Arthroscopic biceps tenodesis: A new technique using bioabsorbable interference screw fixation


      Purpose: To report a new technique of arthroscopic biceps tenodesis using bioabsorbable interference screw fixation and the early results. Type of Study: Prospective, nonrandomized study. Methods: Technique: The principle of arthroscopic biceps tenodesis is simple: after biceps tenotomy, the tendon is exteriorized and doubled on a suture; the biceps tendon is then pulled into a humeral socket (7 or 8 mm × 25 mm) drilled at the top of the bicipital groove, and fixed using a bioabsorbable interference screw (8 or 9 mm × 25 mm) under arthroscopic control. Patients: 43 patients treated with this technique between 1997 and 1999 were followed-up for at least 1 year. The technique was indicated in 3 clinical situations: (1) with arthroscopic cuff repair (3 cases), (2) in case of isolated pathology of the biceps tendon with an intact cuff (6 cases), and (3) as an alternative to biceps tenotomy in patients with massive, degenerative and irreparable cuff tears (34 cases). The biceps pathology was tenosynovitis (4 cases), prerupture (15 cases), subluxation (11 cases), and luxation (13 cases). Results: The absolute Constant score improved from 43 points preoperatively to 79 points at review (P < .005). There was no loss of elbow movement and biceps strength was 90% of the strength of the other side. Two patients, operated on early in the series, presented with a rupture of the tenodesis. In both cases the bicipital tendon was very friable and the diameter of the screw proved to be insufficient (7 mm). No neurologic or vascular complications occurred. Conclusions: Arthroscopic biceps tenodesis using bioabsorbable screw fixation is technically possible and gives good clinical results. This technique can be used in cases of isolated pathologic biceps tendon or a cuff tear. A very thin, fragile, almost ruptured biceps tendon is the technical limit of this arthroscopic technique.
      Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 9 (November-December), 2002: pp 1002– 1012


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Meyer AW.
        Spontaneous dislocation and destruction of long head of biceps brachii.
        Arch Surg. 1928; 17: 493-506
        • Hichcock HH
        • Bechtol CO.
        Painful shoulder: Observations on role of tendon of long head of biceps brachii in its causation.
        J Bone Joint Surg Am. 1948; 30: 263-273
        • Neviaser RJ.
        Lesions of the biceps and tendinitis of the shoulder.
        Orthop Clin North Am. 1980; 11: 343-348
        • O ’Donogue DH
        Subluxating biceps tendon in the athlete.
        Clin Orthop. 1982; 164: 26-29
        • Paavolainen P
        • Slatis A
        • Aalto K.
        Surgical pathology in chronic shoulder pain.
        in: Surgery of the shoulder. Mosby, Philadelphia1984: 313-318
        • Warren RF.
        Lesions of the long head of the biceps tendon.
        Instr Course Lect. 1985; 30: 204-209
        • Peterson CJ.
        Spontaneous medial dislocation of the long biceps brachii.
        Clin Orthop. 1986; 21: 224-227
        • Post M
        • Benca P.
        Primary tendinitis of the long head of the biceps.
        Clin Orthop. 1989; 246: 117-125
        • Burkhead Jr., WZ
        The biceps tendon.
        in: The shoulder.Vol 2. WB Saunders, Philadelphia1990: 791-836
        • Boileau P
        • Walch G.
        So-called “ isolated” supraspinatus tears: A plea for systematic opening of the rotator interval.
        in: The cuff. Elsevier, Paris1997: 320-323
        • Walch G
        • Nové-Josserand L
        • Boileau P
        • Lévigne C.
        Subluxations and dislocations of the tendon of the long head of the biceps.
        J Shoulder Elbow Surg. 1998; 7: 100-108
        • Pfahler M
        • Branner S
        • Refior HJ.
        The role of the bicipital groove in tendinopathy of the long biceps tendon.
        J Shoulder Elbow Surg. 1999; 8: 419-424
        • Creenshaw AH
        • Kilgore WE.
        Surgical treatment of bicipital tenosynovitis.
        J Bone Joint Surg Am. 1966; 48: 1496-1502
        • Froimson AL.
        Keyhole tenodesis of biceps origin at the shoulder.
        Clin Orthop. 1974; 112: 245-249
        • Dines D
        • Warren RF
        • Inglis AE.
        Surgical treament of lesions of the long head of the biceps.
        Clin Orthop. 1982; 164: 165-174
        • De Palma AF.
        Surgery of the shoulder.
        in: JB Lippincott, Philadelphia1983: 266-276
        • Becker DA
        • Cofield RH.
        Tenodesis of the long head of the biceps brachii for chronic bicipital tendinitis—Long term results.
        J Bone Joint Surg Am. 1989; 71: 376-381
        • Berleman U
        • Bayley I.
        Tenodesis of the long head of the biceps brachii in the painful shoulder: Improving the results in the long term.
        J Shoulder Elbow Surg. 1995; 4: 429-435
        • Walch G
        • Patte D
        • Boileau P.
        Luxation de la longue portion du biceps et rupture de la coiffe des rotateurs.
        Rev Chir Orthop. 1990; 76: 95
        • Curtis AS
        • Snyder SJ.
        Evaluation and treatment of biceps tendon pathology.
        Arthroscopy. 1993; 24: 33-34
        • Goldfarb C
        • Yamaguchi K.
        The biceps tendon: Dogma and controversies.
        Sports Med Arthrosc Rev. 1999; 7: 93-103
        • Snyder SJ.
        Arthroscope-assisted biceps tendon surgery.
        in: Shoulder arthroscopy. McGraw-Hill, New York1994: 61-76
        • Habermeyer P
        • Mall U.
        Arthroscopic tenodesis of the long head of the biceps: Technique and results.
        J Shoulder Elbow Surg. 1999; 8 (abstr 199): 557
        • Gartsman G
        • Hammerman S.
        Arthroscopic biceps tenodesis.
        Arthroscopy. 2000; 16: 550-552
        • Blickenstaff KR
        • Grana WA
        • Egle D.
        Analysis of a semitendinosus autograft in a rabbit model.
        Am J Sports Med. 1997; 25: 554-559
        • Aune AK
        • Ekeland A
        • Cawley PW.
        Interference screw fixation of hamstring vs patellar tendon grafts for anterior cruciate ligament reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 1998; 6: 99-102
        • Weiler A
        • Windhagen HJ
        • Raschke MJ
        • Laumyer A
        • Hoffmann RFG.
        Biodegradable interference screw fixation exhibits pull- out force and stiffness similar to titanium screws.
        Am J Sports Med. 1998; 26: 119-128
        • Boileau P
        • Walch G.
        A new technique for tenodesis of the long head of the biceps using bioabsorbable screw fixation.
        J Shoulder Elbow Surg. 1999; 8 (abstr 198): 557
        • Boileau P
        • Krishnan SG
        • Coste JS
        • Walch G.
        A new technique for tenodesis of the long head of the biceps using bioabsorbable screw fixation.
        Tech Shoulder Elbow Surg. 2001; 2: 153-165
        • Constant CR
        • Murley AHG.
        A clinical method of functional assessment of the shoulder.
        Clin Orthop. 1987; 214: 160-164
        • Wolf EM.
        Anterior portals in shoulder arthroscopy.
        Arthroscopy. 1989; 5: 201-208
        • Burkhead WZ
        • Sheinberg RR
        • Box G.
        Surgical anatomy of the axillary nerve.
        J Shoulder Elbow Surg. 1992; 1: 31-36
        • Bryan JB
        • Schouder K
        • Tullos HS
        • et al.
        The axillary nerve and its relationship to common sports medicine shoulder procedure.
        Am J Sports Med. 1986; 14: 113-116
        • Athanasiou KA
        • Agrawal CM
        • Barber FA
        • Burkhart SS.
        Orthopaedic application for PLA-PGA biodegradable polymers. Current Concepts.
        Arthroscopy. 1998; 14: 726-737
        • Chambat P
        • Christel P
        • Eloy R
        • Therin M.
        Biocompatibility of a bioabsorbable interference screw until total resorption in a functional sheep model.
        in: Presented at the 4th EFORT Meeting, BrusselsJune 3-8, 1999 (abstract book p 65)