Arthroscopic Supra-pectoral Biceps Tenodesis



The long head of the biceps tendon’s (LHBT) role can range from being a vital component of shoulder biomechanics to solely a vestigial structure. Despite this controversy, the LHBT represents a frequent source of shoulder pain due to tendon degenerative changes or instability as well as residual pain after shoulder surgery [1–4].


  1. 1.
    Itoi E, An KN. Stabilizing function of the biceps in stable and unstable shoulder. J Bone Joint Surg Br. 1993;75:546–50.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Seung-Ho K, Seon-Woo K. Electromyographic activity of biceps brachii muscle in shoulder with anterior instability. Arthroscopy. 2001;17(October):864–8.Google Scholar
  3. 3.
    Richards D, Burkhart S. A biomechanical analysis of two biceps tenodesis fixation techniques. Arthroscopy. 2005;21(7):861–6.PubMedGoogle Scholar
  4. 4.
    Rodosky NW, Harner CD, Fu FH. The role of the long head of the biceps muscle and superior glenoid labrum in anterior stability of the shoulder. Am J Sports Med. 1994;22:121–30.PubMedGoogle Scholar
  5. 5.
    Bennet W. Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy: arthroscopic appearance and incidence of “hidden” rotator interval lesions. Arthroscopy. 2001;17(2):173–80.Google Scholar
  6. 6.
    Bennet W. Visualization of the anatomy of the rotator interval and bicipital sheath. Arthroscopy. 2001;1(January):107–11.Google Scholar
  7. 7.
    Bennet W. Arthroscopic bicipital sheath repair: two-year follow-up with pulley lesions. Arthroscopy. 2004;20(November):964–73.Google Scholar
  8. 8.
    Bennet W. Arthroscopic repair of isolated subscapularis tears: a prospective cohort with 2- to 4- year follow-up. Arthroscopy. 2003;19(February):131–43.Google Scholar
  9. 9.
    Bennet W. Arthroscopic repair of anterosuperior (supraspinatus/subscapularis) rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Classification of biceps subluxation/instability. Arthroscopy. 2003;19(January):21–33.Google Scholar
  10. 10.
    Mac Donald K, Bridger J, Cash C, Parkin I. Transverse humeral ligament: does it exist? Clin Anat. 2007;20(6):663–7.Google Scholar
  11. 11.
    Mariani EM, Cofield RH, Askew LJ, Li G, Chao E. Rupture of the tendon of the long head of the biceps brachii. Surgical vs non-surgical treatment. Clin Orthop Relat Res. 1998;228:233–9.Google Scholar
  12. 12.
    Shank J, Singleton S, Braun S, et al. Comparison of forearm supination and elbow flexion strength in patients with long head of the biceps tenotomy or tenodesis. Arthroscopy. 2011;27(1):9–16.PubMedGoogle Scholar
  13. 13.
    Slata M, Bailey J, Bell R, Frank R, Mc Gill K, Lin E, Kercher J, Wang V, Provencher M, Mazzocca A, Verma N, Romeo A. Effect of interference screw depth on fixation strength in biceps tenodesis. Arthroscopy. 2014;30(1):11–5.Google Scholar
  14. 14.
    Slenker N, Lawson K, Ciccotti M, Dodson C, Cohen S. Systematic review. Biceps tenotomy versus tenodesis: clinical outcomes. Arthroscopy. 2012;28(4):576–82.PubMedGoogle Scholar
  15. 15.
    Werner B, Hakan P, Hart J, Lyons M, Gilmore J, Garreett C, Carson E, Diduch D, Miller M, Brockmeier S. Biceps tenodesis is a viable option for salvage of failed SLAP repair. J Shoulder Elb Surg. 2014;13(8):e179–84.Google Scholar
  16. 16.
    Wolf R, Weichel D. Long head biceps tenotomy versus tenodesis: a cadaveric biomechanical analysis. Arthroscopy. 2005;21(February):182–5.PubMedGoogle Scholar
  17. 17.
    Jarrett CD, McClelland WB Jr, Xerogeanes JW. Minimally invasive proximal biceps tenodesis: an anatomical study for optimal placement and safe surgical technique. J Shoulder Elb Surg. 2011;20(3):477–80.Google Scholar
  18. 18.
    Lemos D, Esquivel A, Duncan D. Outlet biceps tenodesis: a new technique for treatment of biceps long head tendon injury. Arthrosc Tech. 2013;2(2):e83–8.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Lorbach O, Trennheuser C, Kohn D, Anagnostakos K. The biomechanical performance of a new forked knotless biceps tenodesis compared to a standard knotless and suture anchor tenodesis. Arthroscopy. 2013;29(10):e91–2.Google Scholar
  20. 20.
    Lutton D, Gruson K, Gladstone J, Flatow E. Where to tenodese the biceps: proximal or distal? Clin Orthop Relat Res. 2011;469(4):1050–5.PubMedGoogle Scholar
  21. 21.
    Sanders B, Lavery K, Pennington S, Warner J. Biceps tendon tenodesis: success with proximal versus distal fixation. Arthroscopy. 2008;24(6):9.Google Scholar
  22. 22.
    David T, Schildhorn JC. Arthroscopic suprapectoral tenodesis of the long head biceps: reproducing an anatomic length-tension relationship. Arthrosc Tech. 2012;1(1):e127–32.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Denard P, Dai X, Hanypsiak B, Burkhart S. Anatomy of the biceps tendon: implications for restoring physiological length-tension relation during biceps tenodesis with interference screw fixation. Arthroscopy. 2012;28(10):1352–8.PubMedGoogle Scholar
  24. 24.
    Patzer T, Rundic J, Bobrowitsch E, Olender G, Hurschler C, Shofer M. Biomechanical comparison of arthroscopically performable techniques for suprapectoral biceps tenodesis. Arthroscopy. 2011;27(8):1036–47.PubMedGoogle Scholar
  25. 25.
    Kim SH, Yoo JC. Arthroscopic biceps tenodesis using interference screw: end-tunnel technique. Arthroscopy. 2005;21(11):1405.PubMedGoogle Scholar
  26. 26.
    Koch B, Burks R. Failure of biceps tenodesis with interference screw fixation. Arthroscopy. 2012;28(5):735–40.PubMedGoogle Scholar
  27. 27.
    Snow B, Narvy S, Omid R, Atkinson R, Vangsness T. Anatomy and histology of the transverse humeral ligament. Orthopaedics. 2013;36(10):1295–8.Google Scholar
  28. 28.
    Arora A, Singh A, Koonce R. Biomechanical evaluation of a unicortical button versus interference screw for subpectoral biceps tenodesis. Arthroscopy. 2013;29(4):638–44.PubMedGoogle Scholar
  29. 29.
    Dickens J, Kilcoyne K, Tintle S, Giuliani J, Rue J. Subpectoral biceps tenodesis: an anatomic study and evaluation of at-risk structures. Arthroscopy. 2011;27(5):e 40–e41.Google Scholar
  30. 30.
    Mazzocca A, Bicos J, Santangelo S, Romeo A, Arciero R. The biomechanical evaluation of four fixation techniques for proximal biceps tenodesis. Arthroscopy. 2005;21(11):1296–306.PubMedGoogle Scholar
  31. 31.
    Scully WF, Wilson DJ, Grassbaugh JA, Branstetter JG, Marchant BG, Arrington ED. A simple surgical technique for subpectoral biceps tenodesis using a double-loaded suture anchor. Arthrosc Tech. 2013;2(2):e191–6.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Sethl P, Rajaram A, Beitzel K, Hackett T, Chowaniec D, Mazzocca A. Biomechanical performance of subpectoral biceps tenodesis: a comparison of interference screw fixation, cortical button fixation and interference screw diameter. J Shoulder Elb Surg. 2013;22(4):451–7.Google Scholar
  33. 33.
    Scheibel M, Schroder RJ, Chen J. Arthroscopic soft tissue tenodesis vs bony fixation anchor tenodesis of the long head of the biceps tendon. Am J Sports Med. 2011;39(5):1046–52.PubMedGoogle Scholar
  34. 34.
    Motley G, Speer K. An arthroscopic technique for confirming intra-articular subluxation of the long head of the biceps tendon: the ramp test. Arthroscopy. 2002;18(November-December):E46.PubMedGoogle Scholar
  35. 35.
    Nho SJ, Reiff SN, Verma NN, Slabaugh MA, Mazzocca AD, Romeo AA. Complications associated with subpectoral biceps tenodesis: low rates of incidence following surgery. J Shoulder Elb Surg. 2010;19(5):764–8.Google Scholar
  36. 36.
    Golish R, Caldwell P, Miller M, Singanamala N, Ranawat A, et al. Interference screw versus suture anchor fixation for subpectoral tenodesis of the proximal biceps tendon: a cadaveric study. Arthroscopy. 2008;24(10):1003–108.Google Scholar
  37. 37.
    Alpantaki K, McLaughlin D, Karagogeos D, Hadjipavlou A, Kontakis G. Sympathetic and sensory neural elements in the tendon of the long head of the biceps. J Bone Joint Surg Am. 2005;87(7):1580–3.PubMedGoogle Scholar
  38. 38.
    Gothelf T, Bell D, Goldberg J, Harper W, Pelletier M, Yu Y, Walsh W. Anatomic and biomechanical study of the biceps vinculum, a structure within the biceps sheath. Arthroscopy. 2009;25(5):515–21.PubMedGoogle Scholar
  39. 39.
    Soifer T, Levy H, Miller-Soifer F, Kleinbart F, Vigorita V, Bryk E. Neurohistology of the subacromial space. Arthroscopy. 1996;12(2):182–6.PubMedGoogle Scholar
  40. 40.
    Fitzpatrick M, Warren RF. The anatomy, pathology, and definitive treatment of rotator interval lesions: current concepts. Arthroscopy. 2003;19(December):70–9.PubMedGoogle Scholar
  41. 41.
    Gleason PD, Beall DP, Sanders TG, Bond J, Ly J, Holland L, Pasque C. The transverse humeral ligament: a separate anatomic structure or a continuation of the osseous attachment of the rotator cuff? Am J Sports Med. 2006;34(1):72–7.PubMedGoogle Scholar
  42. 42.
    Lo I, Burkhart S. The comma sign: an arthroscopic guide to the torn subscapularis tendon. Arthroscopy. 2003;19(3):334–7.PubMedGoogle Scholar
  43. 43.
    Favorito P, Harding W, Heidt RS Jr. Complete arthroscopic examination of the long head of the biceps tendon. Arthroscopy. 2001;17(April):430–2.PubMedGoogle Scholar
  44. 44.
    Habermeyer P, Magosch P, Pritsch M, Scheibel MT, et al. Anterosuperior impingement of the shoulder as a result of pulley lesions: a prospective arthroscopic study. J Shoulder Elb Surg. 2004;13(1):5–12.Google Scholar
  45. 45.
    Boileau P, Krishnan S, Coste JS, Walch G. Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation. Arthroscopy. 2002;18(9):1002–12.PubMedGoogle Scholar
  46. 46.
    Buchholz A, Martetschlager F, Siebenlist S, et al. Biomechanical comparison of intramedullary cortical button fixation and interference screw technique for subpectoral biceps tenodesis. Arthroscopy. 2013;29(5):845–53.PubMedGoogle Scholar
  47. 47.
    Slabaugh M, Frank R, Van Thiel G, Bell R, Wang V, Trenhaile S, Provencher M, Romeo A, Nikhil V. Biceps tenodesis with interference screw fixation: a biomechanical comparison of screw length and diameter. Arthroscopy. 2011;27(2):161–6.PubMedGoogle Scholar

Copyright information

© ISAKOS 2019

Authors and Affiliations

  1. 1.Department of OrthopaedicsInstituto Argentino de Diagnóstico y TratamientoBuenos AiresArgentina
  2. 2.Department of OrthopaedicsCentro Médico Docente La TrinidadCaracasVenezuela

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