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Updated: Aug 6, 2026
Modified Long Head of Biceps Tendon Rerouting and Fixation as Partial Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears
Published on: March 6, 2026
Restoring the anatomic tension relationship of the long head of the biceps during tenodesis: A prospective,
Hassan Farooq1, Amir M Boubekri1, Andrew Chen1
1Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, CA, USA.
Introduction:
Long head of the biceps (LHB) tendinopathy a common source debilitating shoulder pain. Biceps tenodesis is reserved for patients who fail conservative management, but the optimal tensioning technique remains unclear. This study compared outcomes following standard anatomic landmark-based versus patient-specific anatomic tensioning. We hypothesized that anatomic tensioning would yield decreased pain and superior patient outcomes.
Methods:
A single-blinded randomized control trial (RCT) was conducted at a level-1 trauma center between October 2020 and December 2022. One hundred and sixty patients (56% male) were randomized to undergo standard landmark-based (control, 81) or patient-specific anatomic tensioning techniques (intervention, 79). American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) pain score, and range of motion (ROM) were compared at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year, postoperatively.
Results:
At final postoperative follow-up, ASES scores, VAS scores, forward flexion, external rotation were similar between cohorts (p = .604, 0.308, 0.171, and 0.726, respectively). At 6 weeks, the intervention group demonstrated higher ASES scores (mean difference, 9.1; 95 CI: [0.1, 18.0]; p = .048).
Discussion:
Both biceps tenodesis tensioning techniques are acceptable in the management of LHB tendinopathy. Patient-specific tensioning may provide earlier functional improvement for patients desiring accelerated rehabilitation.
