Is tendinopathy of the long head of the biceps tendon an indication for arthroscopic biceps tenotomy/tenodesis (Arthroscopic Biceps Tenotomy/Tenodesis)?

From the Guidelines

Tendinopathy in the long head of the biceps tendon is not a clear indication for arthroscopic biceps tenotomy or tenodesis based on the available evidence. The current guidelines do not provide a strong recommendation for or against biceps tenotomy or tenodesis in patients with glenohumeral osteoarthritis, as stated in the study published in The Journal of the American Academy of Orthopaedic Surgeons 1.

When considering surgical intervention for biceps tendinopathy, it is essential to weigh the potential benefits and risks. Some key points to consider include:

• The patient's symptoms and functional impairment
• The presence of other shoulder pathologies
• The patient's age, activity level, and cosmetic concerns
• The potential for improvement with conservative management

In general, arthroscopic biceps tenotomy or tenodesis may be considered for patients with persistent pain and dysfunction from biceps tendinopathy that has not responded to conservative management. However, the decision to proceed with surgery should be made on a case-by-case basis, taking into account the individual patient's circumstances and the available evidence.

Some important considerations for the surgical procedure include:

• Tenotomy involves cutting the tendon, allowing it to retract, while tenodesis involves detaching the tendon and reattaching it to the proximal humerus
• The choice between these procedures depends on patient factors, including age, activity level, and cosmetic concerns
• Younger, more active patients typically receive tenodesis to maintain muscle strength and prevent the "Popeye" deformity, while older, less active patients may be candidates for the simpler tenotomy procedure.

It is crucial to note that the available evidence is limited, and more research is needed to provide clear guidance on the indications and outcomes of arthroscopic biceps tenotomy or tenodesis for biceps tendinopathy, as highlighted by the study published in 2010 1.

From the Research

Indications for Arthroscopic Biceps Tenotomy/Tenodesis

• Tendonopathy in the long head of the biceps tendon is a common indication for arthroscopic biceps tenotomy or tenodesis, as it can cause significant shoulder pain and dysfunction 2, 3, 4, 5, 6.
• Severe biceps tendonopathy, partial- or full-thickness tendon tears, or biceps instability associated with rotator cuff tears are also indications for arthroscopic biceps tenotomy or tenodesis 2, 3, 4, 5.
• Degenerative rotator cuff tears with involvement of the long head of the biceps tendon can be treated with arthroscopic isolated biceps tenotomy, especially in patients with a normal acromiohumeral distance (> 10 mm) 6.

Treatment Options

• Arthroscopic biceps tenotomy and tenodesis are both effective treatment options for tendonopathy in the long head of the biceps tendon, with similar clinical outcomes 4.
• Tenodesis is preferred by some authors as it allows for re-establishment of the resting muscle length, avoidance of scarring and spasm, and maintenance of elbow flexion and supination strength 2, 5.
• The choice between tenotomy and tenodesis depends on various factors, including patient age, activity level, and presence of rotator cuff tears or other shoulder pathology 3, 4, 5, 6.

Outcomes and Prognostic Factors

• Arthroscopic biceps tenotomy and tenodesis can significantly improve shoulder pain and function in patients with tendonopathy in the long head of the biceps tendon 2, 3, 4, 5, 6.
• A healthy-appearing teres minor on preoperative imaging is associated with better postoperative outcomes, including increased external rotation and higher Constant scores 4.
• A normal acromiohumeral distance (> 10 mm) is a prognostic factor for improvement in pain and function after arthroscopic isolated biceps tenotomy 6.