The surgical treatment of the long head of biceps tendon and the autotenodesis phenomenon: an ultrasound and arthroscopic study

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Abstract
Background: Open or mini-invasive operative procedures are methods of choice in the treatment of the advanced degenerative process of tendinopathy of long head of biceps tendon (LHBT). Cosmetic arm deformity and fatigue are the main complaints after the surgery. Researchers have noticed that in some cases the typical cosmetic deformity is often barely noticeable and the pain is significantly reduced as it occurs after spontaneous LHBT rupture due to extremely advanced tendinopathy. Materials and methods: This study included 41 of 75 patients who underwent LHBT arthroscopy-assisted tenotomy, followed by examination conducted by means of dedicated clinical tests, ASES score and ultrasounds. The average time interval from surgery to follow-up in the cohort was 31 months, the mean outcome measured with the ASES was 87 points and the “Popeye deformity” (PD) complication was present in 15 individuals. In the group of 26 patients where the PD was absent and the arm contour was similar to that of the opposite arm, sonographic examination revealed the LHBT stump at the level of the intertubercular groove that was hyperechogenic and wider than the part under the groove. Results: Recent reports about the absence of the cosmetic deformity in the anterior area of the arm after shoulder arthroscopy are based on the autotenodesis phenomenon. Conclusions: The intra-articular part of LHBT is painlessly trapped in the bicipital groove by the surrounding soft tissues, which results in unchanged biceps muscle length; however, it is more probable to happen in patients without massive rotator cuff tears. Background: Open or mini-invasive operative procedures are methods of choice in the treatment of the advanced degenerative process of tendinopathy of long head of biceps tendon (LHBT). Cosmetic arm deformity and fatigue are the main complaints after the surgery. Researchers have noticed that in some cases the typical cosmetic deformity is often barely noticeable and the pain is significantly reduced as it occurs after spontaneous LHBT rupture due to extremely advanced tendinopathy. Materials and methods: This study included 41 of 75 patients who underwent LHBT arthroscopy-assisted tenotomy, followed by examination conducted by means of dedicated clinical tests, ASES score and ultrasounds. The average time interval from surgery to follow-up in the cohort was 31 months, the mean outcome measured with the ASES was 87 points and the “Popeye deformity” (PD) complication was present in 15 individuals. In the group of 26 patients where the PD was absent and the arm contour was similar to that of the opposite arm, sonographic examination revealed the LHBT stump at the level of the intertubercular groove that was hyperechogenic and wider than the part under the groove. Results: Recent reports about the absence of the cosmetic deformity in the anterior area of the arm after shoulder arthroscopy are based on the autotenodesis phenomenon. Conclusions: The intra-articular part of LHBT is painlessly trapped in the bicipital groove by the surrounding soft tissues, which results in unchanged biceps muscle length; however, it is more probable to happen in patients without massive rotator cuff tears.

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