“Rocambole-Like” Biceps Tenodesis: Technique and Results

Abstract

Objective: To present a new technique for bicipital tenodesis and its results: accomplished partially via arthroscopy and grounded in concepts of the normal and pathological anatomy of the tendon of the biceps long head. It is based on the predisposition of this tendon towards becoming attached to the intertubercular sulcus after rupture or tenotomy (auto-tenodesis). Methods: Evaluations were conducted on 63 patients (63 shoulders), aged from 32 to 77 years (average 55), consisting of 32 females (51%) and 31 males (49%). Thirty-five of the patients (55.6%) were over 60 years of age and 28 patients (44.4%) were under 60 years of age. Eighteen were sports participants (28.6%). Fourteen had injuries associated with the subscapularis (22.2%). The average follow up was 43 months (ranging from 12 to 74 months). The right shoulder accounted for 48 cases (76.2%), of which one was a left-handed individual and 47 were right-handed. The left shoulder accounted for 15 (23%) of the patients, of whom two were left-handed and 13 were right-handed. There were no bilateral occurrences. The statistical analysis were done using SPSS version 18. Pearson's chi-square test and continuity corrections were used to investigate the statistical significance of associations between variables. Associations were taken to be statistically significant when p was less than 0.05. Results: Residual Popeye deformity was perceived by seven patients (11.1%); it was only observed by the examiner in 15 cases (23.8%); and neither the patient nor the examiner observed it in 41 cases (65%). There were no statistically valid influences from age, participation in contact or throwing sports, subscapularis tendon-associated injury or Popeye deformity. Fifty-eight patients (92.06%) were satisfied, two patients were dissatisfied (3.17%) and three patients were indifferent (4.76%). Conclusion: The technique presented high patient satisfaction rates (92.06%) and residual deformity was perceived by 11.1% of the patients. The appearance did not have any statistically valid correlation with ages over or under 60 years (p = 0.883), sports practice (p = 0.195) or subscapularis-associated injury (p = 0.958).

Disorders of the long head of the biceps: tenotomy versus tenodesis

“…Godinho et al, 39 in a retrospective study of 63 patients, developed a surgical technique known as bicipital “jelly roll” tenodesis, in which LHB tenodesis was indicated after tenotomy when there was injury in up to 50% of the tendon, whether or not associated with rotator cuff injury, or when subluxation or dislocation occurred. In that sample, 92.06% of the patients were satisfied, without loss of supination force of the forearm and elbow flexion.…”

“…The main techniques described for the surgical treatment of LHB disorders were: acromioplasty, debridement, reconstruction of the biceps reflection pulley, tenotomy, and tenodesis. 4 , 5 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 …”

A rare case of an anatomical variation of bilateral long head of the biceps brachii tendons identified within the substance of bifid subscapularis tendons

“… 3 , 18 , 19 The biceps tendon has been documented to subluxate or dislocate medially out of the intertubercular groove, with the LHB tendon found dorsal to the subscapularis when the latter is torn, or ventral when the subscapularis remains intact. 2 , 20 …”

Intra-articular arthroscopic biceps tenodesis with interference screw: clinical and isokinetic evaluation

“…There are many materials and methods for performing an LHB tenodesis, including tenodesis to soft tissues 12 , 15 , 23 and bony tenodesis without interference screws. Though Levin et al 23 defended soft tissue tenodesis arguing that it better reproduces biceps tension, the Popeye deformity may occur in up to 35% of cases, 12 which did not happen in this series. Complications with tenodesis with anchors and cortical buttons have also been described.…”

“… 26 Epidemiologic studies have shown that the number of such procedures has risen between 2007 and 2011, most performed in individuals between ages 30 and 59 years. 52 , 55 Multiple techniques have been described for LHB tenodesis both on soft tissue 12 , 15 , 23 and bone, in which tendon fixation may be obtained with transosseous tunnels, 38 “keyholes,” 19 cortical buttons, 39 suture anchors, 10 , 17 , 45 , 46 , 47 and interference screws. 5 …”