Double on-lay fixation using all suture-type anchor for subpectoral biceps tenodesis has favorable functional outcomes and leads to less cosmetic deformities than single on-lay fixation

  • Sung-Min Rhee
  • Ho Yeon Jeong
  • Kyunghan Ro
  • Samyak Pancholi
  • Yong Girl RheeEmail author



This study aimed to compare the clinical outcomes between single on-lay and double on-lay subpectoral biceps tenodesis (SPBT) using all-suture type anchor in patients with concomitant long head of the biceps tendon (LHBT) lesions and rotator cuff tears.


The study included 130 patients who underwent SPBT using all-suture type anchor and arthroscopic rotator cuff repair. Single and double anchor on-lay fixations were performed in 69 patients (group A) and 61 patients (group B), respectively. In 16 patients of group A and 36 patients of group B, a metallic wire was embedded at tenodesis site and difference of wire location pre-and postoperatively was measured using simple radiography.


In both groups, the mean visual analogue scale (VAS) score during motion, the mean UCLA and constant scores significantly improved at the last follow-up (all p < 0.001). These scores were not significantly different between two groups. However, postoperatively, a significant difference was observed in the incidence of cosmetic deformity between two groups (p = 0.019). The cosmetic deformity was noted in 9 (13.0%) patients (Popeye deformity 7.2% and biceps softening 5.8%) in group A and 1 (1.6%) patient (Popeye deformity) in group B. In the subgroup analysis on biceps migration after the surgery, the mean migration distance of metal wire was 2.5 ± 3.0 mm in group A and 1.9 ± 2.6 mm in group B (n.s.). No patient had migration of > 10 mm.


SPBT using all-suture type anchor was a favorable treatment option for lesions of the LHBT with rotator cuff tear. The clinical relevance of this study is the finding that double on-lay fixation with all-suture type anchor would result less cosmetic deformity than the single on-lay fixation for those who need subpectoral biceps tenodesis.

Level of evidence



Shoulder Biceps tendon Tenodesis Subpectoral tenodesis All-suture anchor Double on-lay 



This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We understand that the Corresponding Author is the sole contact for the Editorial process. He is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Yong Girl Rhee.

Ethical approval

The Institutional Review Board approved an exemption for this study due to its retrospective design (IRB No.: KHUH 2018–01-058, Kyung-Hee University Hospital Institutional Review Board).

Informed consent

For this type of study formal consent is not required.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of MedicineKyung Hee UniversitySeoulRepublic of Korea
  2. 2.Department of Orthopaedic SurgeryH Plus Yangji HospitalSeoulRepublic of Korea

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