Interference screw fixation has been used with success for hamstring anterior cruciate ligament reconstruction of the knee. We propose the same fixation principle for arthroscopic tenodesis of a pathologic long head of the biceps (LHB) using bioabsorbable interference screws. Forty-three patients underwent tenodesis of the LHB for a pathologic tendon (tenosynovitis, pre-rupture, subluxation, or dislocation) encountered in three clinical situations: 1) with arthroscopic or mini-open rotator cuff repair (n = 3); 2) with intact cuffs (n = 6); or 3) with massive, irreparable cuff tears (n = 34). Mean age was 63 years. Minimum clinical and radiographic follow-up was 2 years. Six steps were required: 1) glenohumeral exploration and tenotomy of LHB; 2) anterior bursectomy and opening of bicipital groove; 3) LHB exteriorization and preparation; 4) humeral socket preparation; 5) trans-humeral Beath pin “pull-through” technique; and 6) bioabsorbable interference screw fixation. Constant score averaged 43 points before surgery and 79 points at review (p < 0.05). No deficit in elbow flexion-extension was observed. Spring-balance strength of the tenodesed biceps averaged 90% of the contralateral side (range, 80%–100%). Two early patients demonstrated distal biceps retraction and failure of the tenodesis within 3 months. Magnetic resonance imaging at final review revealed tight fixation of the LHB in the humeral socket and no adverse tissue reaction to the screw. These short-term results compare favorably with both open and previously described arthroscopic tenodeses using sutures. This technique is advantageous for pathologic LHB with intact cuffs, associated arthroscopic cuff repairs, and irreparable cuff tears instead of simple tenotomy.
Department of Orthopaedic Surgery; Hôpital de L'Archet-University of Nice; Nice, France
Shoulder and Elbow Service; W. B. Carrell Memorial Clinic; Dallas, Texas, U.S.A.
Department of Orthopaedic Surgery, Hôpital de L'Archet-University of Nice, Nice, France
Department of Orthopaedic Surgery; Clinique St. Anne Lumiere; Lyon, France
No author has received any benefit for personal or professional use from a commercial party related to the subject of this article.
Address correspondence and reprint requests to Dr. Sumant G. Krishnan, Shoulder and Elbow Service, W.B. Carrell Memorial Clinic, Dallas, TX 75204, USA.