Editorial Commentary: Biceps Tenodesis Location May Not Matter: Go High…Go Low…Go Wherever You Want to Go!

Abstract

Tenodesis of the long head of the biceps tendon has long been a source of dialogue, discussion, debate, and dogma. In general, the shoulder literature has been exhaustive regarding various biceps tenodesis techniques and outcomes, and studies have shown positive clinical outcomes of tenodesis, regardless of location, along the proximal humerus. Fewer studies have evaluated the outcomes of revision tenodesis; however, those that have looked at this have generally found that a revision to a subpectoral tenodesis site is usually quite successful.

Outcomes of Biceps Tenodesis Variations With Concomitant Rotator Cuff Repair: A Multicenter Database Analysis

“…This is in line with previously reported findings that clinical improvement is possible regardless of fixation construct. 1,15 Improvement in the VR-12 Mental score gave a slight advantage to anchor and soft tissue suture compared with screw at 1 year. Of note, Scheibel et al 17 previously recommended bony over soft tissue fixation given greater improvement in pain/cramps, cosmetic result, and elbow flexion strength.…”

“…Additionally, the inlay technique is more likely to create a long-term stress riser because of the larger cortical hole needed and increase the risk of iatrogenic proximal humeral fracture. 1 Jackson et al 8 performed a systematic review and meta-analysis comparing onlay versus inlay tenodesis in the setting of biceps tendinopathy. Patients with concomitant RCR were included in the study; VAS for pain, Constant, and ASES scores and rates of Popeye deformity, cramping, and tenodesis failure did not differ between techniques.…”

“…5,13 Advantages of both suprapectoral and intra-articular top-of-groove fixation include that they do not require an open approach and allow for revision to subpectoral tenodesis, if required. 1 Onlay techniques approximate tendon to bone, whereas inlay techniques “dunk” tendon into a cortical bone socket. 2,6 Some studies have shown a decreased revision rate when an onlay technique is utilized.…”

“…6 Although positive clinical outcomes have been reported regardless of tenodesis methods, the optimal biceps tenodesis remains debated. 1…”

“…However, tenodesis may be performed for a range of indications from tendinopathy and pain to subluxation and mechanical symptoms based on findings from clinical examinations, imaging studies, and/or intraoperative findings. 1,18 Tenotomy is an acceptable alternative to tenodesis when the cosmetic result of a Popeye deformity is not a concern to the patient. 19 Tenodesis techniques vary.…”