Introduction and Objective. Scapholunate instability is the most common cause of carpal instability. When this instability is left untreated, the mechanical relationship between the carpal bones is permanently disrupted, resulting in progressive degenerative changes in the radiocarpal and midcarpal joints. Different tenodesis methods are used in the treatment of acute or early chronic reducible scapholunate instability, where arthritis has not developed yet and the scapholunate ligament cannot be repaired. Although it has been reported that pain is reduced in the early follow up in clinical studies with these methods, radiological results differ between studies. The deterioration of these radiological parameters is associated with wrist osteoarthritis as previously stated. Therefore, more studies are needed to determine the tenodesis method that will improve the wrist biomechanics better and will last longer. In our study, two new tenodesis methods, spiral antipronation tenodesis, and anatomic front and back reconstruction (ANAFAB) were radiologically compared with triple ligament tenodesis (TLT), in the cadaver wrists. Materials and Methods. The study was carried out on a total of 16 fresh frozen cadaver wrists. Samples were randomly allocated to the groups treated with 3 different scapholunate instability treatment methods. These are TLT (n: 6), spiral antipronation tenodesis (n: 5) and ANAFAB tenodesis (n: 5) groups. In all samples SLIL, DCSS, STT, DIC, RSC and LRL ligaments were cut in the same way to create scapholunate instability. Wrist CT scans were taken on the samples in 4 different states, in intact, after the ligaments were cut, after the reconstruction and after the movement cycle. In all of these 4 states, wrist CTs were taken in 6 different wrist positions. For every state and every position through tomography images; Scapholunate (SL) distance, Scapholunate (SL) angle, Radioscaphoid (RS) angle, Radiolunate (RL) angle, Capitolunate (CL) angle, Dorsal scaphoid translation (Dt) measurements were made. Results. Scapholunate distances means were different between intact and cut states only in neutral and clenched fist positions for all groups (p values <0.001). Mean differences were similar between the groups (p > 0.100). In neutral position, for SL center distance, mean difference between cut and reconstruction states were not different between the groups (p=0.497) but it was noted that only TLT group could not restore to the intact state. In neutral position, for SL angle, compared with the cut state, TLT and ANAFAB significantly reduced the angle (TLT: 20° (p=0.005), ANAFAB: 28° (p<0.001)) whereas antipronation tenodesis could not (13°, p=0.080). In clenched fist position, for SL angle, compared with the intact state, only ANAFAB group restored the angle, TLT and antipronation groups were significantly worse than the intact state (TLT: p<0.001, antipronation: p=0.001). In clenched fist position, for RL angle, compared with the intact state, ANAFAB and TLT groups restored the angle but antipronation group was significantly worse than the intact state (p<0.001). In neutral position, for RS angle, compared with the cut state, only ANAFAB significantly reduced the angle (11°, p<0.001) whereas TLT and antipronation groups could not (TLT: 6° (p=0.567), antipronasyon: 4° (p=0.128). Conclusions. In the presence of severe scapholunate instability in which a several number of secondary stabilizers are injured, the ANAFAB tenodesis method may be preferred to the classical method, TLT tenodesis. The results of spiral antipronation tenodesis were not better than the TLT

There remains much debate regarding the optimal method for surgical management of patients with long head of biceps pathology. The aim of this study was to compare the outcomes of tenotomy versus tenodesis. This systematic review and meta-analysis was registered on PROSPERO (ref: CRD42020198658). Electronic databases searched included EMBASE, Medline, PsycINFO, and Cochrane Library. Randomized controlled trials (RCTs) comparing tenotomy versus tenodesis were included. Risk of bias within studies was assessed using the Cochrane risk of bias v2.0 tool and the Jadad score. The primary outcome included patient reported functional outcome measures pooled using standardized mean difference (SMD) and a random effects model. Secondary outcome measures included pain (visual analogue scale VAS), rate of Popeye deformity, and operative time. 860 patients from 11 RCTs (426 tenotomy vs 434 tenodesis) were included in the meta-analysis. Pooled analysis of all PROMs data demonstrated comparable outcomes between tenotomy vs tenodesis (SMD 0.14, 95% CI −0.04 to 0.32; p=0.13). Sensitivity analysis comparing RCTs involving patients with and without an intact rotator cuff did not change the primary outcome. There was no significant difference for pain (VAS). Tenodesis resulted in a lower rate of Popeye deformity (OR 0.29, 95% CI 0.19 to 0.45, p < 0.00001). Tenotomy demonstrated a shorter operative time (MD 15.21, 95% CI 1.06 to 29.36, p < 0.00001). Aside from a lower rate of cosmetic deformity, tenodesis yielded no measurable significant benefit to tenotomy for addressing pathology in the long head of biceps. A large multi-centre clinical effectiveness randomised controlled trial is needed to provide clarity in this area

Introduction and Objective. There remains much debate regarding the optimal method for surgical management of patients with long head of biceps pathology. The aim of this study was to compare the outcomes of tenotomy versus tenodesis. Materials and Methods. This systematic review and meta-analysis was registered on PROSPERO (ref: CRD42020198658). Electronic databases searched included EMBASE, Medline, PsycINFO, and Cochrane Library. Randomized controlled trials (RCTs) comparing tenotomy versus tenodesis were included. Risk of bias within studies was assessed using the Cochrane risk of bias v2.0 tool and the Jadad score. The primary outcome included patient reported functional outcome measures pooled using standardized mean difference (SMD) and a random effects model. Secondary outcome measures included visual analogue scale (VAS), rate of cosmetic deformity (Popeye sign), range of motion, operative time, and elbow flexion strength. Results. 751 patients from 10 RCTs demonstrated (369 tenotomy vs 382 tenodesis) were included in the meta-analysis. Pooled analysis of all PROMs data demonstrated comparable outcomes between tenotomy vs tenodesis (SMD 0.17 95% CI −0.02 to 0.36, p=0.09). Sensitivity analysis comparing RCTs involving patients with and without an intact rotator cuff did not change the primary outcome. Secondary outcomes including VAS, shoulder external rotation, and elbow flexion strength did not reveal any significant difference. Tenodesis resulted in a lower rate of Popeye deformity (OR 0.27 95% CI 0.16 to 0.45, p<0.00001). Conclusions. Aside from a lower rate of cosmetic deformity, tenodesis yielded no measurable significant benefit to tenotomy for addressing pathology in the long head of biceps. This finding was irrespective of the whether the rotator cuff was intact

Management of the pathologic long-head biceps tendon remains controversial. Biceps tenotomy is a simple intervention but may result in visible deformity and subjective cramping. Comparatively, biceps tenodesis is technically challenging, and has increased operative times, and a more prolonged recovery. The purpose of this study was to determine the incidence of popeye deformity following biceps tenotomy versus tenodesis, identify predictors for developing a deformity, and compare subjective and objective outcomes between those that have one and those that do not. Data for this study were collected as part of a randomized clinical trial comparing tenodesis versus tenotomy in the treatment of lesions of the long head of biceps tendon. Patients 18 years of age or older with an arthroscopy confirmed biceps lesion were randomized to one of these two techniques. The primary outcome measure for this sub-study was the rate of a popeye deformity at 24-months post-operative as determined by an evaluator blinded to group allocation. Secondary outcomes were patient reported presence/absence of a popeye deformity, satisfaction with the appearance of their arm, as well as pain and cramping on a VAS. Isometric elbow flexion and supination strength were also measured. Interrater reliability (Cohen's kappa) was calculated between patient and evaluator on the presence of a deformity, and logistic regression was used to identify predictors of its occurrence. Linear regression was performed to identify if age, gender, or BMI were predictive of satisfaction in appearance if a deformity was present. Fifty-six participants were randomly assigned to each group of which 42 in the tenodesis group and 45 in the tenotomy group completed a 24-month follow-up. The incidence of popeye deformity was 9.5% (4/42) in the tenodesis group and 33% (15/45) in the tenotomy group (18 male, 1 female) with a relative risk of 3.5 (p=0.016). There was strong interrater agreement between evaluator and patient perceived deformity (kappa=0.636; p<0.001). Gender tended towards being a significant predictor of having a popeye with males having 6.6 greater odds (p=0.090). BMI also tended towards significance with lower BMI predictive of popeye deformity (OR 1.21; p=0.051). Age was not predictive (p=0.191). Mean (SD) satisfaction score regarding the appearance of their popeye deformity was 7.3 (2.6). Age was a significant predictor, with lower age associated with decreased satisfaction (F=14.951, adjusted r2=0.582, p=0.004), but there was no association with gender (p=0.083) or BMI (p=0.949). There were no differences in pain, cramping, or strength between those who had a popeye deformity and those who did not. The risk of developing a popeye deformity was 3.5 times higher after tenotomy compared to tenodesis. Male gender and lower BMI tended towards being predictive of having a deformity; however, those with a high BMI may have had popeye deformities that were not as visually apparent to an examiner as those with a lower BMI. Younger patients were significantly less satisfied with a deformity despite no difference in functional outcomes at 24 months. Thus, biceps tenodesis may be favored in younger patients with low BMI to mitigate the risk of an unsatisfactory popeye deformity

Anterior cruciate ligament (ACL) injuries are among the most common and debilitating knee injuries in professional athletes with an incidence in females up to eight-times higher than their male counterparts. ACL injuries can be career-threatening and are associated with increased risk of developing knee osteoarthritis in future life. The increased risk of ACL injury in females has been attributed to various anatomical, developmental, neuromuscular, and hormonal factors. Anatomical and hormonal factors have been identified and investigated as significant contributors including osseous anatomy, ligament laxity, and hamstring muscular recruitment. Postural stability and impact absorption are associated with the stabilizing effort and stress on the ACL during sport activity, increasing the risk of noncontact pivot injury. Female patients have smaller diameter hamstring autografts than males, which may predispose to increased risk of re-rupture following ACL reconstruction and to an increased risk of chondral and meniscal injuries. The addition of an extra-articular tenodesis can reduce the risk of failure; therefore, it should routinely be considered in young elite athletes. Prevention programs target key aspects of training including plyometrics, strengthening, balance, endurance and stability, and neuromuscular training, reducing the risk of ACL injuries in female athletes by up to 90%. Sex disparities in access to training facilities may also play an important role in the risk of ACL injuries between males and females. Similarly, football boots, pitches quality, and football size and weight should be considered and tailored around females’ characteristics. Finally, high levels of personal and sport-related stress have been shown to increase the risk of ACL injury which may be related to alterations in attention and coordination, together with increased muscular tension, and compromise the return to sport after ACL injury. Further investigations are still necessary to better understand and address the risk factors involved in ACL injuries in female athletes. Cite this article: Bone Jt Open 2024;5(2):94–100

Abstract. Introduction. The aim of this study was to determine which factors affect a professional footballer's return to play performance level after ACL reconstruction (ACL-R). Additionally, to report their playing performance at 2 and 5 years post ACL-R compared to their preinjury performance. Methods. A retrospective review of a consecutive series of primary ACL-R undertaken in professional footballers between 2005 and 2019 was undertaken. Performance was determined by the number of minutes played and the league level compared to their pre-injury baseline. Playing time (minutes) was classified as same (within 20%), more, or less playing time for each season compared to the one year prior to surgery. Results. Two hundred footballers (mean age 24.1 ± 4.2 years) were included. 194 (97%) returned to professional football. At 2-years after ACL-R 61% of footballers were playing in the same/ higher league, 29% were playing in a lower league and 10% were not playing. At 5-years this was 35%, 37% and 28% respectively. Forty-six percent of footballers were playing the same or more minutes as pre-injury at 2 years post-surgery, 51% were at 3 and 4 years but this reduced to 45% at 5 years. The presence of >50% thickness chondral pathology, ACL-R lacking lateral extra-articular tenodesis and age over 25 years at surgery were all significant risk factors of worse performance rates after ACL-R. Conclusion. While professional footballers achieved high initial RTP rates after ACL-R, with the majority returning to pre-operative levels of competition, significant decreases in performance rates were noted over time

Introduction. Anterior cruciate ligament reconstruction (ACLr) is the most widely published operation in the orthopaedic literature. Over recent years there has been increased interest in the surgical technique and role of concomitant procedures performed during ACLr. The National Ligament Registry (NLR) collects robust data on ACLr performed in the UK. In this registry analysis we explore trends in ACLr surgery and how they relate to published literature and the growing industry portfolio available to surgeons. Methods. Using data from the NLR, 14,352 ACLr performed between 2013–2021 were analysed. High impact papers on ACLr were then cross referenced against this data to see if surgical practice was influenced by literature or whether surgical practice dictated publication. Common trends were also compared to key surgical industry portfolios (Arthrex, Smith and Nephew) to see how new technology influenced surgical practice. Results. The number of ACLr performed in isolation is decreasing. The number of ACL reconstructions involving meniscal surgery shows an increasing trend since 2013, with 57% of ACLr in 2021 now involving meniscus surgery. The number of ACLr with lateral extra-articular tenodesis (LET) has increased sharply since 2018, preceding the stability trial publication in 2020. Graft preference and size has remained static despite the introduction of new graft harvest and fixation devices. Additional procedures such as other ligament reconstruction and additional cartilage surgery have also remained static over time. Conclusion. In this analysis we looked at surgical trends in ACLr and their relation to literature and industry. Meniscal intervention is increasing, in keeping with the growing level of literature in this area. In the setting of LET, a high impact level 1 study appears to have significantly changed the practice of UK surgeons with a sharp increase in the number of LET procedures being performed. Industry appears to have little influence on the change in surgical trends, suggesting high quality evidence is what drives innovation in ACLr while industry supports rather than influences innovation. It will be interesting to see the impact of the stability 2 study, recent work on the medial structures of the knee and the commissioning of cartilage centres on future trends

Purpose: The best strategy to adopt for the long head of the biceps during total shoulder arthroplasty for centred primary joint degeneration remains a controversial issue. We analysed the influence of long head of the biceps (LHB) tenodesis on outcome. Material and methods: From retrospective multicentric series of 766 shoulder prostheses implanted for centred primary degeneration of the shoulder joint, we selected 625 shoulders with sufficient data concerning the LHB. We defined two groups: 131 shoulders with LHB tenodesis and 494 shoulders with a preserved LHB. We analysed clinical outcome with the Constant score and subjective outcome at two years. We identified four groups: 70 humeral prostheses without tenodesis, 10 humeral prostheses with tenodesis, 424 total shoulder arthroplastues without tenodesis, and 121 total shoulder arthroplasties with tenodesis. Results: The Constant score was significantly better in the tenodesis group (74.7) than in the group without tenodesis (70.8). This significant difference was also found for the weighted score and likewise for active anterior elevation and active external rotation in position 1. There was no difference concerning postoperative fatty degeneration. By subgroups, the analysis showed significant improvement in the Constant score for humeral prostheses with tenodesis and total shoulder arthroplasty with tenodesis over the same implants without tenodesis. This same significant difference was observed for the 364 patients who had a minimum follow-up of 36 months: tenodesis improved the Constant score, the weighted Constant score, active anterior elevation, and active external rotation. Discussion: The causal role of the LHB in shoulder pain is now well documented in the literature. Several authors have advocated tenotomy or tenodesis of the LHB during surgical treatment of rotator cuff tears. The same is not true for shoulder arthroplasty for the treatment of primary degeneration. Dines and Hersch reported their experience with ten patients with a painful total shoulder arthroplasty who were improved with arthroscopic tenotomy or tenodesis. Conclusion: Our large series confirms that tenodesis of the LHB is preferable during implantation of a humeral prosthesis or a total shoulder prosthesis for the treatment of centred primary joint degeneration with good results that persist over time

Abstract. Background. Performing lateral extra-articular tenodesis (LET) with ACL reconstruction may conflict with the ACLR femoral tunnel. Methods. 12 fresh-frozen cadaveric knees were used: at 120 flexion, an 8mm ACLR femoral tunnel was drilled in the anteromedial bundle position via the anteromedial portal. A modified Lemaire LET was performed using a 1 cm-wide iliotibial band strip left attached to Gerdy's tubercle. The LET femoral fixation point was identified 10mm proximal / 5 mm posterior to the LCL femoral attachment, and a 2.4-mm guide wire was drilled, aiming at 0, 10, 20, or 30 degrees anteriorly in the axial plane, and at 0, 10, or 20 degrees proximally in the coronal plane. The relationship between the LET drilling guide wire and the ACLR femoral tunnel reamer was recorded for each combination. When collision with the femoral tunnel was recorded, the LET wire depth was measured. Results. Tunnel conflict occurred at a mean LET wire depth of 23.6 mm (15–33 mm). No correlation existed between LET wire depth and LET drilling orientation (r=0.066; p=0.67). Drilling angle in the axial plane was significantly associated with the occurrence of tunnel conflict (P < .001). However, no such association was detected when comparing the drilling angle in the coronal plane (P=0.267). Conclusion. Conflict occurred at as little as 15 mm depth. When longer implants are used, the orientation should be at least 30 degrees anterior in the axial plane. Clinical Relevance. This study provides important information for surgeons performing LET in combination with ACLR

Abstract. Introduction. Anterolateral procedures can reduce the risk of re-rupture after ACL reconstruction in high risk patients however, this effectiveness has never been evaluated in elite athletes. The purpose of this study was to evaluate the effectiveness of lateral extra-articular tenodesis in reducing revision rates in ACL reconstructions in elite athletes. Methodology. A consecutive cohort of elite athletes between 2005 and 2018 undergoing ACLR reconstruction with or without modified Lemaire lateral extra-articular tenodesis were analysed. A minimum of 2 years of follow-up was required. The association between the use of LET and ACL graft failure was evaluated with univariate and multivariate logistic regression models. Results. 455 elite athletes (83% male; 22.5±4.7 years) underwent primary ACL reconstruction with (n=117) or without (n=338) a LET procedure. Overall, 36 athletes (7.9%) experienced ACL graft failure including 32 (9.5%) reconstructions without a LET and 4 (3.4%) with a LET. Utilization of LET during primary ACL reconstruction reduced the risk of graft failure by 2.8 times with 16.5 athletes needing to be treated with LET to prevent a single ACL graft failure. Multivariate models showed that LET significantly reduced the risk of graft rupture (RR=0.325; p=.029) as compared to ACL reconstruction alone after controlling for age at ACL reconstruction and gender. Including graft type in the model did not significantly change the risk profile. Conclusion. The addition of LET in elite athletes undergoing primary ACL reconstruction reduced the risk of undergoing revision by 2.8 times

Adequate visual clarity is paramount to performing arthroscopic shoulder surgery safely, efficiently, and effectively. The addition of epinephrine in irrigation fluid, and the intravenous or local administration of tranexamic acid (TXA) have independently been reported to decrease bleeding thereby improving the surgeon's visualization during arthroscopic shoulder procedures. No study has compared the effect of systemic administered TXA, epinephrine added in the irrigation fluid or the combination of both TXA and epinephrine on visual clarity during shoulder arthroscopy with a placebo group. The purpose of this study is to determine if intravenous TXA is a safe alternative to epinephrine delivered by a pressure-controlled pump in improving arthroscopic shoulder visualization during arthroscopic procedures and whether using both TXA and epinephrine together has an additive effect in improving visualization. The design of the study was a double-blinded, randomized controlled trial with four 1:1:1:1 parallel groups conducted at one center. Patients aged ≥18 years undergoing arthroscopic shoulder procedures including rotator cuff repair, arthroscopic biceps tenotomy/tenodesis, distal clavicle excision, subacromial decompression and labral repair by five fellowship-trained upper extremity surgeons were randomized into one of four arms: Pressure pump-controlled regular saline irrigation fluid (control), epinephrine (1ml of 1:1000) mixed in irrigation fluid (EPI), 1g intravenous TXA (TXA), and epinephrine and TXA (EPI/TXA). Visualization was rated on a 4-point Likert scale every 15 minutes with 0 indicating ‘poor’ quality and 3 indicating ‘excellent’ quality. The primary outcome measure was the unweighted mean of these ratings. Secondary outcomes included mean arterial blood pressure (MAP), surgery duration, surgery complexity, and adverse events within the first postoperative week. One hundred and twenty-eight participants with a mean age (± SD) of 56 (± 11) years were randomized. Mean visualization quality for the control, TXA, EPI, and EPI/TXA groups were 2.1 (±0.40), 2.1 (±0.52), 2.6 (±0.37), 2.6 (±0.35), respectively. In a regression model with visual quality as the dependent variable, the presence/absence of EPI was the most significant predictor of visualization quality (R=0.525; p < 0 .001). TXA presence/absence had no effect, and there was no interaction between TXA and EPI. The addition of MAP and surgery duration strengthened the model (R=0.529; p < 0 .001). Increased MAP and surgery duration were both associated with decreased visualization quality. When surgery duration was controlled, surgery complexity was not a significant predictor of visualization quality. No adverse events were recorded in any of the groups. Intravenous administration of TXA is not an effective alternative to epinephrine in the irrigation fluid to improve visualization during routine arthroscopic shoulder surgeries although its application is safe. There is no additional improvement in visualization when TXA is used in combination with epinephrine beyond the effect of epinephrine alone

Adequate visual clarity is paramount to performing arthroscopic shoulder surgery safely, efficiently, and effectively. The addition of epinephrine in irrigation fluid, and the intravenous or local administration of tranexamic acid (TXA) have independently been reported to decrease bleeding thereby improving the surgeon's visualization during arthroscopic shoulder procedures. No study has compared the effect of systemic administered TXA, epinephrine added in the irrigation fluid or the combination of both TXA and epinephrine on visual clarity during shoulder arthroscopy with a placebo group. The purpose of this study is to determine if intravenous TXA is a safe alternative to epinephrine delivered by a pressure-controlled pump in improving arthroscopic shoulder visualization during arthroscopic procedures and whether using both TXA and epinephrine together has an additive effect in improving visualization. The design of the study was a double-blinded, randomized controlled trial with four 1:1:1:1 parallel groups conducted at one center. Patients aged ≥18 years undergoing arthroscopic shoulder procedures including rotator cuff repair, arthroscopic biceps tenotomy/tenodesis, distal clavicle excision, subacromial decompression and labral repair by five fellowship-trained upper extremity surgeons were randomized into one of four arms: Pressure pump-controlled regular saline irrigation fluid (control), epinephrine (1ml of 1:1000) mixed in irrigation fluid (EPI), 1g intravenous TXA (TXA), and epinephrine and TXA (EPI/TXA). Visualization was rated on a 4-point Likert scale every 15 minutes with 0 indicating ‘poor’ quality and 3 indicating ‘excellent’ quality. The primary outcome measure was the unweighted mean of these ratings. Secondary outcomes included mean arterial blood pressure (MAP), surgery duration, surgery complexity, and adverse events within the first postoperative week. One hundred and twenty-eight participants with a mean age (± SD) of 56 (± 11) years were randomized. Mean visualization quality for the control, TXA, EPI, and EPI/TXA groups were 2.1 (±0.40), 2.1 (±0.52), 2.6 (±0.37), 2.6 (±0.35), respectively. In a regression model with visual quality as the dependent variable, the presence/absence of EPI was the most significant predictor of visualization quality (R=0.525; p < 0 .001). TXA presence/absence had no effect, and there was no interaction between TXA and EPI. The addition of MAP and surgery duration strengthened the model (R=0.529; p < 0 .001). Increased MAP and surgery duration were both associated with decreased visualization quality. When surgery duration was controlled, surgery complexity was not a significant predictor of visualization quality. No adverse events were recorded in any of the groups. Intravenous administration of TXA is not an effective alternative to epinephrine in the irrigation fluid to improve visualization during routine arthroscopic shoulder surgeries although its application is safe. There is no additional improvement in visualization when TXA is used in combination with epinephrine beyond the effect of epinephrine alone

Purpose of the study: Injury to the long head of the biceps is frequently associated with massive rotator cuff tears leading to pain and functional impotency. Tenotomy of the long biceps is a validated option for unrepairable cuff tears, but can lead to an unsatisfactory aesthetic result (Popeye sign) or functional impairment (loss of strength). The objectives of this study were to confirm the clinical efficacy of intra-articular resection of the long head of the biceps, to study the radiographic evolution, to evaluate aesthetic and functional outcome of tenotomy procedures and to compare them with those of tenodesis with an interference screw, an alternative to tenotomy. Materials and Methods: We conducted a retrospective analysis of 151 patients presenting an unrepairable rotator cuff tear. Tenotomy of the long head of the biceps was performed in 63 patients and tenodesis of the long head of the biceps using an interference screw in 88. Acromioplasty was also performed in 21 shoulders with the resection of the long head of the biceps. All patients were reviewed by an independent investigator at mean 63 months follow-up. Results: Patient satisfaction was good or very good for 92%. The absolute Constant score improved from 47.4±13.8 points preoperatively to 70.8±12.2 points at last followup for the whole series, increasing on average 24.4 points (p< 0.05). There was no statistical difference for the Constant score between tenotomy and tenodesis. The subacromial space decreased 2±2.3 mm on average (p< 0.05). Degeneration of the glenohumeral joint was noted in 12% of shoulders at last follow-up. Retraction of the long head of the biceps (Popeye sign) were noted in 31% of patients with tenotomy and in 10% of those with tenodesis (p< 0.001). There were twice as many cases of brachial biceps cramps in the tenotomy group (24%) than in the tenodesis group (12%). Muscle force for elbow flexion in the supination position was greater in the tenodesis group than in the tenotomy group (p< 0.05). Conclusion: Arthroscopic tenotomy or tenodesis of the long head of the biceps are valid therapeutic options for unrepairable rotator cuff tears. The efficacy of the two techniques is the same in terms of the objective outcome (Constant score) but tenodesis limits the aesthetic sequelae and preserves elbow flexion and supination force

Aim: The purpose of this study was to evaluate the results after arthroscopic cuff repair using suture anchors with associated lesions of the long head of the biceps. Does biceps tenodesis lead to better results?. Method: 80 patients (age 41 to 74) with one or two tendon lesons of the rotator cuff and associated lesions of the biceps (instability, partial tear) were treated with arthroscopic ruff repair using suture anchors. Preop examination included MRI and ultrasound. The fatty degeneration and infiltration of the tendon was noted according to Goutallier and Thomazeau. Patients were devided into 2 groups. 40 patients were treated with a biceps tenodesis and 40 cases with a tenotomy. Tenodesis was performed using suture anchors. Patients in both groups were comparable in age, sex, tear size and fatty degeneration. Rehanilitation protocol was equal in both groups. Prospective follow up was done at 3, 6, 12, 24 and 36 months using the Constant score. Ultrasound was documented at all follow-ups, MRI at last follow up. Results: 73 Patients could be completely evaluated, 37 in the tenodesis and 36 in the tenotomy group. The constant score gained 42,3 points from 44,3 to 87,6 overall. There were 4 complete re-tears of the cuff in the tenodesis and 5 in the tenotomy group during follow up, requiring 2 revisions in each group. There was one revision due to stiffness in the tenodesis group, no infections were noted. 29 patients in tenotomy group had a visuable deformity compared to 3 cases in tenodesis group, whereas Ultrasound examination revealed 5 not healed tenodesis. 32 patients in the tenodesis group were satisfied with the result and would do surgery again compared to 25 in the tenotomy group, complaining about the visual deformity. There was no statistical difference in score result between the tenodesis or tenotomy group. Discussion: The arthroscopic treatment of rotator cuff lesions leads to good results after 36 months. The way a lesion of the biceps tendon is treated does not seem to have an effect on the postoperative score result. Cosmetic appearance was better in tenodesis group, leading to better patient acceptance

The functional importance of the long head of biceps tendon remains controversial, but it is well accepted as an important source of anterior shoulder pain. Both biceps tenotomy and tenodesis have well-documented results in the native shoulder. Management of the long head of biceps tendon during shoulder arthroplasty remains controversial. The existing literature supports surgical treatment of the biceps during shoulder arthroplasty. Walch et al. reported the largest series in multicenter study of over eight hundred shoulder arthroplasty patients with or without biceps tenodesis. The authors found more reproducible pain relief with biceps tenodesis and no difference in range of motion. Similarly, Soliman et al. reported on a prospective review of 37 patients undergoing hemiarthroplasty for fracture randomly assigned to biceps tenodesis vs. no treatment. The authors found a statistically significant improvement in Constant score and shoulder pain with biceps tenodesis. If left untreated during shoulder arthroplasty, the intact biceps tendon may be a source of anterior shoulder pain requiring revision surgery. Tuckman et al. reported excellent pain relief after biceps tenotomy or tenodesis for biceps-related pain after previous shoulder arthroplasty. The decision to perform a biceps tenotomy versus a tenodesis during shoulder arthroplasty also remains controversial. Tenotomy may increase the risk of cosmetic pop-eye deformity and muscle cramping or fatigue over tenodesis. Therefore, routine long head of biceps soft tissue tenodesis is recommended during shoulder arthroplasty as it safe, reproducible, cost-effective, associated with improved outcome scores, and minimises the risk of cosmetic deformity and pain associated with biceps tenotomy

Total shoulder arthroplasty is becoming increasingly common. A biceps tenodesis or tenotomy has become a routine part of the operation. There are several advantages to a tenodesis or tenotomy. First, the long head of the biceps tendon is routinely pathologic. One study has shown that there are differences in gene expression and mechanical properties in the long head of the biceps tendon in the setting of glenohumeral joint arthritis. Clinically, we often see inflammation, tearing, adhesions, or other pathology. Second, it is largely accepted that the long head of the biceps tendon has minimal function at the shoulder. The biceps muscle primarily functions at the elbow. Therefore, there is little downside to performing a tenodesis if there is a chance of it generating pain after surgery. Another major reason to perform a tenodesis or a tenotomy is that the technique of total shoulder arthroplasty requires a subscapularis takedown or lesser tuberosity osteotomy. The ligaments and tendon associated with the subscapularis contribute to the stability of the biceps tendon and after subscapularis takedown, it is unlikely that the tendon would remain reduced in the groove. In addition, it is part of a technique to incise and release the rotator interval, additionally creating scarring and/or instability associated with the biceps tendon. Given those reasons, this is a very common and reasonable routine part of the procedure of total shoulder arthroplasty

The treatment of scapholunate (SL) ligament injuries is addressed by surgical procedures to stabilize the carpal joint. Open techniques include bone-ligament-bone transfers, tenodesis, partial fusions and carpectomies. Innovative procedures using wrist arthroscopy, offer minimally invasive fixation without full exposure of carpal bones; however, the success of the technique and its impact on the reduction on the range of carpal movement is as yet not well known. In this work, the performance of Corella tenodesis technique to repair the SL ligament is evaluated for a wrist type II by numerical methods. Human wrist can be classified based on the lunate morphology: type I for lunate that articulates with radius, scaphoid, capitate and triquetrum, and type II which has an extra surface to articulate with the hamate. A finite element model was constructed from CT-scan images, the model includes cortical and trabecular bones, articular cartilage and ligaments. Three scenarios were simulated representing healthy wrist, SL ligament sectioning and the Corella technique. The performance of the technique was assessed by measure the SL gap in dorsal and volar side as well as the SL angle to be compared to cadaveric studies. In intact position, the SL gap and the SL angle predicted by the numerical model is 2.8 mm and 44.8º, these values are consistent to the standard values reported in cadaveric experiments (2.0 ± 0.8 mm for SL gap and 45.8 ± 9.7 for SL angle). Virtual surgeries may help to understand and evaluate the performance of the techniques at clinical application

Purpose of the study: Construction of a key grip is the final objective of programmed functional surgery of the upper limb in the tetraplegic. Three phases are necessary: activation of the grip, simplification of the poly-articular chain, and positioning the thumb column. For this operative phase, two techniques can be used, either fusion of the articulation with a trapezometacarpal arthrodesis (TMA) or a soft tissue procedure (tenodesis of the abductor pollicis longus). Our study compared analytically these two techniques, considering grip force and stability and the quality of the key grip opening. Material and methods: This was a retrospective study of 38 key grips with a mean follow-up of 7.4 years in a population of tetraplegic patients (groups 1 – 5 in the International Classification of Giens. Seventeen active key grips including 11 with TMA and 21 passive key grips including 16 without TMA with regulation of the thumb position by soft tissue procedures. The active and passive grips according to the procedures were comparable statistically for their median ASIA motor scores. Results: The force of the active key grips with TMA (mean 2.7± 1.3 kg) was significantly greater than that obtained after tenodesis (1.3±0.7 kg) (p=0.05). For passive key grips, the difference was not significant, 1.1±0.6 kg with TMA versus 1.0±0.9 kg without. Twenty-three percent of the grips were unstable after TMA versus 24% after tenodesis. Regarding grip opening, the mean distance between the pulp of the thumb and the index was 3.7 cm for active key grips after TMA by tenodesis effect and 5.4 cm for holding large objects while without TMA these values were 3.2 cm and 6.4 cm respectively. For passive grips, these same values were 2.2 and 3.4 cm after TMA versus 2.4 and 6.8 after tenodesis. Discussion: For the active key grip, TMA enables a stronger grip but with loss of opening distance for large objects. Conversely, for the passive key grip, TMA does not enable a stronger grip but significantly limits passive opening. Globally TMA yields a more constant result. In patients with a limited motor potential, it is important to favour the creation of two different grips

The purpose of this study was to evaluate outcome following arthroscopic biceps tenotomy or tenodesis for massive irreparable rotator cuff tears associated with biceps lesions. This is a retrospective study of sixty-eight consecutive patients (mean age 68 ± 6 years) with seventy-two irreparable rotator cuff tears treated with arthroscopic biceps tenotomy (thirty-nine cases) or tenodesis (thirty-three cases). All patients were evaluated clinically and radiographically at a mean follow-up of thirty-five months (range, 24–52). Fifty-three patients (78%) were satisfied. Constant score improved from forty-six to sixty-seven points (p< 0.001). Presence of a healthy, intact teres minor on preoperative imaging correlated with increased postoperative external rotation (40 vs. 18°, p< 0.05) and higher Constant score (p< 0.05). Three patients with a pseudoparalyzed shoulder did not benefit from the procedure and did not regain active elevation above the horizontal level. By contrast, fifteen patients with painful loss of active elevation recovered active elevation. The acromiohumeral distance decreased 1 mm on average, and only one patient developed glenohumeral osteoarthritis. There was no difference between tenotomy and tenodesis (Constant Score sixty-one vs. seventy-three). A “Popeye” sign was clinically apparent in twenty-four tenotomy patients (61%), but none were bothered by it. Two patients required reoperation with a reverse prosthesis. Arthroscopic biceps tenotomy and tenodesis effectively treats severe pain or dysfunction caused by an irreparable rotator cuff tear associated with biceps pathology. Shoulder function is significantly lower if the teres minor is atrophic or fatty infiltrated. Pseudoparalysis or severe cuff arthropathy are contraindications

Purpose of the study: Arthroscopic reinsertion of SLAP lesions is the most commonly used approach. Tenodesis of the long biceps could be proposed as an alternative to reinsertion. The purpose of our study was to report the results of tenodesis and reinsertions for the treatment of type II SLAP lesions. Material and methods: This was a consecutive monocentric comparative series analyzed retrospectively. Isolated type II SLAP lesions treated arthroscopically were retained for study: 25 cases treated from January 2000 to May 2004. Exclusion criteria were: associated instability, associated cuff tears, history of surgery. The long biceps tendon was reinserted on the glenoid tubercle using two threads mounted on resorbable anchors in ten patients (all men), mean age 27.5 years (range 19–57 years). Tenodesis of the long biceps in the gutter was performed in fifteen patients (six women and nine men), mean age 52.2 years (range 28–64 years). All patients were reviewed by an independent observer. Results: In the reinsertion group, mean follow-up was 35 months (range 12–57 months). Three patients had revision tenodesis due to persistent pain and three others were disappointed because they were unable to resume their former sport. Four others were very satisfied. The mean Constant score improved from 65 to 83 points. Force was 16 kg in flexion and 5 kg in supination. In the tenodesis group, mean follow-up was 34 months (range 12–56 months). There were no revision procedures in this group. Subjectively, one patient was disappointed (atypical pain), two were satisfied and 12 very satisfied. The mean Constant score improved from 59 to 89 points. Force was 14.5 kg in flexion and 4.8 kg in supination. Discussion: This series showed that results obtained with reinsertions can be disappointing: three revisions and three disappointed patients among ten procedures. In the tenodesis group, 14 of 15 patients were satisfied or very satisfied. Tenodesis of the long head of the biceps can be considered as an alternative to reinsertion for the treatment of type II SLAP lesions, particularly in older athletes