Biceps Tenodesis Info Evidence Consent

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• Arthroscopic suprapectoral biceps tenodesis using standard portals aims to maximize outcomes and minimize common complications associated with biceps tenodesis [1].
• An arthroscopic suprapectoral onlay technique is described as safe, simple, and reproducible [2].
• The arthroscopic suprapectoral onlay technique reduces the risk of complications related to open subpectoral tenodesis and arthroscopic intraarticular biceps tendon fixation [2].
• Arthroscopic extra-articular suprapectoral biceps tenodesis is considered an excellent option to address biceps pathologies, especially in active patients [3].
• Arthroscopic biceps tenodesis is a safe and reliable treatment for managing intra-articular biceps tendon pathology [4].
• Revision biceps tenodesis with tibialis anterior allograft tendon augmentation is an effective surgical technique for symptomatic failed biceps tenodesis in a young active patient [5].
• A simplified proximal biceps tenodesis fixation described for double-row rotator cuff repair is simple and cost-effective, with no need for additional anchors [6].
• Suprapectoral biceps tenodesis during total shoulder arthroplasty using an onlay technique has good outcomes and low rates of overall and biceps-related complications [7].
• Patients undergoing simultaneous rotator cuff repair and biceps tenodesis demonstrate similar patient-reported and objective outcomes for both lateral-row tenodesis and in-the-groove tenodesis techniques [8].
• An in situ variation of arthroscopic suprapectoral biceps tenodesis using a double loop-and-tack knotless suture anchor provides an option for inclusion in the surgical armamentarium [9].
• A biceps tenodesis technique can be performed percutaneously using needle arthroscopy under regional anesthesia [10].
• The gripping biceps knot technique provides a safe, efficient, and effective approach to enhancing biomechanical integrity and minimizing repair failures in proximal biceps tenodesis [15].
• An all-arthroscopic suprapectoral biceps tenodesis technique utilizes a knotless unicortical locking button [17].

Anatomy & Pathophysiology

Bony Anatomy and Tendon Origin

• The long head of the biceps originates from the bicipital tubercle at the superior rim of the glenoid and along the posterior superior rim of the glenoid and labrum [33].
• 40% to 60% of the biceps tendon attaches to the supraglenoid tubercle, which is located 5 mm medial to the superior glenoid rim [25].
• The remainder of the biceps tendon attaches directly to the superior glenoid labrum [25].
• The biceps tendon is an intra-articular but extrasynovial structure within the glenohumeral joint [25].
• The size of the bicipital tubercle does not reflect the size of the biceps tendon [33].

Labral Anatomy and Variants

• The glenoid labrum consists of parallel collagen fibers that course around the circumference of the glenoid [25].
• The superior labrum inserts on the superior glenoid rim, medial to the articular cartilage margin, through a transitional zone of fibrocartilage [25].
• A normal synovial recess exists between the meniscoid or triangular superior labrum and the articular cartilage extension over the superior glenoid rim [25].
• The superior labrum is usually triangular but can have a meniscoid shape [34].
• The inner portion of the labrum is avascular, and the superior labrum is less vascular compared with the inferior and posterior labrum [34].
• Vascularity to the glenoid labrum originates from the scapular, circumflex scapular, and posterior circumflex humeral arteries via capsular or periosteal vessels [25].
• The suprascapular artery, the circumflex scapular branch of the subscapular artery, and the posterior humeral circumflex artery provide the labrum’s vascular supply [34].
• In a cohort of 73 shoulders, 3.3% had a sublabral foramen [34].
• In a cohort of 73 shoulders, 8.6% had a sublabral foramen with a cordlike middle glenohumeral ligament (Buford complex) [34].
• In a cohort of 73 shoulders, 1.5% had an absent anterosuperior labrum [34].

Biceps Tendon Vascularity and Innervation

• Vascularity of the biceps tendon is provided primarily by the ascending branch of the anterior humeral circumflex artery, which travels within the bicipital groove [25].
• An avascular zone exists at the proximal portion of the biceps tendon, close to the superior glenoid [25].
• Blood is supplied to the long head of the biceps tendon from the thoracoacromial and brachial arteries via the osteotendinous and musculotendinous junctions, respectively [34].
• A hypovascular zone found near the tendon origin at the superior glenoid attachment corresponds to where it commonly tears at the long head of the biceps pulley near the proximal groove [34].
• The long head of the biceps tendon is innervated by thinly myelinated sensory neurons [34].
• Most innervation of the long head of the biceps tendon occurs at its origin, where pathology can generate pain [34].
• Innervation of the biceps is supplied by branches of the musculocutaneous nerve (C5 and C6) [33].
• The blood supply to the biceps is derived from a single large bicipital artery from the brachial artery (35%), multiple very small arteries (40%), or a combination of the two types [33].

Bicipital Groove and Pulley Anatomy

• The biceps tendon passes through the bicipital groove, or intertubercular groove, between the greater and lesser tuberosities [25].
• Stability of the biceps within the bicipital groove is afforded by the biceps sling, or pulley [25].
• The biceps pulley consists of fibers from the subscapularis tendon, supraspinatus tendon, coracohumeral ligament, and superior glenohumeral ligament [25].
• The biceps pulley is composed of the superior glenohumeral ligament and coracohumeral ligament in combination with the subscapularis [26].
• The bicipital tendon does not move up and down in the groove; rather, the humerus moves down and up with adduction and abduction relative to the tendon [33].
• The bicipital tendon is retained within the groove by a pulley made up of fibers from the coracohumeral and superior glenohumeral ligaments, with some reinforcement from adjacent tendons [33].
• The medial wall of the bicipital groove was higher, with an opening angle of 30 to 40 degrees in the largest fraction of patients [33].
• A shallow bicipital groove and supratubercular ridge above the lesser tubercle were thought to predispose to biceps tendon pathology [33].
• The intra-articular biceps tendon is broader than that in the groove [33].

Biceps-Labral Complex Zones

• The superior glenohumeral ligament and long head of the biceps are conceptualized as a biceps-labral complex representing shared anatomic and clinical features [34].
• The biceps-labral complex is classified into three distinct zones: Inside, Junction, and Extra-articular [34].
• The Inside zone of the biceps-labral complex consists of the superior glenohumeral ligament and the long head of the biceps anchor [34].
• The Junction zone includes the intra-articular portion of the long head of the biceps, as well as the stabilizing biceps pulley [34].
• The Extra-articular zone consists of the bicipital tunnel and is further divided into three zones: zone 1 bony groove, zone 2 “No Man’s Land,” and zone 3 subpectoralis [34].
• Zone 1 and zone 2 of the bicipital tunnel contain synovial tissue, which may generate pain [34].
• Zone 2 of the bicipital tunnel cannot be visualized by arthroscopy from above or with an open approach from below the zone [34].

Pathophysiology and Instability

• SLAP tears can be caused by forceful traction to the arm, direct compression loads, and repetitive overhead throwing [27].
• Increased external rotation of the shoulder in the late cocking phase increases torsional force at the long head of the biceps root, resulting in a peel-back injury to the posterosuperior labrum [27].
• Injuries can result from repetitive contact of the posterosuperior labrum with the undersurface of the rotator cuff in the late cocking phase, known as internal impingement [27].
• SLAP tears are seen more frequently in the late cocking position, occurring because of an adaptive posterior capsular contracture [27].
• Throwing athletes demonstrate increased shoulder external rotation and decreased internal rotation in abduction, which causes posterosuperior migration of the humeral head in the late cocking phase [27].
• Increased external rotation results in greater torsional loads across the superior labrum from the more posteriorly oriented long head of the biceps tendon [27].
• The proximal long head of the biceps tendon has been recognized as a source of substantial anterior shoulder pain [27].
• Pathology of the long head of the biceps tendon includes tendinitis, tendinopathy, tears, subluxation, entrapment, delamination, and dislocation out of the bicipital groove [27].
• Because of the relatively anterior position of the bicipital groove along the humeral head combined with humeral retroversion, the tendon is exposed to medial instability [27].
• Variations of bicipital groove morphology can increase the risk of long head of the biceps tendon pathology [27].
• Isolated long head of the biceps tendon pathology frequently is associated with other shoulder pathologies, especially rotator cuff pathology [27].
• When seen in isolation, primary long head of the biceps tendinitis usually occurs in younger patients who participate in overhead activities such as volleyball and baseball [27].
• With long head of the biceps tendon instability, the patient describes a clicking or snapping with overhead motions [27].
• A subscapularis tear is associated with long head of the biceps medial instability [27].
• A supraspinatus tear is associated with posterolateral instability of the long head of the biceps [27].
• Biceps tendinitis is rarely the primary cause of shoulder pain and is usually secondarily involved as a part of an impingement syndrome or degenerative lesions of the rotator cuff [37].
• Bicipital instability is usually associated with rotator interval injury or subscapularis tendon injury, or both [37].
• The long head of the biceps anchor has some inherent physiologic motion, and overconstraint from repair can contribute to stiffness [34].
• Loss of the long head attachment is manifested mainly as loss of supination strength (20%) with a smaller loss (8%) of elbow flexion strength [33].
• In certain conditions, particularly when paralysis or rupture of the supraspinatus has occurred, the long head of the biceps is hypertrophied [33].
• The long head of the biceps can contribute to joint stability, which is increased in external rotation and decreased in internal rotation [33].

Classification

• Arthroscopic suprapectoral biceps tenodesis can be performed using standard arthroscopic portals [1].
• Arthroscopic suprapectoral biceps tenodesis can be performed using an onlay technique [2].
• Arthroscopic extra-articular suprapectoral biceps tenodesis is an option to address biceps pathologies, especially in active patients [3].
• Arthroscopic in situ biceps tenodesis can be performed using a double loop-and-tack knotless suture anchor [4].
• Revision open subpectoral biceps tenodesis with allograft tendon reconstruction is a technique for symptomatic failed biceps tenodesis [5].
• Proximal biceps tenodesis can be performed in double-row fixation of rotator cuff repair [6].
• Suprapectoral onlay biceps tenodesis can be performed during total shoulder arthroplasty using a metal button or soft-body anchor [7].
• Arthroscopic biceps tenodesis can be performed using an "in-the-groove" technique [8].
• Arthroscopic biceps tenodesis can be performed using a lateral-row technique [8].
• Arthroscopic in situ biceps tenodesis is an in situ variation of arthroscopic suprapectoral biceps tenodesis [9].
• Percutaneous biceps tenodesis can be performed using needle arthroscopy and regional anesthesia [10].
• All-arthroscopic falciform portal biceps tenodesis is a technique using suture anchor fixation [11].
• Single-portal proximal biceps tenodesis can be performed in the bicipital groove using an all-suture anchor [13].
• Suprapectoral biceps tenodesis can be performed using a knotless, onlay, all-suture anchor technique [16].
• All-arthroscopic suprapectoral biceps tenodesis can be performed using a knotless unicortical locking button technique [17].
• Arthroscopic bicortical biceps anchorage is an arthroscopic-assisted technique for subpectoral biceps tenodesis [18].
• Arthroscopic high-in-the-groove biceps tenodesis can be performed using a loop-and-tack technique [20].
• Arthroscopic inlay biceps tenodesis can be performed using a tendon-docking anchor [21].
• Cost-effective, implant-free, all-suture modified subpectoral biceps tenodesis is a described technique [29].

Clinical Presentation

• Painful long head of the biceps tendon (LHBT) tendinitis may ensue from tears about the rotator interval or with any chronic inflammatory pathology of the glenohumeral joint [46].
• Clinical tests including the O’Brien, Yergason, Speed, and direct palpation tests have limited specificity for biceps pathology [46].
• A history of radiating anterior shoulder pain may inform the examiner of pain generation from the long head of the biceps tendon when combined with clinical tests [46].
• MRI, ultrasonography, and arthroscopic examination are tools used to evaluate biceps pathology [46].
• Arthroscopic examination is limited to the intra-articular long head of the biceps tendon and the proximal groove, missing less common distal biceps groove lesions [46].
• Isolated traumatic tears of the long head of the biceps tendon are generally treated nonsurgically [46].
• Tenodesis for isolated traumatic tears is a rare exception reserved for the dominant arm of a laborer or an individual who cannot tolerate deformity [46].
• Arthroscopic tenotomy is acceptable for less physically demanding individuals who may tolerate deformity [46].
• Outcomes for arthroscopic tenotomy are generally good to excellent [46].
• Tenotomy results in cosmetic deformity (Popeye) about 30% of the time [46].
• Vigorous activity following tenotomy may result in cramping pain of the biceps muscle belly [46].
• Arthroscopic suprapectoral tenodesis may be performed for SLAP tears or in conjunction with rotator cuff repair for a patient who needs full supination strength and endurance [46].
• Open or arthroscopic-assisted subpectoral tenodesis are options if biceps groove pathology is a concern [46].
• Sutures through bone tunnels have more cyclic displacement than anchors, keyhole, screw, or button techniques [46].
• There is no evidence that substantiates one approach or fixation method over another for biceps tenodesis [46].

Investigations

Imaging Modalities

• Plain radiographs (scapular Y, AP, and axillary lateral views) are obtained to assess the glenohumeral joint for abnormalities [39].
• MRI is used to assess the long head of the biceps tendon, associated fluid, possible synovitis, bicipital groove morphology, and the presence of bony osteophytes [39].
• MRI can help identify concomitant shoulder and acromioclavicular joint pathologies [39].
• Studies have demonstrated poor correlation between MRI and arthroscopic findings regarding long head of the biceps pathology [39].
• MRI has poor to moderate sensitivity for inflammation, partial-thickness tendon tears, and tendon ruptures of the long head of the biceps [39].
• Magnetic resonance arthrography (MRA) is more specific and sensitive for long head of the biceps pathology and SLAP tears than MRI [39].
• In patients with no pathology, MRA shows the biceps tendon surrounded by contrast fluid, resembling a kidney bean [39].
• Both MRI and MRA should be performed in the sagittal oblique and axial planes because long head of the biceps subluxation and dislocation are often associated with partial-thickness and full-thickness subscapularis tendon tears [39].
• Proton density–weighted sequences with fat suppression have the greatest sensitivity for detecting tendon degeneration, although tendon caliber change is more specific [26].
• Diagnosing partial tears of the biceps tendon at the entrance to the bicipital groove can be challenging on MRI or MRA without directed effort [26].
• Biceps tendon partial tears at the groove entrance show abnormal signal intensity, but half have an associated caliber change, and evaluation in all imaging planes aids in identification of a biceps groove entrance lesion [26].
• MRA was found to have sensitivity of 82% to 89% and specificity of 87% to 98% in the evaluation of the biceps pulley [26].
• Diagnostic criteria for biceps pulley evaluation on MRA included nonvisualization or discontinuity of the superior glenohumeral ligament, medial subluxation of the biceps tendon on axial images, biceps tendinopathy, and inferior displacement on oblique sagittal images [26].
• The complex anatomy of the rotator cuff interval is best assessed with MRA because joint distension can separate the components of the rotator cuff interval [26].
• Ultrasonography is accurate and cost-effective in the diagnosis of long head of the biceps dislocation, subluxation, and rupture [39].
• Ultrasonography is not as accurate in diagnosing partial-thickness tendon tears of the long head of the biceps [39].
• The exact role of ultrasonography for the diagnosis of tendon inflammation has not been fully defined [39].

Clinical Diagnosis

• Clinical diagnosis and physical examination of a SLAP tear or symptomatic long head of the biceps tendinopathy is often challenging because the findings are similar to other pathologies within the glenohumeral joint [40].
• No single physical examination finding is completely accurate for the diagnosis of a SLAP tear [40].
• A combined physical examination approach aids in diagnosis of SLAP or long head of the biceps pathology [40].
• MRA helps diagnose long head of the biceps pathology and SLAP tears because it is more specific and more sensitive than MRI alone [40].

Treatment

Arthroscopic Techniques

• An arthroscopic suprapectoral onlay technique is described as safe, simple, reproducible, and reduces the risk of complications related to open subpectoral tenodesis and arthroscopic intraarticular biceps tendon fixation [2].
• An in situ variation of arthroscopic suprapectoral biceps tenodesis using a double loop-and-tack knotless suture anchor provides an option for the surgical armamentarium [9].
• A percutaneous biceps tenodesis technique can be performed using needle arthroscopy under regional anesthesia [10].
• An all-arthroscopic suprapectoral biceps tenodesis can be performed using suture anchor fixation via a falciform portal [11].
• In clinical scenarios involving an upper border subscapularis tear, either a soft tissue or bony technique for suprapectoral biceps tenodesis can effectively address both the subscapularis tear and a symptomatic biceps tendon [12].
• A single portal technique for proximal biceps tenodesis in the bicipital groove can be performed using an all-suture anchor [13].
• A mini-open biceps tenodesis using an onlay technique with enthesis growth augment offers a reproducible and biologically enhanced alternative that may optimize enthesis healing and reduce the risk of failure [14].
• The gripping biceps knot, an all-arthroscopic self-cinching knot, provides a safe, efficient, and effective approach to enhancing biomechanical integrity and minimizing repair failures in proximal biceps tenodesis [15].
• A variation of suprapectoral biceps tenodesis using knotless fixation in an onlay technique has been performed successfully [16].
• An all-arthroscopic suprapectoral biceps tenodesis technique can utilize a knotless unicortical locking button [17].
• An arthroscopic-assisted technique for subpectoral biceps tenodesis using bicortical anchorage underscores the need for further biomechanical and clinical evaluation [18].
• An arthroscopic high-in-the-groove biceps tenodesis using a loop-and-tack technique offers a simple, effective, and reproducible approach to treat high-in-the-groove biceps tenodesis and/or superior labral pathology [20].
• A subpectoral biceps tenodesis can be performed using an all-suture knotless anchor via standard posterior and direct anterior portals [23].
• An all-arthroscopic simple double 360° lasso loop technique for suprapectoral biceps tenodesis requires further clinical and biomechanical studies to evaluate its reliability [28].
• The BITER device can be a useful tool for both arthroscopic and open shoulder surgery during tendon extraction in biceps tenodesis [30].
• An arthroscopic double-cinch double-cerclage technique for proximal biceps tenodesis at the bicipital groove incorporates a construct of circumferential and trans-tendon suture passing [41].

Open and Mini-Open Techniques

• A simplified proximal biceps tenodesis fixation in double-row rotator cuff repair is simple and cost-effective, with no need for additional anchors [6].
• A reproducible systematic technique exists for open repair of teres major and latissimus dorsi tendon ruptures with accompanying biceps tenodesis using cortical suspensory fixation buttons [24].
• Tenodesis can be performed with a PEEK tenodesis screw, two suture anchors, or a FiberSnare [42].
• The ultimate pull-out strength of the biotenodesis screw is stronger than that of suture anchors [42].
• Long-term results are comparable whether biceps tenodesis is done arthroscopically or through a mini-open approach with a small anterior or subpectoral incision [42].
• In the absence of rotator cuff pathology, an anterior approach through the deltopectoral interval can be used to identify the long head of the biceps tendon and perform tenodesis [47].
• If a pathologic process of the rotator cuff is present with a subluxing biceps tendon, an anterosuperior approach is used to expose the deltoid and perform tenodesis [47].
• The long head of the biceps tendon can be tenodese to the humerus with interference or tenodesis screws or suture anchors during open repair [47].

Non-Operative Management

• Ultrasound-guided biceps tenotomy combined with corticosteroid injection can be an optimal option for patients who need nontraditional management for rotator cuff tears [19].

Complications

• Arthroscopic suprapectoral biceps tenodesis using standard portals aims to minimize common complications associated with biceps tenodesis [1].
• Suprapectoral biceps tenodesis performed during total shoulder arthroplasty using an onlay technique has low rates of overall and biceps-related complications [7].
• Revision biceps tenodesis with tibialis anterior allograft tendon augmentation is an effective surgical technique for the rare case of symptomatic failed biceps tenodesis [5].
• Simultaneous musculocutaneous nerve entrapment and radial nerve traction injury can occur after open subpectoral biceps tenodesis via a rope-effect mechanism [22].
• The mini-open biceps tenodesis using an onlay technique with enthesis growth augment may reduce the risk of failure [14].
• The gripping biceps knot technique minimizes repair failures in proximal biceps tenodesis [15].
• The arthroscopic suprapectoral biceps tenodesis technique below the groove carries a minimal risk for major postoperative complications [31].

Recovery

• The arthroscopic suprapectoral onlay technique is described as safe, simple, and reproducible [2].
• Arthroscopic extra-articular suprapectoral biceps tenodesis is considered an excellent option for addressing biceps pathologies, especially in active patients [3].
• The described proximal biceps tenodesis fixation in double-row rotator cuff repair is simple and cost-effective [6].
• The described proximal biceps tenodesis fixation in double-row rotator cuff repair requires no additional anchors [6].
• Suprapectoral biceps tenodesis during total shoulder arthroplasty using an onlay technique has good outcomes [7].
• Suprapectoral biceps tenodesis during total shoulder arthroplasty using an onlay technique has low rates of overall and biceps-related complications [7].
• Patients undergoing simultaneous rotator cuff repair and biceps tenodesis demonstrate similar patient-reported outcomes for lateral-row and in-the-groove tenodesis techniques [8].
• Patients undergoing simultaneous rotator cuff repair and biceps tenodesis demonstrate similar objective outcomes for lateral-row and in-the-groove tenodesis techniques [8].
• In clinical scenarios involving an upper border subscapularis tear, a soft tissue or bony technique can be employed to address both the subscapularis tear and a symptomatic biceps tendon [12].
• Mini-open biceps tenodesis using an onlay technique with enthesis growth augment offers a reproducible and biologically enhanced alternative for proximal biceps tenodesis [14].
• Mini-open biceps tenodesis using an onlay technique with enthesis growth augment may optimize enthesis healing and reduce the risk of failure [14].
• The gripping biceps knot technique provides a safe, efficient, and effective approach to enhancing biomechanical integrity in proximal biceps tenodesis [15].
• Contemporary literature suggests no clear superiority of one specific biceps tenodesis technique over others [20].
• A network meta-analysis by Hurley et al. found no significant differences in multiple outcome measures when comparing open versus arthroscopic biceps tenodesis [20].
• A systematic review by Abraham et al. found no significant difference in Constant scores between arthroscopic and open biceps tenodesis [20].
• A systematic review by Abraham et al. found no significant difference in American Shoulder and Elbow Surgeons scores between arthroscopic and open biceps tenodesis [20].
• A systematic review by Abraham et al. found no significant difference in Single Assessment Numeric Evaluation scores between arthroscopic and open biceps tenodesis [20].
• Dekker et al. found no significant differences in construct strength when comparing suprapectoral versus subpectoral fixation locations for biceps tenodesis [20].
• Dekker et al. found no significant differences in construct strength between different fixation types, including interference screws, suture anchors, and cortical buttons [20].
• Contemporary all-suture anchors appear superior to classical metal anchors with respect to fixation strength [20].
• Greater tendon migration correlates with lower patient-reported outcomes in biceps tenodesis [20].
• A unique case demonstrated simultaneous musculocutaneous nerve entrapment and radial nerve traction injury after open subpectoral biceps tenodesis via a rope-effect mechanism [22].

Key Evidence

• [L5] This technique simplifies the procedure to be performed from standard arthroscopic portals and aims to maximize outcomes and minimize common complications associated with biceps tenodesis. [1] (10.1016/j.eats.2023.04.002)
• [L5] The technique described is safe, simple, reproducible, and reduces risk of complications related to open subpectoral tenodesis and arthroscopic intraarticular biceps tendon fixation. [2] (10.1016/j.eats.2024.103123)
• [L5] We believe arthroscopic extra-articular suprapectoral biceps tenodesis is an excellent option to address biceps pathologies, especially in active patients. [3] (10.1016/j.eats.2024.102922)
• [L5] Arthroscopic biceps tenodesis is a safe and reliable treatment for managing intra-articular biceps tendon pathology. [4] (10.1016/j.eats.2024.103207)
• [L4] Revision biceps tenodesis with tibialis anterior allograft tendon augmentation is an effective surgical technique for the rare case of symptomatic failed biceps tenodesis in a young active patient. [5] (10.1016/j.eats.2021.12.029)
• [L5] The described proximal biceps tenodesis fixation is simple and cost-effective, with no need for additional anchors. [6] (10.1016/j.eats.2025.103634)
• [L3] Suprapectoral biceps tenodesis during TSA using an onlay technique has good outcomes and low rates of overall and biceps-related complications. [7] (10.5435/jaaosglobal-d-25-00369)
• [L3] Patients undergoing simultaneous RCR and BT demonstrate similar patient-reported and objective outcomes for both LR tenodesis and in-the-groove tenodesis techniques. [8] (10.1016/j.jses.2019.09.008)
• [L5] This technique provides an in situ variation of arthroscopic suprapectoral biceps tenodesis for inclusion in the surgical armamentarium. [9] (10.1016/j.eats.2023.04.014)
• [L5] The purpose of this article is to describe a biceps tenodesis technique that can be performed percutaneously using needle arthroscopy under regional anesthesia. [10] (10.1016/j.eats.2024.103414)
• [Paper] This report describes an all-arthroscopic suprapectoral biceps tenodesis using suture anchor fixation. [11] (10.1016/j.eats.2023.09.017)
• [L5] In clinical scenarios in which an upper border subscapularis tear is also to be repaired, either a soft tissue or bony technique can be employed that effectively addresses both the subscapularis tear and a symptomatic biceps tendon. [12] (10.1016/j.eats.2025.103724)
• [L5] The presented technique demonstrates a single portal technique for a proximal biceps tenodesis in the bicipital groove using an all-suture anchor. [13] (10.1016/j.eats.2021.11.023)
• [L5] This method offers a reproducible and biologically enhanced alternative for proximal biceps tenodesis that may optimize enthesis healing and reduce the risk of failure. [14] (10.1002/atn2.70167)
• [L5] This technique provides a safe, efficient, and effective approach to enhancing biomechanical integrity and minimizing repair failures in proximal biceps tenodesis. [15] (10.1016/j.eats.2025.103831)
• [L5] The authors present a variation of suprapectoral biceps tenodesis using knotless fixation in an onlay technique that has been performed successfully at their institution. [16] (10.1016/j.eats.2024.103202)
• [L5] We describe an all-arthroscopic suprapectoral biceps tenodesis technique utilizing a knotless locking button. [17] (10.1016/j.eats.2025.103498)
• [L5] These considerations underscore the need for further biomechanical and clinical evaluation. [18] (10.1002/atn2.70089)
• [L4] Ultrasound-guided biceps tenotomy combined with corticosteroid injection can be an optimal option for patients who need nontraditional management for rotator cuff tears. [19] (10.1016/j.eats.2023.09.022)
• [L5] [20] (10.1002/atn2.70105)
• [Paper] [21] (10.1016/j.eats.2024.103284)
• [L5] [22] (10.1016/j.xrrt.2026.100806)
• [L5] [23] (10.1016/j.eats.2023.02.030)
• [L5] The authors present a reproducible systematic technique for open repair of teres major and latissimus dorsi tendon ruptures with accompanying biceps tenodesis using cortical suspensory fixation buttons. [24] (10.1016/j.eats.2022.10.017)
• [L5] Further clinical and biomechanical studies are needed to evaluate the reliability of this tenodesis technique. [28] (10.1016/j.eats.2023.02.008)
• [L5] [29] (10.1016/j.eats.2023.11.001)
• [L5] The BITER can be a useful device for both arthroscopic and open shoulder surgery. [30] (10.1016/j.eats.2023.09.020)
• [L5] The technique places the bony anchor for the long head of the biceps tendon below the bicipital groove with minimal soft tissue disruption, minimal risk for major postoperative complications, and comparable biomechanical outcomes to other techniques. [31] (10.1016/j.eats.2025.103707)
• [L5] This technical note introduces an arthroscopic technique for proximal biceps tenodesis at the bicipital groove that incorporates a unique construct of circumferential and trans-tendon suture passing. [41] (10.1016/j.eats.2025.103464)

References

[1] Arthroscopic Suprapectoral Biceps Tenodesis Using Standard Portals. Arthroscopy Techniques. 2023. DOI: 10.1016/j.eats.2023.04.002

[2] Arthroscopic Suprapectoral Biceps Tenodesis Using an Onlay Technique. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103123

[3] Arthroscopic Suprapectoral Retensioning Biceps Tenodesis. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.102922

[4] Arthroscopic In Situ Biceps Tenodesis Using a Double Loop‐and‐Tack Knotless Suture Anchor. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103207

[5] Revision Open Subpectoral Biceps Tenodesis With Allograft Tendon Reconstruction for Symptomatic Failed Biceps Tenodesis. Arthroscopy Techniques. 2022. DOI: 10.1016/j.eats.2021.12.029

[6] Simplified Proximal Biceps Tenodesis in Double‐Row Fixation of Rotator Cuff Repair. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103634

[7] Suprapectoral Onlay Biceps Tenodesis With Metal Button or Soft-Body Anchor Is Safe and Effective During Total Shoulder Arthroplasty. JAAOS: Global Research and Reviews. 2026. DOI: 10.5435/jaaosglobal-d-25-00369

[8] Case-control comparison of “in-the-groove” and lateral-row arthroscopic biceps tenodesis with concomitant rotator cuff repair. JSES Open Access. 2019. DOI: 10.1016/j.jses.2019.09.008

[9] Arthroscopic In Situ Biceps Tenodesis Using a Double Loop‐and‐Tack Knotless Suture Anchor. Arthroscopy Techniques. 2023. DOI: 10.1016/j.eats.2023.04.014

[10] Percutaneous Biceps Tenodesis Using Needle Arthroscopy and Regional Anesthesia: The Infinity Technique. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2024.103414

[11] All‐Arthroscopic Falciform Portal Biceps Tenodesis. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2023.09.017

[12] Arthroscopic Suprapectoral Biceps Tenodesis Techniques: Soft‐Tissue and Bony Technique Options. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103724

[13] Single‐Portal Proximal Biceps Tenodesis Using an All‐Suture Anchor. Arthroscopy Techniques. 2022. DOI: 10.1016/j.eats.2021.11.023

[14] Mini‐Open Biceps Tenodesis Using an Onlay Technique With Enthesis Growth Augment. Arthroscopy Techniques. 2026. DOI: 10.1002/atn2.70167

[15] The Gripping Biceps Knot: All‐Arthroscopic Self‐Cinching Knot for Proximal Biceps Tenodesis. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103831

[16] Arthroscopic Suprapectoral Biceps Tenodesis: A Knotless, Onlay, All‐Suture Anchor Technique. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103202

[17] All‐Arthroscopic Suprapectoral Biceps Tenodesis With Knotless Unicortical Locking Button Technique. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103498

[18] Arthroscopic Bicortical Biceps Anchorage: An Arthroscopic‐Assisted Technique for Subpectoral Biceps Tenodesis. Arthroscopy Techniques. 2026. DOI: 10.1002/atn2.70089

[19] Nonsurgical Management of Shoulder Pain in Rotator Cuff Tears: Ultrasound‐Guided Biceps Tenotomy Combined With Corticosteroid Injection. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2023.09.022

[20] Arthroscopic High‐in‐the‐Groove Biceps Tenodesis: Loop‐and‐Tack Technique. Arthroscopy Techniques. 2026. DOI: 10.1002/atn2.70105

[21] Arthroscopic Inlay Biceps Tenodesis Using a Tendon‐Docking Anchor. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2024.103284

[22] Simultaneous musculocutaneous nerve entrapment and radial nerve traction injury after open subpectoral biceps tenodesis: a unique case demonstrating a rope-effect mechanism. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100806

[23] Subpectoral Biceps Tenodesis Using an All‐Suture Knotless Anchor. Arthroscopy Techniques. 2023. DOI: 10.1016/j.eats.2023.02.030

[24] Teres Major and Latissimus Dorsi Repair With Biceps Tenodesis Utilizing Cortical Suspensory Fixation Buttons. Arthroscopy Techniques. 2023. DOI: 10.1016/j.eats.2022.10.017

[25] Aaos Comprehensive Orthopaedic Review 3. Superior Labrum Anterior to Posterior Tears and Lesions of the Proximal Biceps Tendon > II. Anatomy.

[26] Orthopaedic Knowledge Update Sports Medicine 6. Magnetic Resonance Imaging of the Glenohumeral Joint > The Biceps Tendon and Rotator Cuff Interval.

[27] Orthopaedic Knowledge Update Sports Medicine 6. Superior Labrum and Biceps Pathology > Pathophysiology.

[28] An All‐Arthroscopic Simple Double 360° Lasso Loop Technique for Supraopectoral Biceps Tenodesis. Arthroscopy Techniques. 2023. DOI: 10.1016/j.eats.2023.02.008

[29] Cost‐Effective, Implant‐Free, All‐Suture Modified Subpectoral Biceps Tenodesis Technique. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2023.11.001

[30] One‐Step Release Technique for Tendon Extraction During Biceps Tenodesis. Arthroscopy Techniques. 2024. DOI: 10.1016/j.eats.2023.09.020

[31] Arthroscopic Suprapectoral Biceps Tenodesis Below the Groove: A Surgical Technique. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103707

[33] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > Biceps Brachii.

[34] Orthopaedic Knowledge Update Sports Medicine 6. Superior Labrum and Biceps Pathology > Anatomy.

[37] Rockwood And Matsen S The Shoulder. Developmental Anatomy of the Shoulder and Anatomy of the Glenohumeral Joint > BICEPS TENDON.

[39] Orthopaedic Knowledge Update Sports Medicine 6. Superior Labrum and Biceps Pathology > Imaging.

[40] Orthopaedic Knowledge Update Sports Medicine 6. Superior Labrum and Biceps Pathology > Summary.

[41] Arthroscopic Double‐Cinch Double‐Cerclage Technique for Proximal Biceps Tenodesis. Arthroscopy Techniques. 2025. DOI: 10.1016/j.eats.2025.103464

[42] Campbell S Operative Orthopaedics 4 Volume Set. ARTHROSCOPIC BICEPS TENODESIS: PERCUTANEOUS INTRAARTICULAR TRANSTENDON TECHNIQUE > BICEPS TENODESIS: ARTHROSCOPIC OR MINI-OPEN TECHNIQUE WITH SCREW FIXATION.

[46] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Shoulder Instability, Rotator Cuff Disorders, Muscular Ruptures, Adhesive Capsulitis, Calcific Tendinitis > Rotator Cuff Tears > Role of the Biceps Tendon.

[47] Campbell S Operative Orthopaedics 4 Volume Set. ACHILLES TENDON AUGMENTATION OF SUPERIOR PERONEAL RETINACULUM REPAIR > TREATMENT OF BICEPS BRACHII TENDON DISPLACEMENT.