This document provides information about a new arthroscopic biceps tenodesis technique. It summarizes a study comparing 14 patients who underwent the new technique to 9 patients who had a biceps tenotomy. The new technique resulted in significantly less pain and higher function scores at various points as measured by questionnaires, though it carries a small risk of needing to be converted to a tenotomy if the fixation pulls out. The technique was found to be easy to perform and yielded better outcomes than tenotomy while avoiding complications of proximal fixation methods.

1. Biceps: Below the Groove
Alan M. Hirahara, M.D., FRCS(C)
Board Certified in Orthopaedic Surgery & Orthopaedic Sports Medicine
Specializing in arthroscopic shoulder surgery
Medical Director Team Physician Consultant
Sacramento State Athletics Sacramento River Cats Oakland A’s
MiLB - AAA

2. Proximal Fixation
• Potential failures
– Intra-groove pathology
– Poor fixation in proximal humerus
– Technically challenging

3. Localization of Biceps/Notch

4. A Clinical Evaluation of a New
Arthroscopic Biceps Tenodesis
Technique
Alan M Hirahara, MD, FRCSC
*Presented @ AANA, WOA, & COA 2012

5. Study Design
• Case-control study design
• 14 patients with Biceps Tenodesis / 9 patients with Tenotomy
• 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 noted

6. Surgical Technique

7. 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

8. Results
• No pull-outs of tenodesis
• 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

9. Conclusion
• 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
• Avoids complications associated with proximal fixation

10. Fork Technique

11. Thank You!