5,557

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

Anestis Iossifidis1, Georgios Togias1, Liam Rose1, John Adamu Tiifu1

1 Department of Trauma and Orthopaedic Surgery, Shoulder Unit, Croydon University Hospital, London,UK.

Conflict-of-interest statement: The author(s) declare(s) that there is no conflict of interest regarding the publication of this paper.

Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http: //creativecommons.org/licenses/by-nc/4.0/

Correspondence to: Anestis Iossifidis, MD, FRCS Ed, FRCS Ed (orth.), Senior Trauma & Orthopaedic Surgeon, Croydon University Hospital, 530 London Road, Croydon, London, CR7 7YE, the United Kingdom.
Telephone: +0044 (0) 7802404708
Email: anestis.iossifidis@gmail.com

Received: February 13, 2022
Revised: February 15, 2022
Accepted: February 16 2022
Published online: February 28, 2022

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.

Key words: Long head of biceps; Tendon tears; Rotator cuff tears; Biceps tenodesis; Biceps tenotomy; Suprapectoral tenodesis

© 2022 The Author(s). Published by ACT Publishing Group Ltd. All rights reserved.

Iossifidis A, Togias G, Rose L, Tiifu JA. Long Head of Biceps Tendon Pathology in Rotator Cuff Tears: Review of Incidence, Pathology and Current Trends of Management. International Journal of Orthopaedics 2022; 9(1): 1585-1590 Available from: URL: http://www.ghrnet.org/index.php/ijo/article/view/3264

INTRODUCTION

Pathology of the long head of the biceps tendon (LHBT) is a recognised pain generator and often associated with rotator cuff tears (RCT)[1-8]. In patients with a RCT, the incidence of concomitant LHBT pathology is very high, and has been reported to range from 36% to 76%[4,7-10], and significantly correlates with the size of RCTs. Biceps tendon lesions in the early stage may include, tenosynovitis and dynamic instability and at a later stage, degenerative findings (hypertrophy, hourglass deformity, delamination, partial tears), and static tendon instability. 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. Early biomechanical and clinical data have reported conflicting results in regard to the preferred implant of fixation, tenodesis location, and various tenodesis procedures.

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.

Surgical anatomy, pathology and incidence of LHBT lesions in patients with RCT

The LHBT courses in an oblique direction from its origin toward the intertubercular groove[3]. The LHBT and pulley system lie in close anatomic proximity to the subscapularis and supraspinatus tendons. This unique anatomy of the proximal biceps places it at high risk of abrasive wear and injury.

Injuries to the rotator cuff predispose the LHBT to degenerative and instability lesions

In a prospective arthroscopic study of 89 patients, Neviaser et al. were the first to report a strong association of coexistent biceps tendon lesions and rotator cuff pathology, and an increasing severity of biceps tendon lesions according to the size of rotator cuff tear. Biceps tenodesis was part of the surgical treatment[1]. Common macroscopic pathologic findings affecting the proximal LHBT in the presence of rotator cuff tears include, in the early stage, tenosynovitis and dynamic instability and at a later stage, degenerative findings (hypertrophy, hourglass deformity, delamination, partial tears), and static tendon instability (subluxation or dislocation)[5-8,11-12].

LHBT InstabiIity lesions

Pulley injuries result in LHBT instability, occuring mainly in the presence of a rotator cuff tear. The biceps pulley system is the antero-posterior stabiliser of the LHBT tendon. The anterior pulley is part of the rotator interval between the supraspinatus and subscapularis tendons and consists of the coracohumeral ligament, the superior glenohumeral ligament, and the glenohumeral joint capsule fibers. [13] The posterior pulley is formed by the main part of the coracohumeral ligament blending with the anterior fibers of the supraspinatus tendon[7,14-15]. In the neutral position of the upper limb, the LHB lies against the anterior pulley and the medial wall of the bicipital groove. External rotation increases the stress on the anterior stabilizing structures; internal rotation reverses the load from the anterior to the posterior pulley[7,13]. In external rotation and abduction of shoulder, the LHBT is prevented from posterior subluxation by the posterior sling[7,14].

Incidence of LHBT instability in patients with RCT

An LHBT instability can result in shoulder pain and mainly occurs in the presence of a rotator cuff tears.

In previous studies, LHBT instability was observed in up to 20% of cases almost exclusively in the anterior direction[8,16-18]. Lafosse et al (2007), however, observed LHBT instability in 45% of 200 rotator cuff tears: 16% anteriorly, 19% posteriorly, and 10% antero-posteriorly. Anterior LHB instability was seen in 48% of subscapularis tears and posterior LHBT instability in 31% of supraspinatus tears. LHBT instability was associated with LHBT lesions: an unstable biceps tendon was associated with 85% lesions and a stable biceps tendon was associated with 30% of LHBT lesions. The authors suggested that the high correlation of LHBT instability with LHBT lesions may be explained by the increased anteroposterior motion of the tendon over the tuberosities, like a windshield wiper when rotating the arm. The increasing friction resulting in progressing damage to the tendon[7]. Braun et al (2011) in a prospective study of 207 cases, reported Pulley tears in 32.4% of rotator cuff tears[18].

LHBT degenerative lesions

Lesions of the LHBT are part of the rotator cuff and acromioclavicular joint degenerative process[3]. In the presence of a rotator cuff tear, subacromial impingement and abnormal mechanical loading on the LHB can cause progressive deterioration of the biceps tendon. Several clinical studies have shown increasing biceps tendon lesions with increasing rotator cuff tear size[1-2,7-8].

Histological studies

Several studies have quantified tendon degeneration of the LHBT and showed tendon degeneration, significantly more in the proximal than the distal part of the tendon[19-24]. This can be attributed to the different mechanical forces that the two locations are subjected to, with more compression, shearing and frictional forces proximally and less mechanical tensional strain distally[19,23].

Berenson et al (1996) examined the glycosaminoglycan content of two portions of the biceps tendon (proximal and distal to the transverse humeral ligament) and of the rotator cuff tendons. Glycosaminoglycan content in the intraarticular region of the biceps was two to sixfold higher than in the extraarticular region, distal to the transverse humeral ligament. In addition, there was no difference in glycosaminoglycan content between rotator cuff and intraarticular biceps tendon, suggesting that both structures are subjected to a similar mechanical load[20].

Joseph et al (2009) reported that the intra-articular portion of the LHB exhibits histological characteristics of tendinopathy and showed a threefold increase of mucoid ground substance proliferation indicative of degeneration and mechanical overload, whereas the extra-articular portion had histological characteristics of a healthy tendon. The majority of degenerative changes of the tendon accompanied concomitant rotator cuff pathology[21]. Similarly, Mazzocca et al (2013) observed that the intra-articular segment of the LHBT showed more signs of degenerative changes than the extra-articular portion, both in tendinosis and instability. The tendon instability group showed the greatest degree of degenerative changes in the proximal LHBT[23]. Wu et al (2014), reported that the macroscopic pathology of LHB may not fully reflect the severity of tendinopathy, and the coexisting size of RCTs plays a role in the severity of LHB tendinopathy. The histology of the macroscopically normal LHBT in patients with chronic RCT, showed a 75% incidence of advanced tendinopathy and none with normal histology[24]. Lakemeier et al. (2010.) have reported that the LHBT at the molecular level shows significantly increased levels of vascular endothelial growth factor and matrix metalloproteinases in patients with rotator cuff pathology compared to healthy controls. Both of these markers are known to correlate with tendon degeneration. The authors suggested that these findings indicate that LHB degeneration is related to the course of degenerative rotator cuff and that LHBT degeneration is secondary to the development of rotator cuff tears[22].

Incidence of LHBT lesions in patients with RCT

Rotator cuff tears have a high incidence of concomitant LHBT pathology, and this incidence is likely to increase with increasing size of rotator cuff tears[4,7-10]. The incidence of concomitant LHB pathology in patients with a RCT, has been reported to range from 36% to 76%[4,7-10]. Murthi et al (2000), reported 46.5% LHBT lesions in RCT[4]. Chen et al (2005) in a study of 122 RCT, reported an incidence of 76% LHBT lesions. The size of the RCT influenced the incidence of LHBT lesions with 60% in small tears, 68% in medium tears and 92% in large and massive tears[8]. Lafosse et al (2007) in a prospective study of 200 RCT, reported an incidence of 55% LHBT lesions. Lesions were observed in 35% of isolated subscapularis tears, 17% of isolated supraspinatus tears, 46% in two tendon tears, and 78% in three tendon tears. Desai et al (2017), reported a lower overall incidence of LHBT pathology in 36% of RCT. However, the authors did not include any LHB tendinitis cases[7]. More recently, Candela et al (2021), in a study of 202 RCT, demonstrated a prevalence of 74% LHBT pathology, which significantly correlated with RCT severity. LHBT lesions were present in 53%, 80% and 92% of small, large and massive RCTs, respectively. LHBT was absent in 10.9%[10].

LHB is a recognized as a pain generator in patients with Rotator cuff tears

In clinical studies, LHBT has been recognized as an important pain generator in RCT[1,4-8,25]. LHBT spontaneous rupture, tenotomy or tenodesis, in association with a rotator cuff repair, result in satisfactory pain relief. In the setting of an irreparable rotator cuff tear, Boileau et al demonstrated significant postoperative pain and functional improvements following biceps tenodesis or tenotomy[5].

Histopathology studies

The following histopathology studies provide the evidence that the LHBT acts as a pain generator.

Alpantaki et al (2005) demonstrated for the first time that the LHBT contains a large network of sensory and sympathetic nerve fibres, mainly near its insertion[26]. Tosounidis et al (2013) investigated the sympathetic innervation of the LHBT with immuno-histochemical staining for protein S-100 and neuropeptide Y and observed that the acute and chronic conditions of LHBT share common sympathetic innervation patterns[27]. Hadjileontis et al (2013) proved neuronal differentiation of tendon stromal cells as the source of biceps tendon pain[28]. Schmalzl et al (2019) in a histological and biomolecular analysis of LHB tendinitis, showed that the gene expression of the proinflammatory cytokines (interleukin 1 alpha, and 1 beta, tumour necrosis factor alpha) and of the catabolic matrix metalloproteinases (MMP1-3-9, -13), was upregulated, whereas the expression of the anti-inflammatory gene tissue inhibitor of matrix metalloproteinase 1, was downregulated. In addition, histological changes of neovascularization, and increased neural innervation could be observed[29]. In a recent study, Izumi et al (2021) reported that both intraarticular and intra-groove samples of degenerative lesions LHB, expressed greater Substance P, a neuropeptide secreted by sensory neurons, than healthy tendons, confirming that LHBT would be a pain generator in RCT patients[30].

Review of Management of LHBT lesions in patients with RCT

Watson et al. (2017) showed that patients who underwent a concomitant biceps procedure when indicated at the time of rotator cuff repair (RCR), demonstrated greater improvement in outcome measures after 1 year, compared with isolated RCR patients[31].

LHBT Tenotomy or Tenodesis

There are several studies in the literature comparing the clinical outcomes of tenotomy and tenodesis for LHBT lesions with concomitant rotator cuff repair. Tenotomy and tenodesis are common treatment options, and both have been shown to be effective in removing the pain. However, a higher incidence of cosmetic deformity was observed in patients treated with tenotomy. In a retrospective study, Godeneche et al, demonstrated equivalent Constant scores in patients with normal biceps who underwent Rotator cuff repair and those with pathologic biceps tendons who were treated with rotator cuff repair and simultaneous biceps tenodesis or tenotomy. However, for patients who had pathologic biceps, Constant scores were significantly better in the tenodesis than the tenotomy group[32].

In a prospective cohort study[33] and two prospective randomised trials[34-35], the authors found no significant difference in functional scores between the two groups. The incidence rate of Popeye deformity was about 3-times higher in tenotomy (9% to 27%) than in tenodesis (2.7% to 9%)[33-35].

However, in three recent systematic reviews and meta-analysis, comparing clinical outcomes after concurrent rotator cuff repair and LHBT tenodesis or tenotomy, Leroux et al (2015)[36], Ge et al (2015)[37], and Na et al (2019)[38], reported that biceps tenodesis resulted in a significantly higher Constant score and a lower risk of Popeye sign compared with biceps tenotomy, 3.9% - 8.6% versus 15.5% - 24.3% respectively.

Current trends

Due to the risk of cosmetic deformity, fatigue and muscle cramping, LHBT tenotomy is now indicated for patients aged > 65 years, who do not perform manual labour or other high-demand activities.

Biceps Tenodesis has become the preferred technique to manage LHBT pathology in younger, more active patients. Tenodesis avoids Popeye deformity, prevents muscle atrophy by maintaining the length-tension relationship of the biceps muscle, and maintains elbow flexion and supination strength[39].

The incidence of biceps tenodesis continues to increase annually, and arthroscopic tenodesis is emerging the most common used technique. Saltzman et al (2020) in a study of 8,547 LHBT tenodesis, reported that the rates of open and arthroscopic LHBT tenodesis procedures increased significantly, doubling from 2011 to 2014. Open techniques were more common when LHB tenodesis was performed in isolation, and the arthroscopic technique was the most common tenodesis performed in conjunction with rotator cuff or superior labrum repair. The overall complication rate was 2.9%[40].

LHBT tenodesis: open or arthroscopic

Biceps tenodesis can be performed through an arthroscopic (intraarticular above the groove, at the articular margin), arthroscopic proximal supra-pectoral (high in the groove) or an open approach (subpectoral, out of the groove). The tendon may be anchored with an interference screw or suture anchors.

Biomechanical studies: Implant Choice and Surgical Approach

Some studies found that interference screws confer greater strength than suture anchors, while other studies reported no difference in ultimate failure load (UFL) between implant types, irrespective of the location of tenodesis[41,42]. More recently, Aida et al (2020) conducted a systematic review and meta-regression using pooled data from 25 published biomechanical studies of biceps tenodesis representing 494 cadaveric specimens. The findings suggested that fixation with interference screws and the use of more sutures are associated with greater biceps tenodesis strength, as well as higher odds of native tissue failure versus implant pull out. Although suture anchors show inferior UFL compared with those with interference screws, incorporation of additional sutures may increase the strength of suture anchor constructs. Supra and subpectoral repairs provide equivalent biomechanical strength. Multivariate analysis also found no significant association between fixation site and UFL[43].

Clinical studies and Surgical Approach: open or arthroscopic tenodesis

A number of clinical studies have failed to demonstrate a difference in clinical outcomes between arthroscopic and open LHB tenodesis[40,44-46]. In a systematic review, Abraham et al (2016) reported that both techniques showed similar pain relief and clinical outcomes in 98% in both groups. There was a low rate of complications with failure (2.4% vs 1.8%), persistent pain (1% vs 1.1%) and Popeye deformity (1.4% vs 0.7%), in arthroscopic and open tenodesis respectively[44]. Hurley et al (2019), in seven clinical trials with 598 patients and a follow-up of 23.6 months showed that both open and arthroscopic tenodesis result in similarly excellent clinical outcomes. There were no significant differences between the functional outcome scores, patient satisfaction or return to sport in any of the included studies. The authors suggested that the decision to perform the biceps tenodesis either via an open or arthroscopic approach, should be based on surgeon and patient preference, as well as patient age, occupation and functional demands. The approach used for tenodesis may also be dictated by concomitant rotator cuff or labral pathology[45].

Forsythe et al (2019) reported the rates and risk factors for revision in 15,257 patients who underwent open or arthroscopic proximal biceps tenodesis between 2008-2017. Of these, 60.8% underwent arthroscopic biceps tenodesis, while 39.2% underwent open biceps tenodesis. There was no significant difference in the revision rate between arthroscopic (1.8%) and open (1.9%) biceps tenodesis. Risk factors for revision surgery included male sex for open biceps tenodesis, while age > 45 years and concomitant rotator cuff repair is not a risk factor for revision procedures, irrespective of the tenodesis technique[46]. Similarly, Saltzman et al (2020) in a study of 8,547 LHBT tenodesis between 2011 and 2014 reported that open techniques were more common when LHB tenodesis was performed in isolation, and the arthroscopic technique was the most common tenodesis technique performed in conjunction with rotator cuff or superior labrum repair. The overall complication rate was 2.9% with no significant difference between open or arthroscopic LHBT tenodesis (stiffness 0.9%, nerve injury 0.2%, humeral fracture 0.3%, infection 0.4%, wound dehiscence 0.2%, haematoma 0.3%)[40].

Discussion

Due to similar outcomes surgeons have the option of using an arthroscopic or an open approach. However, as rotator cuff repairs are performed arthroscopically, most surgeons prefer to treat both pathologies at the same time without additional open procedure. This could explain that over the last decade, arthroscopic tenodesis is emerging as the most commonly used technique in the context of rotator cuff repair or superior labrum pathology[40,46]. Arthroscopic tenodesis performed at the articular margin, largely avoids the complications seen with subpectoral and suprapectoral tenodesis. The arthroscopic technique at the articular margin (above the groove) can be performed as an inlay or an onlay “loop ‘n’ tack” procedure. In a recent biomechanical study, Cagle et al (2020), reported that both procedures had similar ultimate load to failure values. The mode of failure involves the suture knot pulling through the tendon rather than implant pull out from bone. Tenodesis at the articular margin achieved comparable fixation strength as subpectoral and supra-pectoral tenodesis while conferring several advantages over these techniques[47]. The inlay procedure requires tendon externalization and an approximation of the appropriate length-tension relationship. The onlay “loop ‘n’ tack” procedure is now the preferred procedure as the tendon is released after the tenodesis, allowing an accurate length-tension relationship. The procedure has been shown to be a reliable clinical technique with a low revision rate[48].

Early reports of persistent pain with arthroscopic “above the groove” tenodesis techniques were attributed to tenosynovitis and motion of the LHB that remains within the bicipital groove as a pain generator[49]. Other investigators, however, found no increase in residual anterior shoulder pain with “above the groove” tenodesis. Leroux et al, reviewed the reported outcomes after LHBT tenodesis and rotator cuff repair, and across the 5 studies that reported residual bicipital groove pain, observed that the actual rate was very low (0.9%)[36]. Brady et al (2015) in a multi-centre study of arthroscopic biceps tenodesis at the articular margin (above the groove) including 1,083 patients with a mean follow-up period of 2.4 years, reported significant improvements in pain and functional scores, and noted a low rate of residual pain (0.1%) and revision rate (0.3%) for biceps-related problems[48]. More recently, in a biomechanical study, Kelly et al (2021) demonstrated that for intra-articular supra-pectoral fixation (loop ‘n’ tack) tenodesis, movement of the tendon within the groove was minimal[50].

Conclusion

Rotator cuff tears have a high incidence of concomitant LHBT pathology, and this incidence is likely to increase with increasing size of rotator cuff tears. The current literature review suggests that the decision to perform LHBT tenodesis either as an open or arthroscopic approach, should be based on surgeon and patient preference, and the patient’s age, occupation and functional demands. Arthroscopic tenodesis however, is emerging as the most commonly used technique in the context of rotator cuff pathology. This is due to the fact that Rotator cuff repairs are performed arthroscopically and most surgeons prefer to treat both pathologies at the same time without an additional open procedure.

REFERENCES

1. Neviaser TJ, Neviaser RJ, Neviaser JS, Neviaser JS. The four-in-one arthroplasty for the painful arc syndrome. Clin Orthop Relat Res 1982: 107-112. [PMID: 7067240]

2. Neviaser TJ. The role of the biceps tendon in the impingement syndrome. Orthop Clin North Am 1987; 18: 383-386. [PMID: 3441362

3. Sethi N, Wright R, Yamaguchi K. Disorders of the long head of the biceps tendon. J Shoulder Elbow Surg 1999; 8: 644-54. [PMID: 10633904]; [DOI: 10.1016/s1058-2746(99)90105-2]

4. Murthi AM, Vosburgh CL, Neviaser TJ. The incidence of pathologic changes of the long head of the biceps tendon. J Shoulder Elbow Surg 2000; 9: 382-5. [PMID: 11075320]; [DOI: 10.1067/mse.2000.108386]

5. Boileau P, Baque F, Valerio L, Ahrens P, Chuinard C, Trojani C. Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. JBJS 2007; 89: 747-57. [PMID: 17403796]; [DOI: 10.2106/JBJS.E.01097]

6. Boileau P, Ahrens PM, Hatzidakis AM. Entrapment of the long head of the biceps tendon: the hourglass biceps-a cause of pain and locking of the shoulder. J Shoulder Elbow Surg 2004; 13: 249-57.[PMID: 15111893]; [DOI: 10.1016/j.jse.2004.01.001]

7. Lafosse L, Reiland Y, Baier GP, Toussaint B, Jost B. Anterior and posterior instability of the long head of the biceps tendon in rotator cuff tears: a new classification based on arthroscopic observations. Arthroscopy 2007; 23: 73-80. [PMID: 17210430]; [DOI: 10.1016/j.arthro.2006.08.025]

8. Chen CH, Hsu KY, Chen WJ, Shih CH. Incidence and severity of biceps long head tendon lesion in patients with complete rotator cuff tears. J Trauma 2005; 58: 1189-93 [PMID: 15995469]; [DOI: 10.1097/01.ta.0000170052.84544.34]

9. Desai SS, Mata HK. Long head of biceps tendon pathology and results of tenotomy in full-thickness reparable rotator cuff tear. Arthroscopy 2017; 33: 1971-1976.[PMID: 28847573]; [DOI: 10.1016/j.arthro.2017.06.018]

10. Candela V, Standoli JP, Carbone S, Rionero M,Gumina S . Shoulder Long Head Biceps Tendon Pathology Is Associated With Increasing Rotator Cuff Tear Size. Arthrosc Sports Med Rehabil. 2021aug27; 3(5): e1517-e1523.[PMID: 34712989]; [PMCID: PMC8527326]; [DOI: 10.1016/j.asmr.2021.07.013]

11. Mazzocca AD, McCarthy MB, Ledgard FA, Chowaniec DM, McKinnon WJ, Delaronde S, Rubino LJ, Apolostakos J, Romeo AA, Arciero RA, Beitzel K. Histomorphologic changes of the long head of the biceps tendon in common shoulder pathologies. Arthroscopy 2013; 29: 972-81. [PMID: 23571131]; [DOI: 10.1016/j.arthro.2013.02.002]

12. Nho SJ, Strauss EJ, Lenart BA, Lenart BA, Provencher MT, Mazzocca A, Verma NN, Romeo A. Long head of the biceps tendinopathy: diagnosis and management. J Am Acad Orthop Surg 2010; 18: 645-56. [PMID: 21041799]; [DOI: 10.5435/00124635-201011000-00002]

13. Walch G, Nové-Josserand L, Levigne C. Tears of the supraspinatus tendon associated with “hidden” lesions of the rotator interval. J Shoulder Joint Surg 1994; 3: 353-360. [PMID: 22958839]; [DOI: 10.1016/S1058-2746(09)80020-7]

14. Habermeyer P, Magosch P, Pritsch M, Scheibel MT,Lichtenberg S. Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elbow Surg 2004; 13: 5-12. [PMID: 14735066]; [DOI: 10.1016/j.jse.2003.09.013]

15. Werner A, Mueller T, Boehm D, Gohlke F. The stabilizing sling for the long head of the biceps tendon in the rotator cuff interval. A histoanatomic study. Am J Sports Med 2000; 28: 28-31. [PMID: 10653540]; [DOI: 10.1177/03635465000280011701]

16. Walch G, Nove-Josserand L, Boileau P, Levigne C. Subluxations and dislocations of the tendon of the long head of the biceps. J Shoulder Elbow Surg 1998; 7: 100-108. [PMID: 9593086]; [DOI: 10.1016/s1058-2746(98)90218-x]

17. Bennett WF. Arthroscopic repair of anterosuperior (supraspinatus/ subscapularis) rotator cuff tears: A prospective cohort with 2- to 4-year follow-up. Classification of biceps subluxation/ instability. Arthroscopy 2003; 19: 21-33. [PMID: 12522399]; [DOI: 10.1053/jars.2003.50023]

18. Braun S, Horan MP, Elser F, Millett PJ: Lesions of the biceps pulley. Am J Sports Med 2011; 39(4): 790-795. [PMID: 21335355]; [DOI: 10.1177/0363546510393942]

19. Refior HJ, Sowa D. Long tendon of the biceps brachii: Sites of predilection for degenerative lesions. J Shoulder Elbow Surg 1995; 4: 436-440. [PMID: 8665288]; [DOI: 10.1016/s1058-2746(05)80035-7]

20. Berenson MC, Blevins FT, Plaas AH, Vogel KG. Proteoglycans of human rotator cuff tendons. J Orthop Res 1996; 14: 518-525. [PMID: 8764859]; [DOI: 10.1002/jor.1100140404]

21. Joseph M, Maresh CM, McCarthy MB, Kraemer WJ, Ledgard F, Arciero CL, Anderson JM, Nindl BC, Mazzocca AD.Histological and molecular analysis of the biceps tendon long head post-tenotomy. J Orthop Res 2009; 27: 1379-1385. [PMID: 19340876]; [DOI: 10.1002/jor.20868]

22. Lakemeier S, Reichelt JJ, Timmesfeld N, Fuchs-Winkelmann S, Paletta JR, Schofer MD The relevance of long head biceps degeneration in the presence of rotator cuff tears. BMC Musculoskelet Disord 2010; 11: 191. [PMID: 20799939]; [PMCID: PMC2936349]; [DOI: 10.1186/1471-2474-11-191]

23. Mazzocca AD, McCarthy MB, Ledgard FA, Chowaniec DM, McKinnon WJ Jr, Delaronde S, Rubino LJ,Apolostakos J, Romeo AA,Arciero RA, Beitzel K. Histomorphologic changes of the long head of the biceps tendon in common shoulder pathologies. Arthroscopy 2013; 29: 972-981. [PMID: 23571131]; [DOI: 10.1016/j.arthro.2013.02.002]

24. Wu PT, Jou IM, Yang CC, Lin C-J, Yang C-Y,Su F-C, Su W-R. The severity of the long head biceps tendinopathy in patients with chronic rotator cuff tears: Macroscopic versus microscopic results. J Shoulder Elbow Surg 2014; 23: 1099-1106. [PMID: 24496050]; [DOI: 10.1016/j.jse.2013.11.013]

25. Szabo I, Boileau P, Walch G. The proximal biceps as a pain generator and results of tenotomy. Sports Med Arthrosc Rev 2008; 16: 180-6. [PMID: 18703979]; [DOI: 10.1097/JSA.0b013e3181824f1e]

26. Alpantaki K, McLaughlin D, Karagogeos D, Hadjipavlou A, Kontakis G.Sympathetic and sensory neural elements in the tendon of the long head of the biceps. J Bone Joint Surg Am. 2005; 87(7): 1580-3. [PMID: 15995126]; [DOI: 10.2106/JBJS.D.02840]

27. Tosounidis T, Hadjileontis C, Triantafyllou C, Sidiropoulou V, Kafanas A, Kontakis G. Evidence of sympathetic innervation and alpha1-adrenergic receptors of the long head of the biceps brachii tendon. J Orthop Sci. 2013; 18(2): 238-44. [PMID: 23306538]; [DOI: 10.1007/s00776-012-0346-1]

28. Hadjileontis C, Kontakis G Evidence of Neuronal Differentiation of Tendon Stromal Cells in Patients with Biceps Branchi Muscle Pain: A Histological and Immunohistochemical Study of 12 Patients. J Nov Physiother 2013; S2: 007. [DOI: 10.4172/2165-7025.S2-007]

29. Schmalzl J, Plumhoff P, Gilbert F, GohlkeF,Konrads C,Brunner U, Jakob F, Ebert R, Steinert AF. The inflamed biceps tendon as a pain generator in the shoulder: A histological and biomolecular analysis. J Orthop Surg (Hong Kong) 2019; 27. 2309499018820349. [PMID: 30739571]; [DOI: 10.1177/2309499018820349]

30. Izumi M,Harada Y,Kajita Y,Muramatsu Y,Morimoto T,Morisawa Y,Iwahori Y,Ikeuchi M. Expression of Substance P and Nerve Growth Factor in Degenerative Long Head of Biceps Tendon in Patients with Painful Rotator Cuff Tear. J Pain Res 2021 Aug 16; 14: 2481-2490.MID: 34429647]; [PMCID: PMC8379684 ]; [DOI: 10.2147/JPR.S320811]

31. Watson ST, Robbins CB, Bedi A, Carpenter JE, Gagnier JJ, Miller BS. Comparison of outcomes 1 year after rotator cuff repair with and without concomitant biceps surgery. Arthroscopy. 2017; 33 (11): 1928-1936. [PMID: 28822640]; [DOI: 10.1016/j.arthro.2017.05.009]

32. Godeneche A, Kempf J-F, Nove-Josserand L, Michelet A, Saffarini M, Hannink G,Collin P. Tenodesis renders better results than tenotomy in repairs of isolated supraspinatus tears with pathologic biceps. J Shoulder Elbow Surg 2018; 27: 1939-45. [PMID: 29784596]; [DOI: 10.1016/j.jse.2018.03.030]

33. Koh KH, Ahn JH, Kim SM, Yoo JC Treatment of biceps tendon lesions in the setting of rotator cuff tears: prospective cohort study of tenotomy versus tenodesis. Am J Sports Med 2010 ; 38(8): 1584-1590. [PMID: 20551285]; [DOI: 10.1177/0363546510364053]

34. Lee HJ, Jeong JY, Kim CK, Kim YS Surgical treatment of lesions of the long head of the biceps brachii tendon with rotator cuff tear: a prospective randomized clinical trial comparing the clinical results of tenotomy and tenodesis. J Shoulder Elbow Surg 2016; 25(7): 1107-1114. [PMID: 27283370]; [DOI: 10.1016/j.jse.2016.02.006]

35. Zhang Q, Zhou J, Ge H, Cheng B Tenotomy or tenodesis for long head biceps lesions in shoulders with reparable rotator cuff tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc 2015; 23(2): 464-469. [PMID: 23828089]; [DOI: 10.1007/s00167-013-2587-8]

36. Leroux T, Chahal J, Wasserstein D, Verma NN, Romeo AA. A systematic review and meta-analysis comparing clinical outcomes after concurrent rotator cuff repair and long head biceps tenodesis or tenotomy. Sports Health 2015; 7: 303-7. [PMID: 26137174]; [PMCID: PMC4481674]; [DOI: 10.1177/1941738114539627]

37. Ge H, Zhang Q, Sun Y, Li J, Sun L, Cheng B Tenotomy or tenodesis for the long head of biceps lesions in shoulders: a systematic review and meta-analysis. PLoS ONE 2015; 10(3): e0121286. [PMID: 25786125]; [PMCID: PMC4364971]; [DOI: 10.1371/journal.pone.0121286]

38. Na Y, Yong Zhu Y, Shi Y, Ren Y, Zhang T, Liu W, Han C. A meta-analysis comparing tenotomy or tenodesis for lesions of the long head of the biceps tendon with concomitant reparable rotator cuff tears Na et al. Journal of Orthopaedic Surgery and Research 2019; 14: 370. [PMID: 31729995]; [PMCID: PMC6858715]; [DOI: 10.1186/s13018-019-1429-x]

39. Werner BC, Evans CL, Holzgrefe RE, Tuman JM, Hart JM, Carson EW, Diduch DR, Miller MD, Brockmeier SF Arthroscopic suprapectoral and open subpectoral biceps tenodesis: a comparison of minimum 2-year clinical outcomes. Am J Sports Med 2014; 42(11): 2583-2590. [PMID: 25201442]; [DOI: 10.1177/0363546514547226]

40. Saltzman BM, Leroux TS, Eric J. Cotter EJ, Basques B, Griffin J, Frank RM, Romeo AA,Verma NN.Trends in Open and Arthroscopic Long Head of Biceps Tenodesis. HSSJ 2020; 16: 2-8. [PMID: 32015734]; [PMCID: PMC6973858]; [DOI: 10.1007/s11420-018-9645-1]

41. Mazzocca AD, Bicos J, Santangelo S, Romeo AA, Arciero RA. The biomechanical evaluation of four fixation techniques for proximal biceps tenodesis. Arthroscopy. 2005; 21(11): 1296-1306.[PMID: 16325079]; [DOI: 10.1016/j.arthro.2005.08.008]

42. Patzer T, Santo G, Olender GD,Wellmann M, Hurschler C, Schofer M. Suprapectoral or subpectoral position for biceps tenodesis: biomechanical comparison of four different techniques in both positions. J Shoulder Elbow Surg. 2012; 21(1): 116-125.[PMID: 21493102]; [DOI: 10.1016/j.jse.2011.01.022]

43. Aida H, Shi B, Huish EG, McFarland EG, Srikumaran U. Are Implant Choice and Surgical Approach Associated with Biceps Tenodesis Construct Strength? A Systematic Review and Meta-regression. Am J Sports Med. 2020 Apr; 48(5): 1273-1280. [PMID: 31585053]; [DOI: 10.1177/0363546519876107]

44. Abraham VT, Tan BH, Kumar VP. Systematic review of biceps tenodesis: Arthroscopy versus open. Arthroscopy. 2016; 32(2): 365-371. [PMID: 26427631]; [DOI: 10.1016/j.arthro.2015.07.028]

45. Hurley DJ, Hurley ET, Pauzenberger L, Fat DL, Mullett H. Open compared with arthroscopic biceps tenodesis: a systematic review. BJS Rev 2019 May; 7(5): e4. [PMID: 31094891]; [DOI: 10.2106/JBJS.RVW.18.00086]

46. Forsythe B, Agarwalla A, Puzzitiello RN, Mascarenhas R,Werner BC. Rates and risk factors for revision open and arthroscopic proximal biceps tenodesis. Orthop J Sports Med 2019; 7: 2325967118825473. [PMID: 30800694]; [PMCID: PMC6378646]; [DOI: 10.1177/2325967118825473]

47. Cagle PJ, London D, Gluck MJ, Morel S, Parsons BO. Long head of biceps tenodesis at the superior aspect of the biceps groove: A biomechanical comparison on inlay and onlay techniques. Shoulder Elbow 2020; 12: 12-17.[PMID: 32010228]; [PMCID: PMC6974887]; [DOI: 10.1177/1758573218815281]

48. Brady PC, Narbona P, Adams CR, Huberty D, Parten P, Hartzler RU, Arrigoni P, Burkhart SS. Arthroscopic proximal biceps tenodesis at the articular margin: Evaluation of outcomes, complications, and revision rate. Arthroscopy 2015; 31: 470-476.[PMID: 25442650]; [DOI: 10.1016/j.arthro.2014.08.024]

49. Sanders B, Lavery KP, Pennington S, Warner JJP. Clinical success of biceps tenodesis with and without release of the transverse humeral ligament. J Shoulder Elbow Surg. 2012; 21: 66-71.[PMID: 21524923]; [DOI: 10.1016/j.jse.2011.01.037]

50. Kelly BJ, Reynolds AW, Schimoler PJ, Kharlamov A, Miller MC, Akhavan S. Measurements of Tendon Movement Within the Bicipital Groove After Suprapectoral Intra-articular Biceps Tenodesis in a Cadaveric Model. The Orthopaedic Journal of Sports Medicine 2021; 9(1): 2325967120977538. [PMID: 33553457]; [PMCID: PMC7829533]; [DOI: 10.1177/2325967120977538]

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.