title: Arthroscopic knotless suprapectoral tenodesis of the long head of biceps: clinical and structural results.
abstract: BACKGROUND
  Different techniques for tenodesis of the long head of biceps (LHB) have been described. Previous studies focused on intraosseously performed techniques while only little clinical data exists for epiosseously performed knotless LHB tenodesis. The hypothesis is that arthroscopic suprapectoral knotless epiosseous tenodesis of the LHB would have good clinical, cosmetic and structural results.
  
  
  METHODS
  Forty-nine patients [16 women, 33 men; mean age 58; mean follow-up 36.4 months (range 24-57 months)], in whom a tenodesis of the long biceps tendon (LHB) has been performed, were included into this study. The clinical evaluation included the Constant score as well as the LHB score. In addition elbow flexion and supination strength were assessed. The integrity of the tenodesis construct was evaluated indirectly by sonographic detection of the LHB in the bicipital groove.
  
  
  RESULTS
  The overall Constant score did not reveal any significant differences comparing both sides [mean, 86 ± 19 points vs. 89 ± 16 points (p > 0.05)]. The mean LHB score reached 88.3 points (range 54-100 points). Thirty-four patients (69 %) presented an examiner-dependent upper arm deformity although only three patients (6 %) confirmed a subjective cosmetic deformity. Both, flexion and supination strength were significantly decreased compared to the non-operated side (p < 0.05). In five patients (10 %) it was not possible to verify the LHB sonographically in the bicipital groove. Therefore the biceps tenodesis was classified as a failure.
  
  
  CONCLUSIONS
  The arthroscopic suprapectoral epiosseous knotless tenodesis of the LHB provides good functional results. The high rate of examiner-dependent upper arm deformities can be explained by a non-physiological situation of the primary length-tension relationship or an elongation of the tendon after fixation.
authors.affiliation: Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus-Virchow/Campus-Mitte, Charité-Unversitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Kerschbaum
authors.affiliation: Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus-Virchow/Campus-Mitte, Charité-Unversitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
authors.forename: Mitja
authors.initials: M
authors.lastname: Scheuermann
authors.affiliation: Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus-Virchow/Campus-Mitte, Charité-Unversitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Gerhardt
authors.affiliation: Department of Shoulder and Elbow Surgery, Center for Musculoskeletal Surgery, Campus-Virchow/Campus-Mitte, Charité-Unversitaetsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany. markus.scheibel@charite.de.
authors.forename: Markus
authors.initials: M
authors.lastname: Scheibel
mesh_terms: D001182:Arthroscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000601:surgery*; D012189:Retrospective Studies; D012782:Shoulder / Q000601:surgery*; D053441:Suture Anchors; D013710:Tendons / Q000000981:diagnostic imaging; D053656:Tenodesis / Q000379:methods*
keywords: Biceps tenodesis; LHB; Long biceps tendon; Popeye deformity