Relevant Anatomic Landmarks and Measurements for Biceps Tenodesis

Abstract

Background: Biceps tenodesis around the pectoralis major insertion may alter resting tension on the biceps, leading to unfavorable clinical outcomes. Hypothesis: The anatomic relationship between the musculotendinous junction (MTJ) of the biceps and the pectoralis major tendon will provide guidelines for anatomic location to perform biceps tenodesis with the goal of re-establishing biceps tension. Study Design: Descriptive laboratory study. Methods: Cadaveric dissections were performed that reflected the pectoralis major tendon and exposed the long head of the biceps tendon (LHBT). Calipers were used to measure the longitudinal width of the pectoralis major tendon at the humerus, 2 cm away from the humerus, and at its proximal expansion on the humerus. The distance from the proximal extent of the pectoralis major tendon footprint to the beginning of the MTJ of the biceps and the length of the MTJ of the biceps were recorded. The location of the distal end of the MTJ of the biceps relevant to the inferior border of the pectoralis major tendon was calculated. Results: The average longitudinal width of the pectoralis major tendon at its humeral insertion was 76.8 mm, the width 2 cm away from the humerus averaged 37.3 mm, and the proximal expansion averaged 13.3 mm. The MTJ of the biceps began an average of 32.4 mm distal from the proximal aspect of the pectoralis major footprint and extended for an average of 78.1 mm. The MTJ of the LHBT was calculated to extend 3.3 cm distal to the inferior border of the pectoralis major footprint. Conclusion: The MTJ of the biceps begins further proximal than may be appreciated intraoperatively. Knowledge of the anatomic relationships between the LHBT, its MTJ, and the pectoralis major tendon provides helpful guidelines for the biceps tenodesis site. The final resting spot of the most distal aspect of the MTJ of the LHBT after tenodesis should be approximately 3 cm distal to the inferior edge of the pectoralis major tendon footprint on the humerus.