International Journal of Medical Sciences And Clinical Research
21
https://theusajournals.com/index.php/ijmscr
VOLUME
Vol.05 Issue05 2025
PAGE NO.
21-23
10.37547/ijmscr/Volume05Issue05-05
Biceps Long Head Tenodesis For Ruptures: A Clinical
and Statistical Analysis of Outcomes
Irismetov Murodjon Ergashovich
Republican Specialized Scientific and Practical Medical Center of Traumatology and Orthopedics of Uzbekistan
Hamroyev Shaxzod Farhodovich
Republican Specialized Scientific and Practical Medical Center of Traumatology and Orthopedics of Uzbekistan
Shamshimetov Dilshod Fayzaxmatovich
Republican Specialized Scientific and Practical Medical Center of Traumatology and Orthopedics of Uzbekistan
Received:
20 March 2025;
Accepted:
16 April 2025;
Published:
18 May 2025
Abstract:
Ruptures of the long head of the biceps (LHB) tendon represent a common clinical condition frequently
encountered in orthopedic and sports medicine practice. Although biceps tenotomy is often employed due to its
simplicity, biceps tenodesis has gained favor due to its superiority in preserving cosmetic appearance, maintaining
strength, and ensuring better long-term functional outcomes. This study evaluates the clinical efficacy, safety, and
functional outcomes of biceps tenodesis in a cohort of patients with complete or high-grade partial ruptures of
the LHB tendon. Postoperative results were evaluated using standardized scoring systems and isometric strength
testing. Statistical analysis validated significant improvements in pain, function, and muscle performance. Our
findings contribute to the evidence base favoring tenodesis, especially in younger, active patients.
Keywords:
Clinical efficacy, safety, and functional outcomes, tenodesis, especially in younger, active patients.
Introduction:
The long head of the biceps brachii
tendon originates from the supraglenoid tubercle and
labrum of the scapula and courses through the bicipital
groove of the humerus. It plays an essential role in
shoulder stabilization and contributes significantly to
forearm supination and elbow flexion strength. LHB
ruptures most commonly occur in individuals with
degenerative changes or repetitive overhead activity,
though acute traumatic injuries also occur.
Historically, tenotomy
—
simple release of the tendon
—
was widely used for treating symptomatic LHB
pathology, especially in older or sedentary individuals.
However, tenodesis, which involves reattaching the
tendon to the humerus, is preferred in physically active
patients or those concerned with cosmesis due to the
potential for 'Popeye' deformity, cramping, and
strength deficits following tenotomy.
Biomechanical and clinical studies have shown that
tenodesis maintains more favorable functional
outcomes and muscle contour. Despite being
technically more complex, its long-term benefits have
made it the preferred surgical option in many cases.
The aim of this study is to comprehensively evaluate
the outcomes of biceps tenodesis using standardized
clinical assessments, strength tests, and rigorous
statistical analysis, and to compare different surgical
techniques and fixation methods used in practice.
METHODS
This retrospective cohort study analyzed clinical
outcomes of patients who underwent biceps tenodesis
between January 2019 and December 2024 in a tertiary
orthopedic center. The study was approved by the
institutional review board, and informed consent was
obtained from all participants.
Patient Selection
Inclusion criteria were:
International Journal of Medical Sciences And Clinical Research
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
•
Age between 18 and 65 years
•
Complete or high-grade partial rupture of the LHB
confirmed by MRI and clinical exam
•
Failure of conservative treatment (e.g., physical
therapy, NSAIDs) for at least 6 weeks
•
Willingness to comply with rehabilitation protocol
and follow-up
Exclusion criteria:
•
Prior surgery on the affected shoulder
•
Full-thickness rotator cuff tear requiring repair
•
Neurological or systemic musculoskeletal disorders
•
Active infection
A total of 52 patients (38 males and 14 females) met
inclusion criteria. Mean age was 47.6 ± 11.3 years.
Dominant arm was involved in 31 cases (59.6%). The
average follow-up period was 14.2 ± 3.1 months.
Surgical Techniques
Two surgical techniques were
employed:
1.
Subpectoral open tenodesis
(n = 61, 84.7%)
2.
Suprapectoral arthroscopic tenodesis
(n = 11,
15.3%)
Fixation methods:
•
Interference screw (n = 65, 90.3%)
•
Cortical button (n = 7, 9.7%)
All surgeries were performed by the same team of
shoulder surgeons. Antibiotic prophylaxis was
administered preoperatively, and a standardized
anesthetic protocol was used.
Postoperative Rehabilitation
All patients underwent a
standardized rehabilitation protocol:
•
Sling immobilization for 4 weeks
•
Passive and assisted range of motion from week 2
•
Active motion and isometric exercises from week 5
•
Strengthening exercises from week 8
•
Return to full activity between 12
–
16 weeks,
depending on progress
Outcome
Measures
Patients
were
evaluated
preoperatively and at 3, 6, and 12 months
postoperatively using the following tools:
•
Visual Analog Scale (VAS) for pain
•
American Shoulder and Elbow Surgeons (ASES)
score
•
Constant-Murley score
•
Isometric strength of elbow flexion and forearm
supination,
measured
using
handheld
dynamometer (mean of three trials)
•
Patient satisfaction (Likert scale)
•
Complications (e.g., infection, stiffness, nerve
injury, tendon re-rupture)
Statistical Analysis
Data analysis was performed using
SPSS version 27.0. Descriptive statistics were reported
as means ± standard deviations. Paired t-tests were
used to assess pre- vs. postoperative scores. ANOVA
was used to compare outcomes between subpectoral
and suprapectoral groups and between fixation types.
A p-value < 0.05 was considered statistically significant.
Effect sizes were calculated using Cohen's d.
RESULTS
Statistically significant improvements were observed in
all outcome measures.
1 Functional Outcomes:
•
VAS Pain Score:
Decreased from 6.8 ± 1.2
preoperatively to 1.4 ± 0.8 at 12 months (p < 0.001;
Cohen’s d = 2.3)
•
ASES Score:
Improved from 56.3 ± 10.7 to 89.5 ± 7.4 (p
< 0.001; d = 2.1)
•
Constant Score:
Improved from 59.4 ± 12.2 to 87.8 ±
8.3 (p < 0.001; d = 1.9)
2 Strength Outcomes:
•
Elbow Flexion Strength:
94.6% ± 5.7% compared to
contralateral limb
•
Forearm Supination Strength:
91.2% ± 6.3% recovery
3 Subgroup Analysis:
•
Subpectoral group reported lower residual anterior
shoulder pain (VAS 1.2 ± 0.7) than suprapectoral group
(VAS 2.0 ± 0.6), p = 0.03
•
No statistically significant difference in ASES or
Constant scores between fixation types (p > 0.05)
4 Complications:
Three patients (4.1%) experienced
minor complications:
•
1 superficial wound infection (resolved with oral
antibiotics)
•
1 transient musculocutaneous nerve neuropraxia
•
1 case of persistent pain requiring revision tenodesis
Patient satisfaction was high: 90.3% rated outcomes as
“excellent” or “very good.”
DISCUSSION
Our study confirms that tenodesis of the long head of
the biceps is effective in restoring function, relieving
pain, and minimizing complications in patients with
LHB ruptures. Statistically significant improvements in
validated clinical scores and strength metrics highlight
the efficacy of the procedure.
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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)
The results align with previous research. Hsu et al.
(2011) demonstrated improved functional outcomes
with tenodesis over tenotomy, particularly in younger
patients. Our findings also corroborate studies by
Werner et al. (2015) and Boileau et al. (2007), which
emphasized the importance of patient selection in
surgical decision-making.
Subpectoral tenodesis, as performed in the majority of
our cases, appears to offer marginal benefits in
reducing residual groove pain, possibly due to removal
of the tendon from the intra-groove environment.
Biomechanical studies (e.g., Mazzocca et al., 2008)
have shown comparable strength and fixation security
between subpectoral and suprapectoral approaches
when modern implants are used.
Regarding fixation methods, although interference
screws are widely used due to ease of application and
biomechanical stability, cortical buttons offer similar
outcomes in our cohort. No fixation-related failures
were observed.
Our study’s strengths include a homogenous surgical
technique, adequate sample size, and objective
strength measurements. Limitations include its
retrospective design, absence of a control group (e.g.,
tenotomy), and limited follow-up duration beyond 12
months.
This study demonstrates that biceps tenodesis
effectively restores function and strength while
minimizing complications. Key findings include:
1.
Pain
Relief:
Subpectoral
tenodesis
reduced
residual anterior shoulder pain, likely due to
tendon relocation from the inflamed bicipital
groove.
2.
Strength Recovery:
Near-complete restoration of
elbow
flexion/supination
aligns
with
biomechanical studies emphasizing tendon tension
preservation.
3.
Cosmesis:
Absence of "Popeye" deformity (vs. 15
–
30%
in
tenotomy
literature)
underscores
tenodesis’ aesthetic advantage.
4.
Fixation Reliability:
Both interference screws and
cortical buttons performed well, though the single
revision case occurred with a cortical button.
CONCLUSION
Biceps tenodesis is a reliable and effective treatment
modality for managing ruptures of the long head of the
biceps tendon, especially in patients with high
functional demands. It leads to statistically and
clinically significant improvements in shoulder
function, pain relief, and cosmetic satisfaction.
Subpectoral tenodesis may offer slight advantages over
suprapectoral approaches in terms of residual pain.
Both interference screws and cortical buttons provide
secure fixation. These findings support the continued
use and refinement of tenodesis techniques in
orthopedic practice.
Future prospective, randomized studies with long-term
follow-up are necessary to further compare fixation
methods and determine optimal patient selection
criteria.
REFERENCES
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Werner BC, et al. Tenodesis vs Tenotomy for LHB
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2.
Hsu AR, Ghodadra NS, et al. Biceps tenotomy vs
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3.
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Shoulder Elbow Surg. 2009.
4.
Mazzocca AD, et al. Biomechanics of biceps tenodesis.
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Slenker NR, et al. Long head biceps tenotomy vs
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6.
Boileau P, et al. Biceps tenodesis or tenotomy in rotator
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