The “fishmouth” Long Head Of The Biceps Biological Tenodesis Without Implant

Aim

To describe the technical aspects and clinical outcomes of the “fishmouth” long head of the biceps

biological tenodesis without implant.

Background

Long head of the biceps (LHB) pathology often represent a cause of shoulder pain. Treatments options

are tenotomy or tenodesis. Tenotomy doesn`t involve the complications that may be related to implants.

However, it may produce a cosmetic effect of "popeye deformity" and sometimes cramps in the muscle.

Tenodesis may avoid these side effects, but technically represents a more demanding procedure that

may involve implant-complications as well as residual pain.

Methods

Prospective study (2014-2015) in patients with LHB pathology, without concomitant cuff-tear. In all

patients, a LHB “fishmouth” tenodesis was performed. This technique involves an incomplete section

(50%) of the LHB with a 45° angle, and a subsequent complete tenotomy of the LHB at its labral

insertion. A mechanism for self-tendon anchoring at the groove is achieved.

Clinical outcomes were assessed at the last follow-up visit by means of these items: bicipital groove

pain, muscle cramps, "popeye deformity" and patient satisfaction. Ultrasound control was performed 3

months after surgery.

Results

15 patients: 13 males and 2 females. Mean age 57.9 years (50-64). An acromioplasty was associated in

9 cases, and an ACJ excision in 2. Pain in the groove 0/15, Cramps: 2/15, popeye deformity: 2/15,

General satisfaction: 13/15 very satisfied, 2/15 satisfied, 0/15 dissatisfied, 0/15 very dissatisfied.

Ultrasound control was performed in all cases, and it showed that in 13/15 of the cases the LHB was in

the groove.

Conclusions

The fishmouth technique achieves a biological tenotomy-tenodesis that may significantly reduce the

risk of "popeye deformity" and muscle cramps, providing satisfactory clinical results and saving the

potential complications related to implants.