1. The Biceps Tendon:
Tenotomy v. Tenodesis
Christopher M. Aland MD
Rothman Institute, Newtown, PA

2. 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

3. What We Know--maybe
• We understand the
basics
• Debate regarding
function
• Debate regarding
treatment

4. Anatomy
• Originates from
posterior superior
labrum
• Coracohumeral, SGHL
• Tuberosities
• Rich innervation

5. Function
• Long felt to be humeral
head depressor
• Stability?
• Dynamic role
– EMG variable

7. Diagnosis
• PE is sensitive, not
specific
• Variety of tests
– Yergasons
– Speeds
– Subscap lift off
• MRI
• Dx at surgery

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

9. Treatment options
• Tenotomy • Tenodesis
– Easy to do – Preserves length
– Popeye muscle – Minimizes Popeye
– Cramping – Less cramping
– Requires implant
– Longer surgery

10. However
• Ospar (2002)
– No significant difference
• Slenker (2012)
– Increase in cosmetic
deformity, otherwise no
significant difference

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

12. Tenodesis
 Variety of Methods
 Soft tissue
 Semi soft
 Subpectoral
 http://www.youtube.com
/watch?v=qCQwSDcslp8
 Bone
 Socket
 Anchor

13. Tenodesis
• Soft/ semi soft
– Involves suturing to
rotator cuff
– Suture anchors
– Conjoint tendon
– Pectoralis major
– May not be much
different that tenotomy

14. Tenotomy
• Keyhole technique

15. 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

16. Sub pectoral
• Small incision
• Good for chronic tears
• Length tension
relationship important
• Burkhart (2012)
– 15 mm from MT junction
– Suture 2cm above lower
margin

17. 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

18. 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

19. Thank you