Long Head of the Biceps Tenodesis: Proximal Soft Tissue Fixation Without Anchors

Introduction

Treatment of the long head of biceps (LHBT) tendon pathology is an area of great interest among orthopedic surgeons. Controversy persists in the literature regarding the function of the LHBT and the appropriate management of its disorders. Tendinopathy of the LHBT has inflammatory, degenerative, overuse-related, and traumatic causes. In fact, although isolated bicipital tendinitis has been described, LHBT tendinitis more commonly presents in combination with other shoulder pathology including impingement, rotator cuff disorders, superior labrum anterior posterior (SLAP) lesions, bursitis, and acromioclavicular joint disorders. Many authors have recommended tenotomy or tenodesis, to preserve tendon function in cases of LHBT instability, or chronic degeneration and incomplete tears that cause shoulder pain.

Tenotomy is usually indicated in older patients that are not willing to participate in the rehabilitation program. On the other hand, LHBT tenodesis is indicated in severe biceps tendinopathy, partial or complete LHBT tears, medial subluxation of the tendon, or nonreparable SLAP lesions, especially in younger and active patients. Several open and arthroscopic tenodesis techniques have been described, but none of them seems to be superior to another, and soft tissue tenodesis has not been demonstrated to produce inferior clinical results compared to other biceps tenodesis techniques. In this chapter we describe the soft tissue tenodesis of LHBT without anchors.