Outlet biceps tenodesis: a new technique for treatment of biceps long head tendon injury

Degeneration and tearing of the long head of the biceps brachii tendon (LHBT) are common intra-articular findings, and surgical intervention including tenodesis or tenotomy is beneficial. A new arthroscopic shoulder technique may be performed through an anterior portal while one is viewing from a posterior portal: (1) Visualize the intra-articular biceps tendon. (2) Identify the segment of the LHBT to be enlarged. (3) Use a tissue modulation wand to enlarge the tendon. (4) Evaluate the diameter of the enlarged segment. It should be twice the original diameter. (5) Cut the biceps tendon at the proximal end of the enlarged segment. (6) View the tendon within the tunnel. (7) Identify and cut the remaining stump of the biceps tendon. Seventeen cadaveric shoulders were used to compare the pullout force, stiffness, and displacement of outlet tenodesis versus tenotomy. There was a significant increase in pullout force for the outlet tenodesis group when compared with tenotomy. This technique is used to operatively treat LHBT intra-articular pathology in patients who would benefit from tenotomy and traditional biceps tenodesis and may minimize the retraction of the biceps tendon distally.