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Complications and Special Considerations

Complications of the biceps tenotomy primarily involve the anticipated 21% risk of a Popeye deformity of the biceps muscle as it retracts distally. Most men may not be concerned about this deformity, but it may not be cosmetically acceptable to women or bodybuilders. Patients should be counseled on these risks if this treatment modality is elected. If this is unacceptable to the patient, a tenodesis should be performed.

Arthroscopic biceps tenotomy is otherwise a relatively safe procedure with very minor risks of infection, blood clots or neurovascular injury. The portals used for a tenotomy are the standard arthroscopy portals and the risks are comparable to diagnostic shoulder arthroscopy risks.

Pain relief is generally very good although occasionally a patient may have some residual pain or cramping with activities involving forceful elbow flexion. Risks of shoulder arthroscopy include infection, blood vessel or nerve injury, upper extremity deep venous thrombosis, neuropraxia of ulnar nerve secondary to compression of the nerve at the cubital tunnel, and brachial plexus traction injuries which are usually a result of head and neck position.

Complications associated with the BioTenodesis screw technique as described by Lo and Burkhart  include the same associated risks as tenotomy except a Popeye deformity would not be expected unless failure of fixation occurred. Prominence of the BioTenodesis screw could potentially cause impingement upon the acromion if it were not adequately seated in the bone bed.

Therefore the surgeon must advance the screwhead until it is flush with the bone surface. The tendon may not pull down into the drill hole resulting in a lax tendon or fixation of the tendon down with sutures alone. Close attention to technique will prevent this problem. Fractures could potentially occur depending on the location of screw insertion but we have not seen this complication.

Osteoporotic bone may not allow rigid fixation but the BioTenodesis screw would be expected to have better fixation than suture anchors in osteoporotic bone. If the BioTenodesis screw appears somewhat loose after insertion into osteoporotic bone, its stability may be improved by inserting a 5 mm BioCorkscrew suture anchor directly adjacent to it, thereby achieving an interference fit of the anchor against the BioTenodesis screw.

Complications associated with suture anchors carry all the standard arthroscopy risks. Additionally, failure of fixation can occur in the form of anchor pullout or suture breakage. When postoperative anchor pullout occurs an additional procedure is required to retrieve the anchor if a metallic anchor is used. Failure of fixation of the biceps tendon results in a biceps tenotomy with the potential Popeye deformity, so the surgeon should discuss this possibility with the patient.

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