Implant-free loop tenodesis of the long head of biceps: surgical technique and functional results

Driven by the idea of providing stable fixation without an implant and, therefore, reducing the risk of complications a new implant-free tenodesis technique for the long head of biceps (LHB) tendon was introduced and published by Kerschbaum et al. in 2019. By creating a tendon loop at the tendon stump after tenotomy, the proximal tendon blocks itself from slippage through the bicipital groove when released. After publication of the surgical technique, the procedure was first tested in a biomechanical investigation comparing the new loop tenodesis to tenotomy in human adult cadaveric shoulder joints. The ultimate load of failure was significantly higher in the loop tenodesis group than in the tenotomy group. In all specimens, loop tenodesis only failed in case of complete tendon rupture distal to the loop. After these promising results, loop tenodesis was implemented into clinical practice, and a prospective cohort pilot study was conducted. The study patients reported significant improvement of the total Constant score, the LHB score, pain, and range of motion 6 months after surgical treatment. The outcome based on the Constant score and LHB score was comparable to the outcome after suprapectoral anchor tenodesis in previous trials.