outcomes

Functional impairment after successful surgical reconstruction for proximal hamstring avulsion

Arthroscopic rotator cuff repair with or without suprascapular nerve decompression in posterosuperior massive rotator cuff tears

Clinical and radiologic outcomes of two patellar resection techniques during total knee arthroplasty: a prospective randomized controlled study