How we do a biceps tenodesis with shoulder arthroplasty?

We stive to maintain the long head of the biceps tendon in performing shoulder arthroplasty unless it is frayed or unstable. While contrary to the opinion of some, we do not find that the biceps becomes a 'pain generator' after arthroplasty.
However, if the biceps is unstable or frayed, a tenodesis can easily be performed using what we call the 'in and out' technique.
In this technique, we transect the biceps at its insertion to the supraglenoid tubercle,  make a 8 mm hole in the strong bone of the biceps groove 10 cm below the humeral neck cut. The proximal end of the long head tendon is threaded through this hole and then brought out the neck cut. When the humeral component is driven into position, it robustly fixes the long head tendon so that no modification of the post operative rehabilitation is necessary.

Here's a photo from yesterday's OR. The patient had inflammatory arthritis with biceps tendon involvement. The lower blue arrow points to the hole in the bicipital groove with the tendon entering it. The upper blue arrow points to the tendon (with a single traction suture in it) exiting the medullary space where it will be fixed when the prosthesis is seated. The other six sutures have been placed for repair of the subscapularis.

And a diagram from Steve Lippitt

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Biceps tenodesis in the setting of rotator cuff repair - does it make a difference?

Clinical and radiologic results of arthroscopic biceps tenodesis with suture anchor in the setting of rotator cuff tear

These authors wanted to find the  clinical and radiologic results of arthroscopic biceps tenodesis in 84 patients having rotator cuff repair. The description of the management of the rotator cuff tear is sparse: "The residual biceps tendon was cut from a site just proximal to the sutures, and the remaining stump was excised at an attachment site to the superior labrum. Afterward, the rotator cuff and combined lesion were addressed." The anatomic outcome of the cuff surgery was not described even though 60 patients had post op MRI's.

Clinical measures were improved after surgery. Eleven patients had popeye deformity, indicating failure of the tenodesis, yet the presence of this deformity did not correlate with poorer clinical scores. postoperative magnetic resonance imagine analysis, 15 patients (25%) showed distal migration of tenodesed biceps tendon, although only 6 (7.1%) had clinical popeye. 

While the authors concluded that "arthroscopic biceps tenodesis with 1 suture anchor resulted in good clinical outcomes at 2 years postoperatively", the data presented do not show a relationship between the clinical outcome and the success of the tenodesis. The data presented do not suggest any advantage of tenodesis over tenotomy and do not distinguish the relative roles of the biceps surgery and the cuff surgery in determining the clinical result.

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