Randomized Prospective Analysis of Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodesis: 1 Year Follow-up


      Surgical treatment for biceps pathology can include tenotomy or various forms of tenodesis. Techniques for tenodesis include intra-articular soft tissue fixation or osseous fixation, suprapectoral osseous fixation, and subpectoral osseous fixation. Regarding the latter two, it is unclear if there is a clinical or surgical benefit of performing an open subpectoral biceps tenodesis (OBT) versus arthroscopic suprapectoral biceps tenodesis (ABT). This randomized clinical trial assesses these two techniques.


      Patients diagnosed with biceps tendinopathy who met the inclusion criteria were randomized into the ABT or the OBT group. Prior to surgery, patients were asked a series of questions regarding their anterior shoulder pain and underwent a subsequent shoulder exam. Follow-up was completed at 3 months, 6 months, and 1 year time points, during which the shoulder exam and patient questionnaires were completed.


      A total of 38 patients were enrolled, 18 ABT and 20 OBT, with a mean age of 43.5 ± 10.5 years and a mean BMI of 28.3 ± 5.4. The surgical time for the ABT group, 17.2 ± 3.7 minutes, was significantly greater than the OBT group, 11.7 ± 6.1 (p<0.01). One patient was converted from the ABT group to the OBT group due to sheering of a severely attenuated tendon preventing an ABT. One patient in the OBT group required a revision tenodesis. No significant difference (p > 0.05) was found in strength or anterior shoulder pain. Additionally, no significant difference (p > 0.05) was found in clinical outcome scores (ASES, Constant subjective, WORC, KJOC) between the two groups.


      This randomized clinical trial suggests there is no clinical difference between the two techniques. Additionally, while the arthroscopic procedure requires more surgical time, the revision rates are not different. Besides the cosmetic concern for an additional scar, we recommend decisions to be made based on surgeon preference and experience.