Measurements of Tendon Movement Within the Bicipital Groove After Suprapectoral Intra-articular Biceps Tenodesis in a Cadaveric Model

Abstract

Background: Lesions of the long head of the biceps can be successfully treated with biceps tenotomy or tenodesis when surgical management is elected. The advantage of a tenodesis is that it prevents the potential development of a cosmetic deformity or cramping muscle pain. Proponents of a subpectoral tenodesis believe that "groove pain" may remain a problem after suprapectoral tenodesis as a result of persistent motion of the tendon within the bicipital groove.

Purpose/hypothesis: To evaluate the motion of the biceps tendon within the bicipital groove before and after a suprapectoral intra-articular tenodesis. The hypothesis was that there would be minimal to no motion of the biceps tendon within the bicipital groove after tenodesis.

Study design: Controlled laboratory study.

Methods: Six fresh-frozen cadaveric arms were dissected to expose the long head of the biceps tendon as well as the bicipital groove. Inclinometers and fiducials (optical markers) were used to measure the motions of the scapula, forearm, and biceps tendon through a full range of shoulder and elbow motions. A suprapectoral biceps tenodesis was then performed, and the motions were repeated. The motion of the biceps tendon was quantified as a function of scapular or forearm motion in each plane, both before and after the tenodesis.

Results: There was minimal motion of the native biceps tendon during elbow flexion and extension but significant motion during all planes of scapular motion before tenodesis, with the most motion occurring during shoulder flexion-extension (20.73 ± 8.21 mm). The motion of the biceps tendon after tenodesis was significantly reduced during every plane of scapular motion compared with the native state (P < .01 in all planes of motion), with a maximum motion of only 1.57 mm.

Conclusion: There was a statistically significant reduction in motion of the biceps tendon in all planes of scapular motion after the intra-articular biceps tenodesis. The motion of the biceps tendon within the bicipital groove was essentially eliminated after the suprapectoral biceps tenodesis.

Clinical relevance: This arthroscopic suprapectoral tenodesis technique can significantly reduce motion of the biceps tendon within the groove in this cadaveric study, possibly reducing the likelihood of groove pain in the clinical setting.

Keywords: biceps tendon; shoulder; shoulder arthroscopy; tendinopathy; tendon biomechanics.

Figure 1.

The proximal specimen has been mounted in the custom-made apparatus with inclinometers to measure internal-external rotation and flexion-extension. The long head of the biceps tendon and bicipital groove are marked with white fiducials that can be easily tracked by the cameras. C, conjoined tendon; CC, coracoid; I, inclinometer; P, pectoralis major; SS, subscapularis; THL, transverse humeral ligament.

Figure 2.

The middle third of the ulnar shaft was affixed with a third inclinometer (I) to measure elbow flexion-extension.

Figure 3.

A resting tension of 5 N was applied to the distal biceps tendon (DBT) using a manual tensionometer.

Figure 4.

A large protractor was centered under the center of rotation of the humeral head, with the 0° line parallel to the humeral shaft. A wire was drilled through the scapula, from the inferior angle toward the center of rotation of the humeral head.

Figure 5.

A left shoulder in the lateral decubitus position viewing with a 30° arthroscope from the posterior portal. (A) The suture loop has been cinched around the biceps tendon (BT), and an arthroscopic tissue penetrator is being passed through the BT just distal to the looped suture. (B) The suture has been looped around the BT, and it is tacked in place just distal to the loop. (C) The BT has been secured with a suture anchor at the most distally visualized portion of the intra-articular bicipital groove. The cut end of the BT is marked with an asterisk. The cut end of the BT is seen distally translated from its original insertion at the superior labrum (chevron). G, glenoid; H, humerus.

Figure 6.

The mean tendon motion for each motion tested under both the native and post-tenodesis conditions. The SD is represented by the bars, and differences that achieved statistical significance are marked with an asterisk. Ab, abduction; FE, flexion-extension; IE, internal-external rotation; Neu, neutral forearm; Pro, pronated forearm; Sup, supinated forearm.

Figure 7.

A graphical representation of tendon motion as a function of shoulder flexion and extension in the native (preoperative) and post-tenodesis conditions. Zero is the baseline tendon position. This plane of motion exhibited the largest amount of motion under both conditions.