Long Head of Biceps Tendon Pathology in Rotator Cuff Tears: Review of Incidence, Pathology and Current Trends of Management

Abstract

Pathology of the long head of the biceps tendon (LHBT) is a recognised pain generator and often associated with rotator cuff tears (RCT). In patients with a RCT, the incidence of concomitant LHBT pathology is very high, and has been reported to range from 36% to 76%, and significantly correlates with the size of RCTs. Treatment of LHBT lesions with tenotomy or tenodesis in the context of RCT has been controversial particularly in the early 2020’s. Over the last decade the dilemma tenotomy versus tenodesis has been supplanted by arthroscopic versus open tenodesis. We present an update of incidence, pathology and histopathology of LHBT lesions and review the relevant biomechanical and clinical studies. We also discuss the current trends and management of biceps tendon lesions in the context of rotator cuff repair.