The Loop Tenodesis Procedure—From Biomechanics to First Clinical Results

Abstract

(1) Introduction: Several surgical therapy options for the treatment of pathologies of the long biceps tendon (LHB) have been established. However, tenotomy, as well as established tenodesis techniques, has disadvantages, such as cosmetic deformities, functional impairments and residual shoulder pain. This study presents the first clinical and structural results of the recently introduced loop tenodesis procedure for the LHB, developed to overcome these issues. (2) Methods: 37 patients (11 women, 26 men, mean age 52 years), who underwent loop tenodesis of the LHB were examined six months after surgery. For the clinical evaluation the Constant score, as well as the LHB score, were used, complemented by elbow flexion and supination strength measurements. The integrity of the tenodesis construct was evaluated indirectly by sonographic detection of the LHB in the bicipital groove. (3) Results: Both, the overall Constant score as well as the LHB score showed significant improvements six months postoperatively, as compared to the preoperative value. Fourteen patients (38%) presented an examiner-dependent upper arm deformity, although only five patients (13%) reported subjective cosmetic deformities. Both, flexion and supination strength were preserved compared to the preoperative level. In 35 patients (95%), the tenodesis in the bicipital groove was proofed sonographically. (4) Conclusion: The loop tenodesis of the LHB provides good-to-excellent overall clinical results after a short-term follow-up of six month. The incidence of cosmetic deformities was inferior compared to conventional therapy options (tenotomy and anchor tenodesis).

Clinical effectiveness of tenotomy versus tenodesis for long head of biceps pathology: a systematic review and meta-analysis

“…With significant advances in arthroscopic instrumentation and implants, a large increase in variations of both tenotomy and tenodesis have been reported. [9][10][11][12][13][14][15] Some authors have demonstrated tenotomy at the biceps anchor can autotenodese in the intra-articular opening of the groove, as the stump base retracts. 16 This implant-free technique may have cost and time-saving benefits; however, a larger proportion of techniques have reported utilisation of implants to secure the tendon.…”

“…This can be either intra-articularly, withing the bicipital groove, or in the subpectoral region of the proximal humerus. With significant advances in arthroscopic instrumentation and implants, a large increase in variations of both tenotomy and tenodesis have been reported 9–15. Some authors have demonstrated tenotomy at the biceps anchor can auto-tenodese in the intra-articular opening of the groove, as the stump base retracts 16.…”

New Trends in Shoulder Surgery from Biomechanics to the Operating Room

“…The study presented by Riedl et al [ 10 ] showed the first clinical and structural results of the recently introduced loop LHB tenodesis procedure. This technique provided good-to-excellent overall clinical results after a short-term follow-up of six months, with an inferior incidence of cosmetic deformities compared to conventional therapy options, such as tenotomy and anchor tenodesis.…”