Long-term functional results and isokinetic strength evaluation after arthroscopic tenotomy of the long head of biceps tendon

Abstract

Introduction:The objective of this study is to evaluate the biomechanical function of the upper arm after arthroscopic long head of biceps (LHB) tenotomy at long-term follow-up.Materials and Methods:Twenty-five male subjects ranging from 30 to 63 years old were evaluated at a mean follow-up of 7.0 years after tenotomy. Bilateral isokinetic testing was performed to obtain peak torque values, as well as total work done throughout the full range of elbow flexion and supination.Results:Magnetic resonance imaging scans revealed nine unrecognized LHB ruptures in the contralateral arm, leaving 16 subjects to complete the testing protocol. The mean quickDASH score was 8.1 (standard error [SE] 2.5). The mean oxford elbow score was 97.9 (SE 1.6). The tenotomy arm recorded a decrease in peak flexion torque of 7.0% (confidence interval [CI] 1.2-12.8), and a decrease in the peak supination torque of 9.1% (CI 1.8-16.4) relative to the contralateral arm. The total work carried out through the full range of joint motion was reduced in elbow flexion by 5.1% (CI −1.3-11.4) and in forearm supination by 5.7% (CI-2.4-13.9).Discussion:Maximum strength in elbow flexion and forearm supination is significantly reduced compared with the contralateral arm. However, this impairment is partially compensated for by relatively greater strength sustained through the latter stages of joint motion. This results in comparable total work measurements between the tenotomised and contralateral side, potentially accounting for ongoing high levels of patient satisfaction and clinical function in the long term after LHB tenotomy.Level of Evidence IV:Case series without comparison group.

The Arthroscopic Loop Tenodesis Procedure: An Implant-Free Technique to Treat Long Biceps Tendon Pathologies

“…Many authors recommend a strong bony fixation of the LHB compared with a simple tenotomy to reduce complications resulting from a distalization of the LHB such as muscle cramps, cosmetic deformities, or reduction of elbow flexion and supination strength. 2 , 3 , 8 A complete slippage of the tenotomized tendon with a subsequent distalization of the biceps muscle occurs in very few patients only. 8 This self-locking potential of the tendon in the bicipital groove is described as “autotenodesis” of the LHB.…”

The All-Inside Arthroscopic Loop Tenodesis Procedure to Treat Long Head of Biceps Tendon Pathologies

“…7 In particular, bony fixation techniques are recommended to reduce complications caused by distalization of the biceps muscle, observed after simple tenotomy. 2,3,8 Recently, the loop tenodesis procedure has been introduced. 1 This technique is based on the self-locking potential of the tenotomized LHB at the bicipital groove.…”

“…L esions of the long head of the biceps (LHB) are a common cause of anterior shoulder pain. Although distalization of the biceps muscle can often be observed after simple LHB tenotomy, [1][2][3] implant-associated complications can occur with bony tenodesis techniques using an anchor or interference screw. [4][5][6] Recently, the loop tenodesis procedure was presenteddan arthroscopically assisted technique that enlarges the tenotomized proximal LHB diameter by creating a tendon loop and supports the self-locking mechanism with a subsequent stable "autotenodesis" at the entrance to the bicipital groove.…”

“…Long head of biceps (LHB) tendon stitch configuration: arthroscopic visualization of the right LHB from the posterior portal with the patient placed in the beach-chair position, showing stitch 1 about 2.5 cm distal to the SLAP complex (1); stitch 2 in a caudocranial direction close to the tendon's base(2); stitch 3 in a craniocaudal direction close to the tendon's base (3); and stitch 4 in a caudocranial direction about 2.5 cm distal to the SLAP complex(4). (AIP, anteroinferior portal; CH, caput humeri; SSC, subscapularis tendon; SSP, supraspinatus tendon.…”

Erratum: Long-term functional results and isokinetic strength evaluation after arthroscopic tenotomy of the long head of biceps tendon

“…In the article titled, “Long-term functional results and isokinetic strength evaluation after arthroscopic tenotomy of the long head of biceps tendon” published in pages 76-80, issue 3, vol. 8 of International Journal of Shoulder Surgery[ 1 ], the section, “Declaration of Patient Consent” having the following content went missing due to technical errors:…”