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Is it a must to tenotomize the biceps intraarticular origin during tenodesis? A prospective case series study of biceps tenodesis without tenotomy

Background: This study was conducted to investigate three questions; Does biceps tenodesis without tenotomy reduce short-term tenodesis failure and revision rate? Does preserved biceps origin increase the prevalence of postoperative bicipital pain and tenderness? Does this technical modification limit postoperative range of motion? Methods: Between October 2014 and December 2018, a case series of 24 patients with different isolated biceps tendon lesions were prospectively managed by arthroscopic intraarticular suture-anchor biceps tenodesis without tenotomizing the biceps intraarticular origin. Patients were evaluated for demographics and for preoperative and 2-year postoperative range of motion, University of California Los Angeles (UCLA) scoring system, return to work, persistent bicipital pain or tenderness, and Popeye sign (tenodesis failure). Results: Mean age of the group was 46.7 yr. Statistical analysis revealed highly significant postoperative improvement in UCLA score parameters (P<0.001) and in active range of motion (P<0.001). However, when compared with its sound counterpart, the operated shoulder had 12.5-degree range deficits of external rotation at 0-degree abduction. Five (20.8%) patients reported persistent or recurrent bicipital pain or tenderness; four (80%) of those five patients responded well to local steroid injection. A Popeye sign was not reported subjectively or objectively, and there was no reported tenodesis revision. Conclusions: Providing potential biological, biomechanical, and technical advantages and rendering low rates of short-term tenodesis failure and revision, this technique of modified (without-tenotomy) arthroscopic biceps tenodesis can achieve satisfactory outcomes. However, this technique could have the disadvantages of external rotational range deficits, relatively high prevalence of postoperative bicipital pain and tenderness, and technical irreproducibility in extensive biceps lesions that involve the tendon segment proposed for tenodesis. Level of Evidence: Level IV.