Long Head of Biceps Tendon Pathology and Results of Tenotomy in Full-Thickness Reparable Rotator Cuff Tear

Arthroscopy. 2017 Nov;33(11):1971-1976. doi: 10.1016/j.arthro.2017.06.018. Epub 2017 Aug 26.


Purpose: To document the incidence of long head of the biceps tendon (LHBT) pathology in full-thickness reparable rotator cuff tears and report the clinical results of arthroscopic LHBT tenotomy combined with rotator cuff repair.

Methods: Between January 2012 and January 2014, 141 shoulders with full-thickness rotator cuff tears that had undergone arthroscopic repair were included for the analysis. The LHBT was thoroughly examined during arthroscopy, and tenotomy was performed in all patients with a pathologic LHBT. Shoulder range of movement and the Constant score were recorded at an average follow-up of 2.2 years (range, 24-40 months).

Results: The overall incidence of LHBT pathology was 36.1% (51 of 141 shoulders). The increase in LHBT pathology with the increase in the size of the rotator cuff tear was statistically significant (P = .001). Tears involving the subscapularis had a statistically significantly higher incidence of LHBT pathology (P = .001). The duration of the rotator cuff tear showed no statistical significance regarding the incidence of LHBT pathology (P = .598). Of 141 patients with full-thickness rotator cuff tears, 89 had tears due to trauma and 52 had atraumatic tears. The difference in the incidence of LHBT pathology between the traumatic and atraumatic groups was not statistically significant (P = .412). The average Constant score in the patients who had undergone LHBT tenotomy was 82 (range, 70-90), and in those with normal tendons, it was 84 (range, 72-92). The difference was not statistically significant (P = .423).

Conclusions: About one-third of patients with full-thickness reparable rotator cuff tears are likely to have LHBT pathology. Large and massive rotator cuff tears and tears involving the subscapularis are more likely to have LHBT pathology. Tenotomy of the pathologic LHBT as an adjunct to rotator cuff repair produces satisfactory results.

Level of evidence: Level IV, therapeutic case series.

MeSH terms

  • Adult
  • Aged
  • Arthroscopy / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Muscle, Skeletal / surgery
  • Rotator Cuff / surgery
  • Rotator Cuff Injuries / surgery*
  • Shoulder Joint / surgery
  • Tendon Injuries / pathology
  • Tendon Injuries / surgery
  • Tendons / pathology
  • Tendons / surgery
  • Tenotomy / methods*