Clinical and biomechanical evaluation of an all-arthroscopic suprapectoral biceps tenodesis

Background: Pathology of the long head of the biceps (LHB) is a well-recognized cause of shoulder pain in the adult population and can be managed surgically with tenotomy or tenodesis. Purpose: To compare the biomechanical strength of an all-arthroscopic biceps tenodesis technique that places the LHB distal to the bicipital groove in the suprapectoral region with a more traditional mini-open subpectoral tenodesis. This study also evaluates the clinical outcomes of patients who underwent biceps tenodesis using the all-arthroscopic technique. Study Design: Controlled laboratory study and case series; Level of evidence, 4. Methods: For the biomechanical evaluation of the all-arthroscopic biceps tenodesis technique, in which the biceps tendon is secured to the suprapectoral region distal to the bicipital groove with an interference screw, 14 fresh-frozen human cadaveric shoulders (7 matched pairs) were used to compare load to failure and displacement at peak load with a traditional open subpectoral location. For the clinical evaluation, 49 consecutive patients (51 shoulders) with a mean follow-up of 2.4 years who underwent an all-arthroscopic biceps tenodesis were evaluated using the American Shoulder and Elbow Surgeons (ASES) score preoperatively and at last follow-up, as well as the University of California, Los Angeles (UCLA) Shoulder Score at last follow-up. Results: On biomechanical evaluation, there was no significant difference in peak failure load, displacement at peak load, or displacement after cyclic testing between the arthroscopic suprapectoral and mini-open subpectoral groups. In the clinical evaluation, the mean preoperative ASES score was 65.4, compared with 87.1 at last follow-up. The mean UCLA score at last follow-up was 30.2. Forty-eight (94.1%) patients reported satisfaction with the surgery. In subgroup analysis comparing patients who had a rotator cuff repair or labral repair at time of tenodesis with patients who did not have either of these procedures, there were no significant differences in UCLA or ASES scores. Conclusion: The excellent biomechanical strength as well as the high rate of satisfaction after surgery and high ASES and UCLA postoperative scores make this technique a novel option for treatment of biceps tendon pathology.