Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 7, pp 961–970 | Cite as

Biceps tenodesis versus tenotomy in isolated LHB lesions: a prospective randomized clinical trial

  • Martin HufelandEmail author
  • Sabrina Wicke
  • Pablo E. Verde
  • Rüdiger Krauspe
  • Thilo Patzer
Arthroscopy and Sports Medicine



Currently there exists no clear evidence concerning the surgical treatment of LHB lesions with either tenotomy or tenodesis. The aim of the study is therefore to evaluate elbow flexion and forearm supination force as well as the biceps muscle distalization according to both techniques in isolated LHB lesions.


Consecutive patients aged 40–70 years with shoulder arthroscopies for isolated SLAP or biceps pulley lesions were prospectively randomized to arthroscopic suprapectoral intraosseous LHB tenodesis or tenotomy. Pre-, 6 and 12 months postoperatively, the SST, ASES, Constant–Murley and LHB scores were recorded. The elbow flexion force was measured in 10°/90° flexion, the supination force in neutral/pronation position. In addition, the maximum upper-arm circumference and its position relative to the radial epicondyle of the humerus were evaluated preoperatively and in follow-up.


20/22 patients (mean age 52.0 ± 8.5; range 36–63 years, 11 male) completed the follow-up. 9/20 were treated with LHB tenodesis (mean age 51.5 ± 9.5; range 37–63 years, 7 male) and 11/20 with tenotomy (mean age 52.8 ± 8.0; range 36–62 years, 4 male). The force measurements and scores showed no significant difference after 12 months. Tenodesis achieved a significant increase in force 6 months postoperatively compared to preoperatively. One tenodesis patient and three tenotomy patients showed a postoperative popeye-sign deformity.


This prospective randomized study comparing LHB tenodesis and tenotomy in isolated LHB lesions has shown no significant difference in elbow flexion and forearm supination force and clinical scores after 12 months. After LHB tenotomy, there was a non-significant trend for a higher rate of popeye-sign deformities of the upper arm and biceps muscle cramps.


Biceps SLAP lesion Biceps pulley lesion Tenodesis Tenotomy Thrower shoulder 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no competing interests. The senior author receives royalties by Arthrex, (Freiham, Germany), Smith & Nephew (Hamburg, Germany) and Lima (Hamburg, Germany) which have no influences on this study.

Research involving human and animal participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The local ethics committee approved this study (Registration Number 4647R).

Informed consent

Written consent was given by all participants.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Universitätsklinikum Düsseldorf, Klinik für OrthopädieDüsseldorfGermany
  2. 2.Heinrich-Heine-Universität Düsseldorf, Koordinierungszentrum für klinische Studien (KKS)DüsseldorfGermany
  3. 3.Schön-Klinik Düsseldorf, Fachzentrum für Schulter, Ellenbogen, Knie und SportorthopädieDüsseldorfGermany

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