long head of biceps tenodesis ; indications and techniques : systematic review

Abstract

The long head of the biceps (LHB) tendon is often implicated in various shoulder pathologies because of its anatomic course and its close relation to the rotator cuff and the superior labrum of the glenoid. Nonoperative treatment continues to have a role for patients who have mild symptoms with tendinopathy or partial tears of the biceps tendon. Surgical treatment is considered for patients with partial tears of the biceps tendon, biceps pulley lesions and SLAP lesions. The choice of treatment whether repair, tenotomy or biceps tenodesis remains controversial. Biceps tenodesis is the preferred technique to manage LHB lesions especially in younger patients, laborers, athletes and patients who want to avoid a cosmetic deformity. This systematic review suggested that the most commonly used and studied indications for LHB tenodesis were LHB tearing, LHB instability, and LHB tenosynovitis. Biceps tenodesis can be performed by arthroscopic or open techniques, using either soft tissue or bony fixation, and the fixation devices varies from screws to anchors to buttons to just bony tunnels with no hardware. According to our review, both arthroscopic and open biceps tenodesis showed similar pain relief and clinical outcomes and either of these methods may be recommended for patients with disorders of the biceps tendon and there is no consensus about the best fixation technique.