The Biceps Tendon: Tenotomy v. Tenodesis

Christopher M. Aland MDRothman Institute, Newtown, PA

Disclaimer

• I own stock in Arthrocare and Johnson and Johnson

• I am on the Membership committee of AANA• I have no conflicts of interest that affect my

ability to teach this course

What We Know--maybe

• We understand the basics

• Debate regarding function

• Debate regarding treatment

Anatomy

• Originates from posterior superior labrum

• Coracohumeral, SGHL• Tuberosities• Rich innervation

Function

• Long felt to be humeral head depressor

• Stability?• Dynamic role– EMG variable

Diagnosis

• PE is sensitive, not specific

• Variety of tests– Yergasons– Speeds– Subscap lift off

• MRI• Dx at surgery

What We Don’t• Why it hurts• What is best treatment

Treatment options

• Tenotomy– Easy to do– Popeye muscle– Cramping

• Tenodesis– Preserves length– Minimizes Popeye– Less cramping– Requires implant– Longer surgery

However

• Ospar (2002)– No significant difference

• Slenker (2012)– Increase in cosmetic

deformity, otherwise no significant difference

Tenotomy• Fifty percent rule• Fix associated pathology• Variety of devices• Don’t leave a stump• Pre-op planning

TenodesisVariety of MethodsSoft tissueSemi softSubpectoral

http://www.youtube.com/watch?v=qCQwSDcslp8

BoneSocketAnchor

Tenodesis

• Soft/ semi soft– Involves suturing to

rotator cuff– Suture anchors– Conjoint tendon– Pectoralis major– May not be much

different that tenotomy

Tenotomy

• Keyhole technique

Socket with Screw

• Variety of systems• Essentially creating

socket and using interference screw, or push-lock type device

• Burkhart (2012) has quantified length relationship– 25 mm

Sub pectoral

• Small incision• Good for chronic tears• Length tension

relationship important• Burkhart (2012)– 15 mm from MT junction– Suture 2cm above lower

margin

Results

• Systemic review by Slenker et al. (2012)– No consensus– Few controlled trials– Cosmesis only signif. diff

• Most studies fail to show significant difference– Steadman

• Arthroscopy 1/2011

Discussion

• If tear is less than 50%, debridement

• Greater than 50%, over sixty, tenotomy

• Younger, high demand, tenodesis– Bony procedures have

higher rate of success

Thank you