Biceps tenodesis to the coracoid tip: results after a very long follow-up period.

Aims: Shoulders of patients who underwent long head biceps tenodesis to the coracoid tip (Gilcreest technique), consequently to atraumatic rupture, have been evaluated after a very long follow-up period in order to verify technique validity and natural history of the humeral head deprived of one of its depressor. Methods: During the years 1969-1981, 14 patients were submitted, in our Institute, to Gllcreest tenodesis. At the operation, the cuff was healthy. The mean age of the patients (all males) was 32 (range 20-48 yrs). Right shouider was involved in 9 cases. Three patients were professional gymnasts. All but one have been traced for a clinical and MRI assessment. Results: At the follow-up (average: 25 years), the mean Constant score was 82 (range 44-94). In 11 cases, comprehending the athletes, it was >86. Out of the other two, both have clinical evidence of rotator cuff tear (Constant score 44 and 70, respectively). The two patients, aged at the present 71 and 66, have been engaging in manual jobs. MRI shows a large rotator cuff tear only in the two patients with clinical evidence of tear. No patients had appreciable decrease in elbow flexion and supination strength. All the athletes have begun the activity at the previous level, changing in two cases the sequence of the exercises. At the present, all patients have occasionally mild shoulder pain, except the two with cuff tear who have continuous and severe pain. Conclusion: Even after 25 years, functional outcomes in patients submitted to Gllcreest surgical technique are satisfactory. Only two patients, the oldest of our series and both manual workers, developed an impingement syndrome and a rotator cuff tear. This reduces the rule of biceps tendon as depressor of the humeral head.