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Long head biceps tenotomy versus tenodesis: a cadaveric biomechanical analysis
Robert S Wolf1, Nigel Zheng, Derek Weichel
1American Sports Medicine Institute, Birmingham, Alabama, USA. rswolfmd@yahoo.com
Summary
Biceps tenotomy risks long head biceps (LHB) tendon migration and has lower failure load than tenodesis. Tenodesis is recommended to avoid cosmetic deformity and dysfunction from LHB tendon migration.
Area of Science:
- Orthopaedic surgery
- Biomechanics
- Tendon pathology
Background:
- Long head biceps (LHB) tendon pathology treatment is gaining interest.
- Tenotomy and tenodesis are surgical options, with tenodesis potentially avoiding distal stump migration and cosmetic deformity.
Purpose of the Study:
- To assess the risk of distal LHB tendon migration after tenotomy under physiologic loading.
- To determine the ultimate load to failure for tenotomized LHB tendons.
- To compare these outcomes with tenodesis using an interference screw in a cadaveric model.
Main Methods:
- Anatomic cadaveric biomechanical study.
- Cyclic loading of LHB tendons to 50 N for 200 cycles, followed by load-to-failure testing.
- Comparison of tenotomy versus tenodesis with a bioabsorbable interference screw.
Main Results:
- 40% of tenotomized specimens (4/10) failed during cyclic loading (average 35 cycles).
- Average ultimate load to failure for tenotomized tendons was 110.7 N.
- Tenodesis specimens showed significantly higher ultimate load to failure (310.8 N) and all passed cyclic loading (P = .001).
Conclusions:
- Biceps tenotomy carries a significant risk of LHB tendon migration and has a lower load to failure compared to tenodesis.
- Gentle range of motion loads caused failure in 40% of tenotomized specimens.
- LHB tenodesis should be considered to prevent cosmetic deformity and dysfunction from tendon migration.