Biceps tenotomy (release) vs Biceps tenodesis (re-attachment) for treatment of SLAP tear

A SLAP tear is a superior labral tear anterior to posterior. The labrum is the rim of cartilage in the shoulder joint. The long head of the biceps attaches at the top of the labrum. When a patient gets a SLAP tear, the biceps tendon can continue to pull on this torn cartilage creating pain. Usually we do not attempt to repair a SLAP tear in patients older than 35 years of age. This means that most patients have to choose between biceps tenotomy (release of the biceps tendon) vs biceps tenodesis (re-attachment of the biceps tendon lower down in the bicipital groove) for treatment of their SLAP tear. In the past, we have told patients that the down side of tenotomy was possible decrease in strength that can range from 8-20% or possible Popeye deformity (a bulge resulting from the released biceps retracting down the arm). Due to their being a second head of the biceps and intertwining of the muscle fibers between the two heads, most patients would maintain most of their strength after releasing the long head of the biceps tendon. The down side to doing biceps tenodesis was increased recovery time. Usually we would recommend biceps tenodesis in young, active patients, or if the affected arm was the dominant side. However, this new article comparing strength, perceived Popeye deformity, and subjective results after biceps tenotomy vs tenodesis  in patients younger than 55 years of age found that one year after surgery, there was no significant difference in results. This was still true whether the arm was the dominant or non-dominant side. This could potentially have a big impact on our patients if they can get the same results with bicep tenotomy without all the recovery time of a tenodesis.

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