Arthroscopic Proximal Biceps versus Subpectoral tenodesis: 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 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.


      Eighty-three patients were followed for mean 10.4 years in the proximal group. This was in contrast to 44 patients treated mini-open 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 34 patients and in 49 patients, the suture used was from an arthroscopically placed suture anchor. In the second, 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 18.8 to a mean of 31.2. Following tenodesis, only one patient developed a cosmetic deformity and no patient complained of upper arm cramping. There were no complications related to the procedure. All patients who obtained a good result at short-term follow-up continued to maintain a good result at final follow-up. Reoperation involving distal tenodesis was not required in any patient. No complications occurred in the subpectoral group. All patients rated their arms as cosmetically normal. All procedures were done outpatient as well. Postoperative UCLA scores averaged 32.37.


      Arthroscopic proximal biceps tenodesis appears to be a reliable technique to manage the pathologic biceps tendon. The ease and low morbidity compares favorably with a subpectoral approach. The subpectoral approach however did not appear to have significant increase in morbidity. Concerns about pain related to the retention of the biceps within the bicipital groove appear unfounded even at long-term follow-up.