Arthroscopic transfer of the long head of the biceps tendon: Functional outcome and clinical results

Purpose: We sought to evaluate clinical and functional outcome in a cohort of patients who underwent transfer of the long head of the biceps tendon (LHBT). Methods: Patients who were diagnosed with biceps pathology or instability underwent an arthroscopic assisted or all arthroscopic transfer LHBT as either an isolated procedure or part of another shoulder procedure by the senior author. The procedure was performed using a new arthroscopic subdeltoid technique. Forty shoulders in 39 patients were examined at a minimum of 2 years. Patients underwent complete shoulder evaluation and clinical outcomes were scored based on American Society of Shoulder and Elbow Surgeons (ASES), University of California at Los Angeles (UCLA), and L'Insalata questionnaires. Ipsilateral and contralateral metrics were also evaluated. Results: Forty shoulders (13 female, 26 male, 1 bilateral; average age, 38.5 years) were evaluated with L'Insalata, UCLA, and ASES questionnaires, scoring 75.57, 27.32, and 78.72, respectively. In the 25 patients who had an isolated LHBT transfer, the L'Insalata, UCLA, and ASES scores were 85.2, 29.5, and 84.8, respectively. Three patients had early traumatic failure related to noncompliance with postoperative rehabilitation protocol. This included the only 2 patients who had a Popeye sign at follow-up during active elbow flexion. There was not a statistically significant side-to-side strength difference using a 10-pound weight. Eighty percent of patients were self-rated as good to excellent, and 20% of patients were self-graded as fair or poor, which includes the 3 failures mentioned above. All of the patients reported no arm pain at rest with regard to the biceps. Ninety-five percent of patients reported no biceps tenderness upon palpation of the bicipital groove. Five patients complained of fatigue discomfort (soreness) isolated to the biceps muscle following resisted elbow flexion. Conclusions: Arthroscopic subdeltoid transfer of the LHBT is an appropriate and reliable intervention for active patients with chronic, refractory biceps pathology. There was no loss of strength for biceps curls. All patients reported no pain isolated to biceps muscle at rest. Ninety-five percent of patients had resolution of their preoperative biceps symptoms. Level of Evidence: Level IV, therapeutic case series.