Arthroscopic Biceps Tenodesis Outcomes: A Comparison of Inlay and Onlay Techniques

Abstract

Background: Arthroscopic biceps tenodesis (ABT) high in the groove can be achieved using an inlay or an onlay technique. However, there is little information comparing outcomes between the 2. Purpose: To compare postoperative healing and functional outcomes of ABT high in the groove performed using either an onlay or an inlay technique. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was performed on patients undergoing ABT at the articular margin (high in the groove) at a single center over a 2-year period. An inlay technique using an interference screw was performed during the first year, followed by an onlay technique using a knotless suture anchor during the second. Tendon healing, elbow flexion strength, functional outcome, and complications were evaluated at a postoperative minimum of 1 year. Results: A total of 37 patients with inlay and 53 with onlay ABTs were available for follow-up. There was no difference in range of motion, functional outcome scores, or elbow flexion strength between the groups. A postoperative popeye deformity was noted in 27% of patients in the inlay group as compared with 9.4% of the onlay group ( P = .028). Four patients (10.8%) in the inlay group required revision surgery (2 of which were biceps tenodesis related) as compared with 0% in the onlay group ( P = .015). Conclusion: An onlay technique using a knotless suture anchor for ABT at the top of the articular margin is an acceptable alternative to an inlay technique using an interference screw. The onlay technique was associated with lower rates of postoperative popeye deformity and revision surgery as compared with the inlay technique.

Onlay Versus Inlay Biceps Tenodesis for Long Head of Biceps Tendinopathy: A Systematic Review and Meta-analysis

“…Regardless of whether the biceps tenodesis was done using an onlay or inlay technique, both methods report improved outcomes, with few complications. 2,13,14,25,26 Although this analysis showed no statistical difference in Popeye deformities between the two techniques, a recent study of 37 patients reported an increased number of deformities with the inlay technique (27%) when compared with the onlay technique (9.4%). 2 These findings were greater than the findings within this analysis in which 11.28% of inlay patients and 7.80% of onlay patients reported Popeye deformities, which were not statistically significant.…”

The high resistance loop (H-loop) technique used for all-inside arthroscopic knotless suprapectoral biceps tenodesis: A case series

“…However, in the torsion test, implant-related fractures occurred in only 29% of the suture anchor tenodesis structures versus 170% of the interference screw tenodesis structures ( 25 ). In clinical practice, the interference screw bone tunnel tenodesis technique has been confirmed to have a higher incidence rate of postoperative cosmetic deformities and revision surgery as compared with the all-suture anchor bone surface tenodesis technique ( 26 ). Therefore, the suture anchor bone surface tenodesis technique was proposed as a reasonable option to reduce these risks.…”

“…Numerous types of tenodesis techniques can be used to treat LHBT pathology, such as suture anchor, interference screw, and cortical button ( 22 – 24 ). Biomechanics studies have evaluated these different tenodesis techniques and showed slight differences; but there was no difference in clinical outcomes ( 6 , 25 , 26 ). Therefore, using a relatively simple and safe fixation method is the best choice for tenodesis.…”

Failure and Complication Rates in Common Sports and Arthroscopic Procedures: Reality Check

“…7 Overall revision rates remain low between 0% to 5.4%. 7 The overall complication rate after biceps tenodesis is 2.9%, and the most common complications after biceps tenodesis are stiffness in 0.9% of patients and superficial infection in 0.4% of patients. 6 Additional complications are less common but more serious because of their devastating nature.…”

“…31 Arthroscopic failure rates are between 0% and 21% for interference screw and 0% and 5.8% for onlay technique with suture anchor. 5,7,31 Compared with intact biceps tenodesis, those that failed demonstrated no difference in bicipital pain, tenderness, muscle cramping, or elbow strength but had significantly higher rates of Popeye deformity. 5 Because of difficulty with tensioning or failure, Popeye deformity was noted in up to 27% of inlay techniques and 9.4% of onlay techniques.…”