Visualization of the Extra‐Articular Portion of the Long Head of the Biceps Tendon During Intra‐Articular Shoulder Arthroscopy

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Abstract
Purpose: To quantify the amount of the extra‐articular long head of the biceps tendon (LHBT) seen during intra‐articular shoulder arthroscopy by pulling the tendon into the joint with a probe through an anterior portal while viewing through a standard posterior portal. Methods: Intra‐articular shoulder arthroscopy was performed on 10 forequarter cadaveric specimens. The extra‐articular portion of the LHBT was evaluated by pulling the tendon into the joint with an arthroscopic probe inserted through an anterior portal. The tendon was marked at the pulley insertion on the humerus with a vascular clip before and after the tendon was pulled into the joint. An open deltopectoral approach was performed, and the amount of extra‐articular tendon visualized was calculated as an absolute amount and in relation to nearby anatomic structures. Results: An additional 1.9 cm (range, 1.4 to 2.6 cm) of extra‐articular LHBT was viewed by pulling the tendon into the joint with an arthroscopic probe through an anterior portal during shoulder arthroscopy. This represented 30.8% of the extra‐articular portion of the tendon, 47.7% of tendon in the bicipital groove, and 76.3% of the tendon that lies under the area from the pulley insertion to the distal edge of the transverse humeral ligament. Conclusions: During intra‐articular shoulder arthroscopy, the extra‐articular portion of the LHBT is incompletely visualized by pulling the tendon into the joint with a probe placed through an anterior portal while viewing through a standard posterior portal. Clinical Relevance: An additional extra‐articular portion of the LHBT may be viewed by pulling the tendon into the joint with an arthroscopic probe during shoulder arthroscopy.

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