Arthroscopic Proximal Biceps Versus Subpectoral Tenodesis: Short-Term Differences and Long-Term Follow-Up



Recent publications have suggested that proximal biceps tenodesis creates higher reoperation rates and complications related to retention of the biceps in the bicipital groove. Few studies have presented comparative data between the two techniques. Presented here is the first study contrasting the long-term outcome of arthroscopic proximal biceps tenodesis versus mini-open subpectoral repair. Ninety-two patients were followed for a mean 10.4 years in the proximal group. Fifty-three were soft tissue tenodesis, the remainder proximal suture anchor repairs. This was in contrast to 44 patients treated with mini-open subpectoral repair with mean follow-up of 6.71 years. The biceps was tenotomized arthroscopically. It was then sutured to the rotator cuff tendon using permanent sutures in the soft tissue group, and in the remainder, the suture used was from an arthroscopically placed suture anchor incorporated in the repair. In open, distal group, the bicipital groove was exposed through a subpectoral approach, and the tendon is then fixed in place using a screw and spiked washer. UCLA scores improved in the proximal group from a mean of 18.93 to a mean of 30.12 and in the distal group from 17.61 to 32.37. Following proximal tenodesis, two patients had mild deformity, but all patients rated their arms as cosmetically normal, and no patient complained of upper arm cramping. There were no complications related to the procedure in either group. Operative times were significantly shorter for proximal tenodesis (p < 0.0001), but perioperative narcotics and recovery room stays were not significantly different between the two procedures. The shorter operating times and absence of cost of an interference screw resulted in a cost savings of $1647.37 with proximal tenodesis. All patients who obtained a good result at short-term follow-up continued to maintain a good result at final follow-up. Reoperation involving conversion to distal tenodesis was not required in any proximal tenodesis patient. Arthroscopic proximal biceps tenodesis appears to be a reliable technique to manage the pathologic biceps tendon. The operative time and cost were significantly less than with a subpectoral approach, especially if interference screws were used. The subpectoral approach however did not appear to have significant increase in morbidity in short or long term. Concerns about pain related to the retention of the biceps within the bicipital groove appear unfounded even at long-term follow-up.


  1. 1.
    Froimson AJ, Oh I. Keyhole tenodesis of biceps origin at the shoulder. Clin Orthop. 1975;112:245–9.CrossRefGoogle Scholar
  2. 2.
    Hichcock HH, Bechtol CO. Painful shoulder: observations on role of tendon of long head of biceps brachii in its causation. J Bone Joint Surg Am. 1948;30:263–73.CrossRefGoogle Scholar
  3. 3.
    Sethi N, Wright R, Yamaguchi K. Disorders of the long head of the biceps tendon. J Shoulder Elb Surg. 1999;8:644–54.CrossRefGoogle Scholar
  4. 4.
    Becker DA, Cofield RH. Tenodesis of the long head of the biceps brachii for chronic bicipital tendonitis. Long term results. J Bone Joint Surg Am. 1989;71:376–81.CrossRefGoogle Scholar
  5. 5.
    Weber SC. Arthroscopic “mini-open” technique in the treatment of ruptures of the long head of the biceps. Arthroscopy. 1993;9(3):365.Google Scholar
  6. 6.
    Klepps S, Hazrati Y, Flatlow E. Arthroscopic biceps Tenodesis. Arthroscopy. 2002;18:1040–5.CrossRefGoogle Scholar
  7. 7.
    Mazzocca AD, Bicos J, Santangelo S, et al. The biomechanical evaluation of four fixation techniques for proximal biceps tenodesis. Arthroscopy. 2005;21(11):1296–306.CrossRefGoogle Scholar
  8. 8.
    Mazzocca AD, Cote MP, Arciero CL, et al. Clinical outcomes after subpectoral biceps tenodesis with an interference screw. Am J Sports Med. 2008;36(10):1922–9.CrossRefGoogle Scholar
  9. 9.
    Mazzocca AD, Rios CG, Romeo AA, et al. Subpectoral biceps tenodesis with interference screw fixation. The subpectoral portion as the optimal tenodesis site. Arthroscopy. 2005;21(7):896.CrossRefGoogle Scholar
  10. 10.
    Nho SJ, Reiff SN, Verma NN, et al. Complications associated with subpectoral biceps tenodesis: low rates of incidence following surgery. J Shoulder Elb Surg. 2010;19(5):764–8.CrossRefGoogle Scholar
  11. 11.
    Romeo AA, Mazzoca AD, Tauro JC. Arthroscopic biceps tenodesis. Arthroscopy. 2004;20(2):206–13.CrossRefGoogle Scholar
  12. 12.
    Sanders B, Lavery KP, Pennington S, et al. Clinical success of biceps tenodesis with and without release of the transverse humeral ligament. J Shoulder Elb Surg. 2012;21(1):66–71.CrossRefGoogle Scholar
  13. 13.
    Wiley WB, Meyers JF, Weber SC, et al. Arthroscopic assisted mini-open biceps tenodesis: surgical technique. Arthroscopy. 2004;20(4):444–6.CrossRefGoogle Scholar
  14. 14.
    Bicknell RT, Chuinard D, Boileau P. Arthroscopic biceps tenotomy and tenodesis of massive irreparable rotator cuff tears. Presented 26th annual meeting AANA, San Francisco, CA. 2007.Google Scholar
  15. 15.
    Cameron ML. The incidence of “popeye” deformity and muscle weakness following tenotomy for recalcitrant biceps tendonitis. Proc Am Acad Orthop Surg. 2003;442Google Scholar
  16. 16.
    Frost A, Zafar MS, Maffulli N. Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii. Am J Sports Med. 2009;37(4):828–33.CrossRefGoogle Scholar
  17. 17.
    Gill TJ, McIrvin E, Mair SD, Hawkins RJ. Results of biceps tenotomy for treatment of pathology of the long head of the biceps brachii. J Shoulder Elbow Surg. 2001;10(3):247–9.CrossRefGoogle Scholar
  18. 18.
    Slenker NR, Lawson K, Ciccotti MG, et al. Biceps tenotomy versus tenodesis: clinical outcomes. Arthroscopy. 2012;28(4):576–82.CrossRefGoogle Scholar
  19. 19.
    Castagna A, Sacchi G, D’Ortona A, Bungaro P. Rottura del capo lungo del bicipite, lesioni SLAP e conflitto superio-interno: trattamento chirurgico. G It Ort Trauma. 2002;28(Supp I):644–52.Google Scholar
  20. 20.
    Elkousy HA, Fluhme DJ, O’Connor DP, et al. Arthroscopic biceps tenodesis using the percutaneous, intra-articular trans-tendon technique: preliminary results. Orthopedics. 2005;28(11):1316–9.PubMedGoogle Scholar
  21. 21.
    Kauffman JI, Weber SC, Higgins D. Arthroscopic biceps tenodesis: experience with the Castagna technique. Proc Am Acad Orthop Surg. 2004;5:525.Google Scholar
  22. 22.
    Sekiya JK, Elkousy HA, Rodosky MW. Arthroscopic biceps tenodesis using the percutaneous intra-articular transtendon technique. Arthroscopy. 2003;19(10):1137–41.CrossRefGoogle Scholar
  23. 23.
    Brady PC, Narbona P, Adams CR, et al. Arthroscopic proximal biceps Tenodesis at the articular margin: evaluation of outcomes, complications, and revision rate. Arthroscopy. 2014.Google Scholar
  24. 24.
    Gartsman GM, Hammerman SM. Arthroscopic biceps tenodesis: operative technique. Arthroscopy. 2000;16(5):550–2.CrossRefGoogle Scholar
  25. 25.
    Scheibel M, Schroder RJ, Chen J, Bartsch M. Arthroscopic soft tissue tenodesis versus bony fixation anchor tenodesis of the long head of the biceps tendon. Am J Sports Med. 2011;39(5):1046–52.CrossRefGoogle Scholar
  26. 26.
    Gombera MM, Kahlenberg CA, Nair R, Saltzman MD, Terry MA. All-arthroscopic suprapectoral versus open subpectoral tenodesis of the long head of the biceps brachii. Presented 2015 Specialty Day, AOSSM.Google Scholar
  27. 27.
    Verma NN, Drakos M, O’Brien SJ. Arthroscopic transfer of the long head biceps to the conjoint tendon. Arthroscopy. 2005;21(6):764.CrossRefGoogle Scholar
  28. 28.
    Post M, Brenca P. Primary tendonitis of the long head of the biceps. Clin Orthop. 1989;246:117–25.Google Scholar
  29. 29.
    Werner BC, Cody CL, Holzgrefe RE, Tuman JM, Hart JM, Carson EW, Diduch DR, Miller MD, Brockmeyer DF. Arthroscopic suprapectoral and open subpectoral biceps tenodesis. Minimal 2-year clinical outcomes. Am J Sports Med. 2014;42(11):2584–90.CrossRefGoogle Scholar
  30. 30.
    Sears BW, Spencer EE, Getz CL. Humeral fracture following subpectoral biceps tenodesis in two active healthy patients. J Shoulder Elb Surg. 2011;20:e7–11.CrossRefGoogle Scholar
  31. 31.
    Rhee PC, Spinner RJ, Bishop AT, Shin AY. Iatrogenic brachial plexus injuries associated with open subpectoral biceps tenodesis: a report of 4 cases. Am J Sports Med. 2013;41(9):2048–53.CrossRefGoogle Scholar
  32. 32.
    Koch BS, Burks RT. Failure of biceps tenodesis with interference screw fixation. Arthroscopy. 2012;28(5):735–40.CrossRefGoogle Scholar
  33. 33.
    Warren RF. Lesions of the long head of the biceps tendon. Instr Course Lect. 1985;30:204–9.Google Scholar
  34. 34.
    Gregory JM, Harwood DP, Gochanour E, Sherman SL, Romeo AA. Clinical outcomes of revision biceps tenodesis. Int J Shoulder Surg. 2012;6:45–50.CrossRefGoogle Scholar
  35. 35.
    Gilmer BB, Demers AM, Guerrero D, Reid JB, Lubowitz JH, Guttman D. Arthroscopic versus open comparison of long head of biceps tendon visualization and pathology in patients requiring Tenodesis. J Arthroscopy. 2015;31(1):29–34.CrossRefGoogle Scholar
  36. 36.
    Lutton DM, Gruson KI, Harrison AK, et al. Where to tenodese the biceps: proximal or distal? Clin Orthop Relat Res. 2011;469(4):1050–5.CrossRefGoogle Scholar
  37. 37.
    Moon SC, Cho NS, Rhee YG. Analysis of “hidden lesions” of the extra-articular biceps after subpectoral biceps tenodesis. Am J Sports Med. 2014;43(1):63–8.CrossRefGoogle Scholar
  38. 38.
    Boileau P, Krishnan SG, Coste JS, et al. Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation. Arthroscopy. 2002;18(9):1002–12.CrossRefGoogle Scholar
  39. 39.
    Dickens JF, Kilcoyne K, Tintle S, Guliani J, Rue JP. Subpectoral bicep tenodesis: an anatomic study and evaluation of at risk structures. Am J Sports Med. 2012;40(10):2337–41.CrossRefGoogle Scholar
  40. 40.
    Mellano CR, Shin JJ, Mascerhanas R, Shewman E, Wang VM, Romeo AA, Verma NN Forsthe B. Subpectoral biceps tenodesis with peek interference screw. A biomechanical analysis of humerus fracture risk. Arthroscopy. 2018;34(3):806–13.CrossRefGoogle Scholar
  41. 41.
    McDonald LS, Dewing CB, Shupe PG, Provencher MT. Disorders of the proximal and distal aspects of the biceps muscle. J Bone Joint Surg Am. 2013;95:1235–45.CrossRefGoogle Scholar

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© ISAKOS 2019

Authors and Affiliations

  1. 1.Department of OrthopedicsThe Johns Hopkins School of MedicineBaltimoreUSA

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