Crossfire Tenotomy Versus Tenodesis: Pro-tenotomy



The biceps tendon has now been recognized as an important pain generator in the shoulder [1], and biceps pathology occurs in up to 90% of patients presenting with rotator cuff pathology [2]. Failure to treat biceps pathology can result in significant postoperative pain and disability. Further complicating this issue is the fact that biceps pathology can be easily missed in the bicipital groove and often is a “hidden lesion.” Proximal biceps tenodesis may not correct these problems. Tenotomy and tenodesis are the two mainstays of treatment for this pathology. Both techniques have proponents, but tenotomy has multiple advantages.


  1. 1.
    Duraldi XA, McClelland WB Jr. Face-Off: tenotomy versus tenodesis. Accessed
  2. 2.
    Boileau P, Baqué F, Valerio L, Ahrens P, Chuinard C, Trojani C. Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am. 2007;89(4):747–57.CrossRefGoogle Scholar
  3. 3.
    Duff SJ, Campbell PT. Patient acceptance of long head of biceps tenotomy. J Shoulder Elb Surg. 2012;21:61–5.CrossRefGoogle Scholar
  4. 4.
    Wittstein JR, Queen R, Abbey A, Toth A, Moorman CT. Isokinetic strength, endurance, and subjective outcomes after biceps tenotomy versus tenodesis. Am J Sport Med. 2011;39:857–65.CrossRefGoogle Scholar
  5. 5.
    Slenker NR, Lawson K, Ciccotti MG, Dodson CC, Cohen SB. Biceps tenotomy versus tenodesis: clinical outcomes. Arthroscopy. 2012;28:576–82.CrossRefGoogle Scholar
  6. 6.
    Gill TJ, McIrvin E, Mair SD, Hawkins RJ. Results of biceps tenotomy for treatment of pathology of the long head of the biceps brachii. J Shoulder Elb Surg. 2001;10:247–9.CrossRefGoogle Scholar
  7. 7.
    Osbahr DC, Diamond AB, Speer KP. The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis. Arthroscopy. 2002;18:483–7.CrossRefGoogle Scholar
  8. 8.
    Shank J, Singleton SB, Braun S, Kissenberth MJ, Ramappa A, Ellis H, Decker MJ, Hawkins RJ, Torry MR. A comparison of forearm supination and elbow flexion strength in patients with long head of the biceps tenotomy or tenodesis. Arthroscopy. 2011;27:9–16.CrossRefGoogle Scholar
  9. 9.
    Franceschi F, Longo UG, Ruzzini L, Papalia R, Rizzello G, Denaro V. To detach the long head of the biceps tendon after tenodesis or not: outcome analysis at the 4-year follow-up of two different techniques. Int Orthop. 2007;31:537–45.CrossRefGoogle Scholar
  10. 10.
    Friedman JL, FitzPatrick JL, Rylander LS, Bennett C, Vidal AF, McCarty EC. Biceps tenotomy versus tenodesis in active patients younger than 55 years: is there a difference in strength and outcomes? Orthop J Sports Med. 2015;3(2):1–6.Google Scholar
  11. 11.
    Frost A, Zafar MS, Maffulli N. Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii. Am J Sport Med. 2009;37:828–33.CrossRefGoogle Scholar
  12. 12.
    Gurnani N, Van Deurzen DF, Janmaat VT, Van Den Bekerom MP. Tenotomy or tenodesis for pathology of the long head of the biceps brachii: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2015.Google Scholar
  13. 13.
    Hsu AR, Ghodadra NS, Provencher CDRMT, Lewis PB, Bach BR. Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results. J Shoulder Elb Surg. 2011;20:326–32.CrossRefGoogle Scholar
  14. 14.
    Koh KH, Ahn JH, Kim SM, Yoo JC. Treatment of biceps tendon lesions in the setting of rotator cuff tears: prospective cohort study of tenotomy versus tenodesis. Am J Sports Med. 2010;38:1584–90.CrossRefGoogle Scholar
  15. 15.
    Lam F, Mok D. Treatment of the painful biceps tendon—tenotomy or tenodesis? Curr Orthopaed. 2006;20:370–5.CrossRefGoogle Scholar
  16. 16.
    Zhang Q, Zhou J, Ge H, Cheng B. Tenotomy or tenodesis for long head biceps lesions in shoulders with reparable rotator cuff tears: a prospective randomised trial. Knee Surg Sports Traumatol Arthrosc. 2015;23(2):464–9.CrossRefGoogle Scholar
  17. 17.
    Gosselin M, Brophy RH, Wright RW, Matva MJ, Smith MV. Patient preferences regarding treatment of shoulder and proximal biceps disorders. Presented AAOS 2018, New Orleans, LA.Google Scholar
  18. 18.
    Hurley E, Calvo-Gurry M, Fat DL, Mullett H. Tenodesis versus tenotomy for lesions of the long head of biceps—a systematic review and meta-analysis. Presented AAOS 2018, New Orleans, LA.Google Scholar
  19. 19.
    Kelly AM, Drakos MC, Fealy S, Taylor SA, O’Brien SJ. Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results. Am J Sports Med. 2005;33(2):208–13.CrossRefGoogle Scholar
  20. 20.
    Narvani AA, Tongel AV, Atoun E, Levy O. The “anchor shape” technique for long head of the biceps tenotomy to avoid the popeye deformity. Arth Tech. 2013;2(2):e176–0.Google Scholar
  21. 21.
    Sekiya JK, Elkousy JA, Rodosky MW. Arthroscopic biceps tenodesis using the percutaneous intra-articular transtendon technique. Arthroscopy. 2003;19(10):1137–41.CrossRefGoogle Scholar
  22. 22.
    Weber SC, Kauffman JI. Arthroscopic biceps tenodesis: experience with the Castagna technique: long-term follow-up. Arthroscopy. 2008;24(6):e9–e10.CrossRefGoogle Scholar

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© ISAKOS 2019

Authors and Affiliations

  1. 1.Department of OrthopedicsThe Johns Hopkins School of MedicineBaltimoreUSA

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