Biceps tenodesis for long head of the biceps after auto-rupture or failed surgical tenotomy: Results in an active population

Background: Long head of the biceps (LHB) deformity after surgical tenotomy or auto-rupture may result from attrition or injury. The purpose of this study was to describe the surgical outcomes of biceps tenodesis after failed surgical tenotomy or auto-rupture of the LHB tendon in a population of active patients. Methods: During a 5-year period, 11 patients with a mean age of 43.3 years (range, 33-56 years) presented with symptoms of biceps cramping with activity (100%), deformity (100%), or pain (36%) at a mean of 8months (range, 0.5-22months) from a tenotomy (6 of 11) or an auto-rupture (5 of 11). All patients underwent a mini-open subpectoral biceps tenodesis with interference screw fixation. Patients were independently evaluated by patient-reported outcome measures (Single Assessment Numeric Evaluation [SANE] and Western Ontario Rotator Cuff Index [WORC]) and a biceps position examination. Results: Of the 11 patients, 10 (91%) completed the study requirements at a mean of 2.6years (range, 1.6-4.2years). A total of 9 of the 10 patients (90%) returned to full activity. The mean preoperative SANE score was 61.1 (standard deviation [SD], 8.8), and the mean preoperative WORC score was 53.2 (SD, 9.2), which improved postoperatively to a SANE score of 84.2 (SD, 7.1) and a WORC score of 86 (SD, 8.2). There were no differences in LHB muscle position relative to the antecubital fossa (3.17cm preoperatively to 3.25cm postoperatively; P=.35). Deformity was resolved in all patients; 9 of 10 patients reported full resolution of cramping, and pain was resolved in 8 of10. Conclusions: LHB tenodesis after auto-rupture or surgical tenotomy improved symptoms and allowed predictable return to activity and patient satisfaction. Additional work is necessary to determine the optimal treatment of primary biceps lesions.