How is Biceps Tenodesis Surgery Performed?
Bicep tendon tearing is similar to a rope fraying and tearing on just one end of where the rope is attached. There is not an effective way to repair the frayed, partially torn part of the rope. In biceps tenodesis surgery, the bicep tendon is secured to the bone further down along its normal course where the tendon is normal and not frayed, and then the frayed end of the biceps tendon is removed and discarded.
Biceps tenodesis can be performed through a small open incision about an inch long or it can be done arthroscopically. In cases where the tendon is significantly frayed and damaged, an open, subpectoral biceps tenodesis technique may be performed. In this technique, a one inch incision is made down near the armpit, the biceps tendon is retrieved from where it sits underneath the pectoralis muscle, and the diseased part of the tendon is resected and discarded, a small bone socket is drilled in the upper part of the humerus, and the remaining healthy portion of the tendon is threaded into this bone socket and secured. The tendon will grow into this new attachment site and the patient will regain all strength and should not have any pain as the diseased portion of the tendon has been removed.
Biceps tenodesis surgery can also be performed arthroscopically. It is very similar to the open surgery described above, but the surgery is done utilizing the arthroscope and securing the tendon up in the shoulder joint. However, if there is tearing of the bicep tendon that extends further down the arm, then an open technique may be used in order to remove all areas of the diseased, torn tendon.
Finally, in an older, less active patient, consideration can be given to simply surgically releasing the long head of bicep tendon from its attachment in the shoulder joint and letting the tendon fall down the arm 1-2 inches where it will then scar in and heal. This procedure is called an arthroscopic biceps tenotomy. The recovery from this is fast, as there is no repair to protect after surgery. However, there may be a small cosmetic deformity as the biceps muscle belly will sit slightly lower than its normal position. There is also a slight loss of strength with this procedure, but studies show that the majority of older patients do well with no long-term pain and good function.