Ayyappan V. Nair, D.Ortho., D.N.B.Ortho., Pramod K. Mohan, M.S.Ortho.,
Maythilisharan Rambhojan, M.S.Ortho., Sreejith Thampy J, M.S.Ortho., Pavan K. Uppaluri, M.S.Ortho., Aebel Raju, M.R.C.S., and Prince Shanavas Khan, D.Ortho., M.S.Ortho.
Arthroscopy Techniques – 2024
LINK: https://www.arthroscopytechniques.org/article/S2212-6287(24)00255-X/fulltext
Pathologies of the long head of the biceps tendon (LHBT), including tendinitis, instability, and tears, are commonly associated with SLAP lesions and shoulder pain. While both tenotomy and tenodesis are treatment options, tenodesis offers better functional and cosmetic outcomes, particularly in younger patients. The choice between suprapectoral and subpectoral tenodesis remains debated.
This article describes a reproducible technique for arthroscopic suprapectoral biceps tenodesis. With the patient in the lateral decubitus position, standard arthroscopic portals are used for diagnostic evaluation and exposure of the bicipital groove. The transverse humeral ligament is incised to identify the LHBT, followed by tissue clearance and bone bed preparation with microfracturing. A double-row anchor construct is employed: the first suture anchor placed distally, followed by a cinch suture for tendon apposition, then a second anchor for re-tensioning. This onlay fixation preserves the native length-tension relationship of the tendon, enhances tendon-to-bone healing, and minimizes risk of implant-related complications. Finally, the LHBT is transected proximal to fixation.
Compared with tenotomy and subpectoral approaches, this method reduces Popeye deformity risk, maintains physiologic tension, and avoids neurovascular risks. Although technically demanding, this suprapectoral technique provides stable fixation, good cosmetic outcomes, and cost-effective reproducibility in appropriately selected patients.