Optimizing Rotator Cuff Repair with Biceps Tendon Transfer
The shoulder is one of the most intricate joints in the human body, allowing a wide range of motion crucial for daily activities and sports. However, this complexity also makes the shoulder prone to injuries, especially in the rotator cuff—a key group of muscles and tendons that stabilize the shoulder. When the rotator cuff is injured, it can significantly impact mobility and quality of life. Proximal biceps tendon transfer is an advanced surgical technique that not only repairs rotator cuff tears but also alleviates associated shoulder pain. In this post, we’ll break down this procedure and its outcomes in rotator cuff repair.
Understanding Rotator Cuff Injuries and the Role of the Biceps Tendon
Rotator cuff injuries are common, particularly among athletes and individuals engaged in repetitive overhead activities. These injuries range from inflammation and tendonitis to partial or full-thickness tears. In many cases, the long head of the biceps tendon (LHBT) is also involved, contributing to shoulder pain and dysfunction.
The LHBT runs through the shoulder joint, where it can become inflamed or damaged, often in conjunction with rotator cuff pathology. When the LHBT is involved, surgical intervention may include a procedure known as biceps tenodesis, where the tendon is reattached to a different location, or biceps tenotomy, where the tendon is simply released. However, in cases where both rotator cuff repair and biceps pathology need to be addressed, proximal biceps tendon transfer offers a strategic solution.
The Proximal Biceps Tendon Transfer Technique
Proximal biceps tendon transfer is a surgical technique used in conjunction with rotator cuff repair to address both rotator cuff tears and associated biceps tendon pathology. Instead of reattaching or releasing the LHBT, the tendon is transferred to a new anatomical location. This procedure is often performed when the biceps tendon is damaged or contributing to the patient’s pain, providing relief and improving shoulder function.
What Happens During Proximal Biceps Tendon Transfer?
Preoperative Planning: Preoperative imaging, including MRI and ultrasound, is crucial for assessing the extent of the rotator cuff tear and the condition of the biceps tendon. This helps the surgeon determine the most appropriate surgical approach.
Arthroscopic Evaluation: The procedure begins with an arthroscopic evaluation of the shoulder joint. Small incisions are made to insert a camera (arthroscope) and surgical instruments. This allows the surgeon to visualize the rotator cuff tear and assess the condition of the biceps tendon.
Rotator Cuff Repair: The rotator cuff is repaired using sutures and anchors to reattach the torn tendon to the bone. This restores the stability and function of the shoulder.
Biceps Tendon Release: If the biceps tendon is inflamed or damaged, it is released from its attachment point at the top of the shoulder joint. This step alleviates pain and prevents further damage to the tendon.
Tendon Transfer: The released biceps tendon is then transferred to a new location. Common transfer sites include the supraspinatus or subscapularis tendons, where the biceps tendon can be securely reattached. This transfer helps redistribute the forces acting on the shoulder, reducing pain and improving function.
Postoperative Care: After the procedure, the patient’s arm is immobilized in a sling to protect the repair. Physical therapy begins shortly after surgery, focusing on gentle range-of-motion exercises. Gradual strengthening exercises are introduced as the shoulder heals.
Outcomes and Benefits of Proximal Biceps Tendon Transfer
Proximal biceps tendon transfer in conjunction with rotator cuff repair has shown promising outcomes for patients with complex shoulder injuries. Here are some key benefits and outcomes associated with this technique:
Pain Relief: Patients often experience significant pain relief following the procedure, particularly in cases where the biceps tendon was a major source of discomfort.
Improved Shoulder Function: By repairing the rotator cuff and addressing the biceps tendon pathology, this procedure restores shoulder function, allowing patients to return to their daily activities and sports.
Reduced Risk of Re-injury: The tendon transfer helps redistribute forces across the shoulder joint, reducing the risk of re-injury and improving the durability of the repair.
Enhanced Quality of Life: Patients report improved quality of life, with increased shoulder stability, strength, and range of motion following the procedure.
Favorable Long-Term Outcomes: Long-term studies indicate that patients who undergo proximal biceps tendon transfer experience sustained improvements in shoulder function and pain relief, with low rates of complications or the need for revision surgery.
Potential Complications:
- While all surgeries carry some risks, such as infection or stiffness, these are rare and can be effectively managed with careful surgical technique and diligent postoperative care.
- There is low risk for loss of biceps contour. This complication does not affect shoulder function, but increases the chance of biceps cramping. This complication is a risk for all surgeries performed on the tendon of the long head of the biceps.
- Additionally, some patients might experience mild cramping in the biceps muscle after surgery, but this usually subsides over time.
Proximal biceps tendon transfer is a valuable surgical technique that enhances the outcomes of rotator cuff repair by addressing both rotator cuff tears and biceps tendon pathology. This approach not only relieves pain but also restores shoulder function, helping patients regain their active lifestyles.
If shoulder pain or a rotator cuff injury is affecting your quality of life, don’t wait. Schedule a consultation with one of Rothman’s orthopedic experts today to explore how proximal biceps tendon transfer can help you reclaim your strength, mobility, and active lifestyle. We're dedicated to supporting you every step of the way on your journey to recovery.
