Feasibility of Biceps Tenotomy Using Small Needle Arthroscopy: A Cadaver Analysis

Untreated lesions of the long head of the biceps tendon are a common cause of shoulder pain and dysfunction. Although the use of in-office arthroscopy has been described for biceps tenotomy, advances have led to portable arthroscopy devices. Tenotomy was performed in 10 cadaveric shoulders (average age 62.8) with an intact elbow and distal insertion point of the biceps tendon. A biceps tendon in the bicipital groove was confirmed using ultrasound. The portable arthroscopy device was introduced through an anterior-superior portal. Tenotomies were carried out under direct visualization with a standard straight arthroscopic punch through a separate adjacent portal. Following tenotomy, a second-look was performed to identify injuries caused by the procedure. Specimens were disarticulated and examined for iatrogenic injury to cartilage and completion of tenotomy. Biceps stump lengths were measured. Tenotomies were confirmed in 9 of 10 specimens with an average residual stump of 4.23±2.08 mm (range: 0 to 6.94 mm). Stability of the labrum was confirmed post-tenotomy. No iatrogenic injuries were observed on arthroscopy. This study demonstrates the safety and efficacy of an intra-articular, minimally invasive tenotomy of the long head of the biceps in a cadaveric model using a portable arthroscopy device as a possible alternative to operating room arthroscopic tenotomy.