Bicep Tenodesis Techniques With Rotator Cuff Tears: Fork, Rope, and Open

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The long head of the bicep (LHB) brachii tendon is a well-known pain generator in the shoulder. However, it can be difficult to identify the LHB as the cause of the pain as it commonly is combined with other shoulder conditions. Initial treatment of LHB tendon pathologies is usually nonoperative treatment; however, if this fails the surgical options include tenotomy versus tenodesis. Tenotomies can be done quickly and commonly relieve pain associated with the pathology and requires less postoperative restrictions and rehabilitation compared with tenodesis. Despite these advantages, a tenodesis is recommended in patients less than 40 years of age with high physical activity demands, people who have a concern for cosmetics, and patients involved in workers compensation claims. When looking at the different methods of bicep tenodesis, the literature is lacking with regard to which technique is superior. There are multiple different techniques for LHB tenodesis including arthroscopically or an open manner, either above the bicipital groove or through a subpectoral approach. Future studies should be aimed at which position (proximal or distal) and type of fixation is superior when performing a LHB tenodesis.

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