This document describes a study that evaluated a new arthroscopic biceps tenodesis technique. The study compared 14 patients who underwent the new technique to 9 control patients who had a traditional tenodesis or tenotomy. The new technique resulted in significantly less pain and better function scores compared to the control group at several post-op intervals based on questionnaires. Both groups had similar range of motion recovery and time to return to work/discharge. No failures of the tenodesis occurred with the new technique. The conclusion is that this new arthroscopic technique is easy, reproducible, and yields better outcomes than other approaches while avoiding their complications.

1. A Clinical Evaluation of a New
Arthroscopic Biceps Tenodesis
Technique
Alan M. Hirahara, M.D., FRCS(C)
Private Practice
Sacramento, CA USA
Medical Director Team Physician Consultant
Sacramento State Athletics Sacramento River Cats Oakland A’s
MiLB - AAA

2. Objective of Study
• To evaluate the clinical effectiveness of a new
arthroscopic biceps tenodesis technique

3. Introduction
• Many studies have discussed the utility of biceps
tenodesis over tenotomy
• Most techniques are open, performed at the
proximal groove, or technically difficult
arthroscopically

4. Study Design
• Case-control study
• Collection period: 12/09 – 9/11
• Pain scores, ASES scores taken every month for 6
months
– ROM measured pre-op and monthly for 3 months post
– Date of discharge and date of return to work were noted

5. Study Design
• Inclusions:
– All patients with proximal biceps tears requiring
tenodesis or tenotomy
• Exclusions:
– any post-operative trauma
– non-compliance with physical therapy protocol

6. Patient Data
Study Group Control Group
• 14 patients • 9 patients
• 8 male / 6 female • 4 male / 5 female
• Age range: 28 – 75 years • Age range: 42 – 80 years
• Age average: 55.33 years • Age average: 61.06 years

7. Surgical Technique

8. Results
Pain Scores ASES Scores
p = NS p = 0.03 p=NS p = NS p = 0.01 p=NS p = 0.04
8.0 90.0
7.0 80.0
70.0
6.0
60.0
5.0
50.0
4.0
40.0
3.0
30.0
2.0
20.0
1.0 10.0
0.0 0.0
Pre-op 1 2 3 4 5 6 Pre-op 1 2 3 4 5 6
Month Month Month Month Month Month Month Month Month Month Month Month
 Control Group: n = 9
 Study Group: n = 14

9. Range of Motion
ROM
180
160
Control Flexion
140
Study Flexion
120
Control
Degrees
100
Abduction
80 Study Abduction
60 Control ER
40 Study ER
20
0
Initial Visit 1 Month 2 Month 3 Month
No Significant Difference Between the 2 Groups

10. Results – Return to Work
p = NS
147.5
160.0
140.0 105.8
120.0
100.0
Days
80.0
60.0
40.0
20.0
0.0
Control Group Study Group

11. Results – Days to Discharge
p = NS
127.1
128.0
126.0
124.0
122.0 118.3
Days
120.0
118.0
116.0
114.0
112.0
Control Group Study Group

12. Results: Failures
• No patients suffered pull out of the tenodesis

13. Results
• Statistical significant difference in:
– VAS pain scores at 3 months only
– ASES scores at 3, 5, & 6 months
• No statistical significance in:
– Return to work
– Time to discharge

14. Discussion: vs Proximal Fixation
• Other arthroscopic methods have performed
tenodesis at the proximal groove
– This has resulted in failures related to intra-
groove pathology
– Our technique avoids those complications

15. Discussion
• Biceps tenodesis results in:
– Significantly less pain
– Significantly higher function
– But does carry a risk of conversion to tenotomy if pull out occurs
• However, this simple arthroscopic technique is easy, reproducible
and yields outstanding results compared with tenotomy
• Will require a randomized controlled trial to confirm the results

16. Conclusion
• This new arthroscopic biceps tenodesis
technique:
– Easy
– Reproducible
– Outstanding results
– Avoids the complications of proximal fixation or open
tenodesis

17. Thank You