Subpectoral Biceps Tenodesis: All-Suture Anchor Onlay Technique

Abstract

Surgical management for biceps pathologies has advanced to provide stronger fixation and to be less invasive. The long head of the biceps tendon has been recognized as a common contributor to anterior shoulder pain and is often associated with other glenohumeral pathologies such as SLAP lesions, rotator cuff tears, and subacromial impingement. Both tenotomy and tenodesis have shown to be effective in ameliorating pain associated with the long head of the biceps tendon. However, decreased muscle function and cosmetic concerns are seen at higher rates after tenotomy compared with tenodesis. One option for the treatment of biceps tendon pathology includes mini-open subpectoral biceps tenodesis. Lower reoperation rates are observed after subpectoral biceps tenodesis than after suprapectoral biceps tenodesis, with thoughts that releasing the tendon from its sheath and the bicipital groove relieves the patient of most associated pain. The purpose of this Technical Note is to describe in detail our preferred operative technique for mini-open subpectoral biceps tenodesis using an onlay technique with all-suture anchor fixation.

Editorial Commentary: All-Suture Anchor for Shoulder Biceps Tenodesis Results in Excellent Outcomes

“…Currently, different kinds of techniques using all-suture anchors for subpectoral biceps tenodesis have been proposed. 5,6 Biomechanical studies also support the use of all-suture anchors for biceps tenodesis due to comparable fixation strengths compared to interference screws, 7,8 conventional suture anchors, 7 and unicortical button fixations. 9 The study "Reliable Clinical and Sonographic Outcomes of Subpectoral Biceps Tenodesis Using an All-Suture Anchor Onlay Technique" by Degenhardt, Pogorzelski, Themessl, Muench, Wechselberger, Woertler, Siebenlist, Imhoff, and Scheiderer further evaluated the clinical outcomes and structural integrity using sonography in patients treated with subpectoral biceps tenodesis using an all-suture anchor onlay technique.…”

Ultrasound-Guided Suprapectoral Tenodesis of the Long Head of the Biceps Brachii

“…Technical aspects of biceps tenodesis procedures can vary significantly based on attachment location, open versus arthroscopic visualization, and suture fixation methods. 1 , 2 , 3 , 4 Tenodesis procedures can be broadly categorized into 2 main types: suprapectoral and subpectoral. The former can be further subcategorized depending on the location of fixation with respect to the bicipital groove: above, within, or below the groove.…”

“…Numerous biceps tenodesis procedures have been described in the literature, and these procedures can vary based on the method of visualization, tenodesis location with respect to the bicipital groove and pectoralis major, and hardware. 1 , 2 , 3 , 4 Techniques that fix the long head of the biceps tendon (LHBT) at any position above the pectoralis major are typically performed arthroscopically, whereas a subpectoral tenodesis is an open or mini-open procedure. 1 , 2 , 3 , 4 For arthroscopic procedures performed in a suprapectoral manner, exposing the location in or below the groove can be challenging.…”

“… 1 , 2 , 3 , 4 Techniques that fix the long head of the biceps tendon (LHBT) at any position above the pectoralis major are typically performed arthroscopically, whereas a subpectoral tenodesis is an open or mini-open procedure. 1 , 2 , 3 , 4 For arthroscopic procedures performed in a suprapectoral manner, exposing the location in or below the groove can be challenging. The tissue layer overlying the bicipital groove (transverse humeral ligament) makes exposure of the tendon within the groove the greatest challenge using arthroscopy.…”

Arthroscopic Proximal Subpectoral Tenodesis of the Long Head of the Biceps

“…5,6 Advantages of anchor fixation in biceps tenodesis have been described by Papp et al 7 Newgeneration suture anchors, which are smaller in size and have increased pullout strength compared with other types of anchors, may be used in tenodesis treatments. 8,9 The technique also has several disadvantages, like the micromotion of the biceps during healing and delayed recovery. To overcome this disadvantage, we describe an arthroscopic technique that combines all-suture anchor fixation to bone and additional soft-tissue fixation to the proximal part of the pectoralis major tendon.…”