Editorial Commentary: Aim High or Go Low? Outcomes Are Equivalent for Arthroscopic Suprapectoral and Mini-open Subpectoral Biceps Tenodesis

Abstract

The contemporary management of biceps-labral pathology has increasingly transitioned toward primary treatment of the long head of the biceps tendon, largely in response to more consistent outcomes relative to SLAP repair and so-called benign neglect. Accordingly, there has been renewed interest in evaluating relevant differences between varying operative techniques and constructs for biceps tenodesis, including an array of subacromial, intra-articular, suprapectoral, and subpectoral methods. Among these, arthroscopic suprapectoral tenodesis and mini-open subpectoral tenodesis remain in contention for "best in show," albeit with distinctly different merits and risks. Important considerations with either technique include restoration of the native length-tension relation, avoidance of perioperative complications, surgical-site morbidity, and technical ease. Dogma aside, surgeons facile with both techniques can confidently counsel their patients on the comparable short-term results after suprapectoral or subpectoral biceps tenodesis.

Subpectoral, Suprapectoral, and Top-of-Groove Biceps Tenodesis Procedures Lead to Similar Good Clinical Outcomes: Comparison of Biceps Tenodesis Procedures

“…Proponents of each technique tout its distinctly different merits and disadvantages. 19 The open subpectoral technique is a simple, technically easy, reproducible muscle-sparing procedure with an extremely low complication rate, with a reported rate of 2% in the literature. 20 , 21 It is easy to maintain the biceps muscle length-tension relation, and this technique is not dependent on proximal tendon quality to achieve stable fixation.…”

“… 4 , 8 , 10 , 11 , 12 Advocates of arthroscopic techniques suggest high patient satisfaction, lower wound-healing complication rates especially owing to Propionibacterium acnes infection, and avoidance of iatrogenic injuries attendant to open surgery including rare nerve injuries to the musculocutaneous nerve. 12 , 18 , 19 , 21 , 26 , 27 , 28 , 29 , 30 Because the fixation is in cancellous metaphyseal bone, there are fewer intraoperative and postoperative fractures by avoiding placing a hole in the diaphyseal bone, creating a potential stress riser. 31 …”