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Biceps Tenodesis

Biceps tenodesis and tenotomy — when, where (suprapectoral vs subpectoral) and what to expect afterwards.

122 citationsUpdated Oct 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Biceps tenodesis serves as a definitive surgical option for long head of biceps tendon pathology and superior labrum anterior and posterior (SLAP) lesions, particularly when nonoperative management fails [18]. The procedure is indicated for symptomatic SLAP tears in middle-aged patients, where it demonstrates increased effectiveness and lower costs compared to primary SLAP repair [12]. It also offers a viable alternative to SLAP repair in young patients when specifically indicated [6]. While outcomes vary based on treatment method, associated pathology, and patient characteristics [3], biceps tenodesis has gained popularity due to encouraging functional outcomes and return-to-sport rates [18]. In patients aged 35 years and younger, the procedure yields excellent clinical outcome scores [10], though reported return-to-sport rates show wide variability [10]. For those under 25 years of age, two-thirds of patients return to sport with a low revision rate [2].

Clinically significant outcomes are typically attained by 13 months postoperatively, with most patients achieving these results between 5 and 8 months [8]. Survivorship remains high at two years, with significant clinical improvement observed [1]. Complication rates are generally low; both tenotomy and open tenodesis present safe options with low 30-day postoperative complication rates [9]. In the setting of rotator cuff repair, both open and arthroscopic techniques show low complication rates [74]. However, biceps tenodesis has proven more successful than tenotomy in non-isolated cuff tears [63].

The choice between biceps tenodesis, tenotomy, and SLAP repair is ultimately an individual decision made with the patient [53]. High-quality randomized controlled trials have largely demonstrated statistical noninferiority of clinical outcomes between tenotomy and tenodesis [38], and both procedures result in comparable postoperative clinical and functional outcomes [36]. Consequently, the decision can be based on surgeon and patient preference in active patients younger than 55 years [28], as patient age should not be the sole criterion [57]. While tenotomy offers faster recovery and less narcotic use [133], tenodesis carries a lower risk of Popeye deformity [133]. There remains a lack of consensus on superior clinical outcomes between the two in isolated biceps disease [133].

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 [43]. Approximately 40% to 60% of the biceps tendon attaches to the supraglenoid tubercle, which is located 5 mm medial to the superior glenoid rim, while the remainder of the fibers attach directly to the superior glenoid labrum [41]. The biceps tendon is an intra-articular but extrasynovial structure within the glenohumeral joint [41]. The size of the bicipital tubercle does not reflect the size of the biceps tendon [43]. The intra-articular portion of the biceps tendon is broader than the portion within the bicipital groove [43].

The long head of the biceps exits the shoulder through a defect in the capsule between the greater and lesser tuberosities [43]. It passes distally in the bicipital groove, or intertubercular groove, between the greater and lesser tuberosities [41]. A shallow bicipital groove may predispose the long head of the biceps to impingement and subsequent tendon pathology [43]. The medial wall of the bicipital groove is higher, with an opening angle of 30 to 40 degrees in the largest fraction of patients [43].

Labral Anatomy and Attachment Variants

The glenoid labrum consists of parallel collagen fibers that course around the circumference of the glenoid [41]. The superior labrum inserts on the superior glenoid rim, medial to the articular cartilage margin, through a transitional zone of fibrocartilage [41]. A normal synovial recess exists between the meniscoid or triangular superior labrum and the articular cartilage extension over the superior glenoid rim [41].

The biceps tendon typically attaches entirely (type I) or predominantly posterior (type II) on the superior labrum [41]. The labral attachment may have equal anterior and posterior contributions (type III) or, less commonly, predominantly anterior (type IV) [41]. In most cases, the long head of the biceps has a posterior-dominant or entirely posterior labral insertion [44]. The long head of the biceps anchor has some inherent physiologic motion, and overconstraint from repair can contribute to stiffness [44].

Anatomic variants in the superior labrum include a sublabral foramen or absence of the superior labrum, often seen together with a cordlike middle glenohumeral ligament [44]. In a cohort of 73 shoulders, 3.3% had a sublabral foramen, 8.6% had a sublabral foramen with a cordlike middle glenohumeral ligament (Buford complex), and 1.5% had an absent anterosuperior labrum [44]. Surgical repair of unrecognized anatomic variants such as the Buford complex can result in loss of external shoulder rotation [44].

Vascularity and Innervation

Vascularity to the glenoid labrum originates from the scapular, circumflex scapular, and posterior circumflex humeral arteries via capsular or periosteal vessels [41]. The inner portion of the labrum is avascular, and the superior labrum is less vascular compared with the inferior and posterior labrum [44]. Vascularity of the biceps tendon is provided primarily by the ascending branch of the anterior humeral circumflex artery, which travels within the bicipital groove [41]. An avascular zone exists at the proximal portion of the biceps tendon, close to the superior glenoid [41]. Blood is supplied to the long head of the biceps tendon from the thoracoacromial and brachial arteries via the osteotendinous and musculotendinous junctions, respectively [44]. 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 [44].

The long head of the biceps tendon is innervated by thinly myelinated sensory neurons [44]. Most innervation of the long head of the biceps tendon occurs at its origin, allowing pathology in this region to generate pain [44]. Innervation of the biceps muscle is supplied by branches of the musculocutaneous nerve (C5 and C6) [43].

Soft Tissue Stabilizers and Pulley

Stability of the biceps within the bicipital groove is afforded by the biceps sling, or pulley [41]. The biceps pulley consists of fibers from the subscapularis tendon, supraspinatus tendon, coracohumeral ligament, and superior glenohumeral ligament [41]. The long head of the biceps pulley is a capsuloligamentous complex comprising the superior glenohumeral ligament, the coracohumeral ligament, and fibers from the subscapularis and supraspinatus tendons [44]. The long head of the biceps pulley stabilizes the proximal long head of the biceps as the tendon enters the bicipital groove [44]. The biceps pulley is composed of the superior glenohumeral ligament and coracohumeral ligament in combination with the subscapularis [49].

The rotator cuff interval is a triangular region bounded medially by the coracoid process, superiorly by the anterior margin of the supraspinatus, and inferiorly by the superior margin of the subscapularis [49]. The biceps tendon traverses the rotator cuff interval, where it is held in place by the biceps pulley, before exiting the joint via the bicipital groove [49]. A subscapularis tear should be highly suspected in the setting of long head of the biceps instability, and vice versa [44].

Biceps-Labral Complex Zones

The biceps-labral complex consists of the superior glenoid labrum and the long head of the biceps tendon [114]. The biceps-labral complex is classified into three distinct zones: * Inside zone: Consists of the superior glenoid labrum and the long head of the biceps anchor [44]. * Junction zone: Includes the intra-articular portion of the long head of the biceps, as well as the stabilizing biceps pulley [44]. * 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 [44].

Zone 1 and zone 2 of the extra-articular biceps-labral complex contain synovial tissue, which may generate pain [44]. Zone 2 of the extra-articular biceps-labral complex cannot be visualized by arthroscopy from above or with an open approach from below the zone [44].

Biomechanics and Kinematics

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 [43]. 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 [43]. From full adduction to full elevation of the arm, the groove moves a distance of up to 2 to 5 cm along the biceps tendon [110]. Maximal excursion of the humeral head along the biceps tendon results when the shoulder is in a position of maximal external rotation [110]. Minimal excursion of the humeral head along the biceps tendon is seen when the shoulder is in a position of maximal internal rotation [110].

With the arm in full abduction, 1.3 cm of the long head of the biceps tendon lies within the shoulder joint [110]. When the arm is adducted and externally rotated, the length of long head of biceps tendon within the joint increases to 5 cm [110]. The long head of the biceps can act as a dynamic humeral head depressor [110]. The long head of the biceps can act as a static humeral head depressor, preventing migration of the humeral head into the acromion with contraction of the deltoid [110].

Biomechanical studies indicate that the long head of the biceps contributes to stability of the glenohumeral joint in all directions [106]. In vivo studies have yet to establish the stabilizing effect of the long head of the biceps and the physiologic load required remains unknown [106]. The long head of the biceps has a pertinent biomechanical role in glenohumeral stability regardless of the condition of the superior labrum [143]. Long head of the biceps tenodesis does not dramatically alter glenohumeral position during dynamic motions, suggesting the risk for clinically significant alterations in glenohumeral kinematics after tenodesis is low in otherwise intact shoulders [103]. Biceps tenodesis shows no deleterious effect on glenohumeral kinematics and stability in the presence of a SLAP lesion [108].

Loss of the long head attachment is manifested mainly as loss of supination strength (20%) with a smaller loss (8%) of elbow flexion strength [43]. Lucas reported a 20% loss of elevation strength in external rotation with rupture of the long head of the biceps [43]. Pain originating from the long head of biceps tendon induced an approximately 30% decrease of shoulder abduction and elbow flexion strength despite there being no structural or biomechanical abnormalities in this model [104].

Pathophysiology and Injury Mechanisms

SLAP tears can be caused by forceful traction to the arm, direct compression loads, and repetitive overhead throwing [55]. 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 [55]. 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 [55]. SLAP tears are seen more frequently in the late cocking position, occurring because of an adaptive posterior capsular contracture [55]. 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 [55]. Increased external rotation results in greater torsional loads across the superior labrum from the more posteriorly oriented long head of the biceps tendon, causing the labrum and long head of the biceps tendon to displace medially over the glenoid rim [55]. SLAP tears may represent an adaptive process, because the peel-back of the superior glenoid labrum permits increased humeral external rotation needed to participate in overhead sporting activity [114].

The proximal long head of the biceps tendon has been recognized as a source of substantial anterior shoulder pain [55]. Pathology of the long head of the biceps tendon includes tendinitis, tendinopathy, tears, subluxation, entrapment, delamination, and dislocation out of the bicipital groove [55]. 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, which can increase the risk of tendon degeneration [55]. Variations of bicipital groove morphology can also increase the risk of long head of the biceps tendon pathology [55]. Isolated long head of the biceps tendon pathology can occur but frequently is associated with other shoulder pathologies, especially rotator cuff pathology [55]. 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 [55].

With long head of the biceps tendon instability, the patient describes a clicking or snapping with overhead motions [55]. A subscapularis tear is associated with long head of the biceps medial instability and a supraspinatus tear is associated with posterolateral instability [55]. Bicipital instability is usually associated with rotator interval injury or subscapularis tendon injury, or both [58]. Frank dislocations of the long head of the biceps are usually traumatic in origin and associated with complete tears of the subscapularis [20]. Subluxation of the biceps tendon generally occurs in the presence of partial or full-thickness rotator cuff defects [20].

Patients with biceps tendonitis or subluxation generally always have pain at the bicipital groove [20]. Biceps-related pain felt in the bicipital groove should migrate laterally with external rotation of the arm [20]. Pain from rotator cuff tendonitis generally radiates to the deltoid insertion and does not move with arm rotation [20]. In bicipital tendonitis, the pain is almost always accompanied by rotator cuff symptoms [20]. Patients with bicipital tendonitis complain of pain in the anterior aspect of the arm, particularly with extension and internal rotation [20]. Rest pain is seen later in the disease progression of bicipital tendonitis and there can be a significant component of night pain [20]. When longstanding, pain from the long head of the biceps tendon can spontaneously resolve after a full-thickness tendon rupture [20]. Patients with biceps tendon subluxation often notice a painful snapping or clicking sensation in the shoulder, especially with overhead positions going from internal to external rotation [20]. 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 [58].

Classification

Biceps tendon disorders are classified into inflammatory, instability, and traumatic types [60].

Clinical Presentation

Patients with biceps tendonitis or subluxation generally present with pain at the bicipital groove [20]. This biceps-related pain migrates laterally with external rotation of the arm [20]. In bicipital tendonitis, pain is almost always accompanied by rotator cuff symptoms [20]. As the disease progresses, rest pain and a significant component of night pain become evident [20]. Conversely, pain from the long head of the biceps tendon can spontaneously resolve after a full-thickness tendon rupture [20]. A history of radiating anterior shoulder pain may inform the examiner of pain generation from the long head of the biceps tendon [166].

Biceps tendon subluxation generally occurs in the presence of partial or full-thickness rotator cuff defects [20]. Frank dislocations of the long head of the biceps are usually traumatic in origin and associated with complete tears of the subscapula [20]. Clinical tests including the O’Brien, Yergason, Speed, and direct palpation tests have limited specificity for diagnosing long head of biceps tendon pathology [166].

MRI has limited sensitivity for detection of biceps pathology [131]. Macroscopic changes in the long head of the biceps tendon do not always correlate with symptoms [50]. Consequently, a normal arthroscopy does not exclude important symptomatic pathology of the long head of the biceps tendon [50]. In patients with chronic long head biceps tendinopathy, MRI and intraoperative assessment may not show significant structural abnormalities within the tendon despite significant histopathologic changes [66].

Disorders of the biceps tendon are classified into inflammatory, instability, and traumatic types [60]. Diagnosis and nonoperative management of long head of biceps tendon disorders are categorized as inflammation, instability, and rupture [67].

Investigations

Imaging

Plain radiography: Obtain scapular Y, AP, and axillary lateral views to assess the glenohumeral joint for abnormalities [121]. Postoperative imaging should include either computed tomography low enough to visualize the tenodesis site or multiple views on plain radiography [188].

MRI: Magnetic resonance imaging assesses the long head of the biceps tendon, associated fluid, possible synovitis, bicipital groove morphology, and bony osteophytes [121]. It also identifies concomitant shoulder and acromioclavicular joint pathologies [121]. However, MRI demonstrates poor correlation with arthroscopic findings regarding long head of biceps pathology [121]. Sensitivity for inflammation, partial-thickness tendon tears, and tendon ruptures is poor to moderate [121]. Proton density–weighted sequences with fat suppression offer the greatest sensitivity for detecting tendon degeneration, although tendon caliber change is more specific [49]. Diagnosing partial tears at the entrance to the bicipital groove is challenging without directed effort [49]. These lesions show abnormal signal intensity, but only half have an associated caliber change; evaluation in all imaging planes aids in identification of a biceps groove entrance lesion [49]. In patients with chronic long head biceps tendinopathy undergoing open subpectoral tenodesis, MRI and intraoperative assessment often fail to show significant structural abnormalities despite significant histopathologic changes [66]. Biceps tendon pain in the absence of tears is associated with microscopic changes consistent with tendinopathy, which are often missed by MRI [198].

MRA: Magnetic resonance arthrography is more specific and sensitive than MRI for long head of biceps pathology and SLAP tears [121]. In patients with no pathology, MRA shows the tendon surrounded by contrast fluid, resembling a kidney bean [121]. Both MRI and MRA should be performed in the sagittal oblique and axial planes because long head of biceps subluxation and dislocation are often associated with partial-thickness and full-thickness subscapularis tendon tears [121]. MRA has a sensitivity of 82% to 89% and specificity of 87% to 98% in the evaluation of the biceps pulley [49]. Diagnostic criteria for biceps pulley evaluation on MRA include 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 [49]. The rotator cuff interval is best assessed with MRA because joint distension can separate the components of the rotator cuff interval [49].

Ultrasonography: Ultrasonography is accurate and cost-effective for diagnosing long head of biceps dislocation, subluxation, and rupture [121]. It is not as accurate for diagnosing partial-thickness tendon tears of the long head of biceps [121]. The exact role of ultrasonography for the diagnosis of tendon inflammation has not been fully defined [121].

Other Considerations: Diagnosis of long head biceps tendon and subscapularis pathology in association with shoulder rotator cuff pathology can be challenging due to limitations in MRI and arthroscopic visualization [208].

Clinical Examination

No single physical examination finding is completely accurate for the diagnosis of a SLAP tear [59]. A combined physical examination approach aids in the diagnosis of SLAP or long head of biceps pathology [59]. The 3-pack examination for biceps-labrum complex disease consists of the active compression test, throwing test, and bicipital tunnel palpation [42]. These 3-Pack tests were highly sensitive (73% to 98%) for biceps-labrum complex disease [42]. The decision to perform tenotomy or tenodesis should be made preoperatively based on patient symptoms and concomitant pathologies, as macroscopic changes in the long head of the biceps tendon do not always correlate with symptoms and a normal arthroscopy does not exclude important symptomatic pathology [50]. The IBTIS is a preoperative clinical and radiological score with 7 items for surgical treatment by arthroscopic tenotomy of the long head of biceps [78].

Treatment

Non-Operative

Biceps tenodesis is indicated for symptomatic long head of biceps tendon pathology, particularly in patients who have failed non-operative treatment or are undergoing concomitant shoulder procedures [51]. For SLAP tears, operative treatment is reserved for failure of nonoperative management [18].

Operative

Indications: Biceps tenodesis is a reliable surgical option for symptomatic long head of biceps tendon pathology, particularly in patients who have failed non-operative treatment or are undergoing concomitant shoulder procedures [51]. It is a more preferable choice for patients with biceps tendinopathies across all age and gender subgroups [69]. While the choice between biceps tenotomy and tenodesis for proximal biceps tendon pathology can continue to be based on surgeon and patient preference [28], there is currently no consensus regarding the use of tenotomy versus tenodesis for the treatment of lesions of the long head of the biceps brachii [37]. SLAP repair and biceps tenodesis both present viable treatment options with specific advantages and disadvantages, with the decision ultimately made individually with the patient [53]. In elite pitchers, biceps tenodesis is an appealing alternative to SLAP repair, but the indications and technique still need to be defined [123]. There are currently no clear guidelines for the management of concurrent biceps tendon pathology in the setting of massive rotator cuff tears [29], and whether biceps surgery should be performed routinely during arthroscopic rotator cuff repairs, and if so whether tenotomy or tenodesis should be performed, remains to be discussed [16].

Surgical Approach / Technique: Biceps tenodesis is a valuable tool for the treatment of proximal biceps tendon pathology regardless of the specific location or technique used [97]. Whether done arthroscopically or through a mini-open approach with a small anterior incision or a small subpectoral incision, long-term results are comparable, and the technique should be chosen based on the skills and experience of the operating surgeon [122]. The location of biceps tenodesis significantly differs between all-arthroscopic suprapectoral and open subpectoral techniques, with the open subpectoral method achieving fixation in a significantly narrower region of the humerus [54]. Supra- and subpectoral repairs provide equivalent biomechanical strength when controlling for potential confounders [75]. Open subpectoral biceps tenodesis using a dual-fixation construct with no postoperative motion restrictions resulted in excellent outcomes with a low incidence of failure at a minimum 2-year follow-up [155]. Subpectoral biceps tenodesis reliably relieves pain and improves function [82]. With placement of the tenodesis at the inferior aspect of the bicipital groove in conjunction with the musculotendinous junction, open subpectoral tenodesis of the long head of the biceps can be performed using bicortical button fixation without risk to the posterior nervous structures [151]. This technique offers a viable alternative to the open subpectoral biceps tenodesis [94]. The presented technique provides a simple, effective, and efficient method that simultaneously and securely addresses both proximal biceps tenodesis and subscapularis tendon repair [95]. This report describes an all-arthroscopic suprapectoral biceps tenodesis using suture anchor fixation [141]. 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 [90]. The authors present a novel technique for suprapectoral, all-arthroscopic biceps tenodesis with an all-suture anchor, believing it offers advantages regarding implant size, tenodesis location, and the ability to tension the biceps while securing the tendon [163]. This method has potential advantages over existing subpectoral biceps tenodesis techniques such as in situ biceps tendon fixation, creation of a smaller cortical defect, and subcortical attachment of a nonbioreactive device [144]. This technique offers an efficient method for anatomical biceps tenodesis with minimal dissection, resulting in a relatively decreased recovery period and decreased postoperative pain compared to other methods [93].

Implant Selection: Tenodesis can be done with a PEEK tenodesis screw, with two suture anchors, or with the use of a FiberSnare [122]. The resistance to cyclic loading is comparable between PEEK tenodesis screws and suture anchors, whereas the ultimate pull-out strength of the biotenodesis screw is stronger than the suture anchors [122]. Placement of a Bio-Tenodesis screw flush to the humeral cortex is preferred for maximum fixation strength in subpectoral biceps tenodesis [160]. All three all-suture anchors are suitable fixation methods for subpectoral biceps tenodesis [125]. Although its use in proximal biceps tendon tenodesis is still emerging, DBM implant offers the potential to enhance enthesis formation and biomechanical strength at the tenodesis site, particularly in onlay constructs [156]. These considerations underscore the need for further biomechanical and clinical evaluation regarding arthroscopic bicortical biceps anchorage [68].

Clinical Outcomes and Efficacy: Primary biceps tenodesis offers increased effectiveness when compared with both primary SLAP repair and nonoperative treatment and lower costs than primary SLAP repair [12]. The results of biceps reinsertion are disappointing compared with biceps tenodesis for isolated Type II SLAP lesions [40]. Concomitant biceps tenodesis appears to have a favorable effect on 1-year treatment success after total shoulder arthroplasty [45]. Biceps tenodesis with concomitant rotator cuff repair led to improved outcomes regardless of tenodesis fixation construct, location, or technique [142]. Superior clinical outcomes are seen in nonsmokers, those with only 1 tendon affected, and those who undergo tenotomy instead of tenodesis for a damaged long head of biceps tendon in the context of revision rotator cuff repairs [11]. At a short-term follow-up of 1 year, no patients had reoperations or revisions for failed biceps tenodesis in a cohort undergoing arthroscopic-assisted locked loop suprapectoral biceps tenodesis [5]. Over 200 subpectoral biceps tenodesis procedures have been performed at one institution using a double-loaded suture anchor technique over the last 4 years, without any known failures to date [15]. Anecdotally, the author has performed the tack-and-loop biceps tenodesis technique in over 100 shoulders without evidence of biceps deformity or tenodesis failure [25]. Short-term follow-up of 20 subpectoral biceps tenodesis procedures using an all-suture anchor fixation has not shown any failure of fixation or residual biceps discomfort [83]. Loop 'N' Tack biceps tenodesis and subpectoral biceps tenodesis techniques are reliable and effective procedures that can reduce pain scores and restore shoulder function when patients require surgical intervention [196]. Outcomes appear similar between biceps tenotomy versus tenodesis; however, the tenotomy group demonstrated greater incidence of cosmetic deformity but an earlier improvement in postoperative pain [190]. This study found no difference in the functional outcomes or pain relief between proximal vs subpectoral biceps tenodesis [185]. Patients had similar outcomes regardless of arthroscopic, suprapectoral biceps tenodesis fixation technique [147]. Findings suggest double-row surgical fixation and concomitant biceps tenodesis may be superior to single-row fixation and leaving the biceps alone in the context of isolated subscapularis tears, warranting future prospective comparative studies [136]. Arthroscopic biceps tenotomy and tenodesis effectively treats severe pain or dysfunction caused by an irreparable rotator cuff tear associated with biceps pathology [64]. Both tenotomy and tenodesis are effective in relieving pain from biceps tendon disorder in the presence of rotator cuff tears [187].

Postoperative Management and Rehabilitation: Patients undergoing open subpectoral biceps tenodesis may be managed using either early or delayed active motion protocols without compromising functional outcome [73]. If only a biceps tenodesis was done, the postoperative procedure is the same as for arthroscopic acromioplasty, and strengthening activities related to elbow flexion or forward elevation of the arm with the elbow extended should be restricted until 6 weeks after the biceps tenodesis [122]. A shoulder immobilizer is worn for 2 weeks, a sling is used for an additional 2 weeks, and then active use and exercises are begun for open biceps tenodesis with rotator cuff repair [174].

Complications and Safety: Biceps tenodesis provides a new, distal level of fixation for the tenotomized tendon and results in lower risk of cosmetic deformity or cramping in the biceps muscle [161]. Open tenodesis technique performed directly underneath the pectoralis major tendon has the potential for complications associated with open surgery, such as increased rates of blood loss, wound infection, nerve injury, and cosmetic deformity from the scar [169]. Additional care should be taken when operating on patients with previous biceps tenodesis to prevent perioperative fractures [189].

Revision: Revision subpectoral biceps tenodesis is a viable procedure for addressing patients with persistent pain following initial proximal biceps tenodesis [39]. Although revision to subpectoral biceps tenodesis may be an effective strategy to address failed prior biceps surgery, the potential complication of persistent pain must be emphasized [180].

Other Considerations: The described proximal biceps tenodesis fixation in double-row rotator cuff repair is simple and cost-effective, with no need for additional anchors [126]. This technique offers a cost-conscious and clinically effective option to provide pain relief via biceps tenodesis while also avoiding common complications of hardware and axillary incisions [132].

Complications

Overall Complication Rates: The overall complication rate for long head of biceps tendon tenodesis is low [223]. Primary biceps tenodesis for long head pathology carries a low risk for surgical complications [35]. In a population of 353 patients over three years, the incidence of complications after subpectoral biceps tenodesis with interference screw fixation was 2.0% [175]. An overall complication rate of 2.4% was observed after subpectoral biceps tenodesis with interference screw fixation [217].

Infection: Open subpectoral biceps tenodesis (OSPBT) is associated with a surgical site infection rate of 1.1%, which is higher than that seen with arthroscopic suprapectoral biceps tenodesis [202]. Postoperative wound infection rates are significantly greater after open subpectoral biceps tenodesis [202]. Most reported wound infections after open subpectoral biceps tenodesis improved with wound care or antibiotic therapy, with only three patients requiring further intervention [202].

Nerve Injury: Open subpectoral biceps tenodesis is associated with a neurological adverse event rate of 1.1%, which is higher than that seen with arthroscopic suprapectoral biceps tenodesis [202]. Nerve-related complications are significantly greater after open subpectoral biceps tenodesis [202].

Stiffness / Arthrofibrosis: Arthroscopic suprapectoral biceps tenodesis (ASPBT) leads to more frequently reported incidences of postoperative stiffness (2.5%) compared to open subpectoral biceps tenodesis [202]. There is a notably increased incidence of postoperative stiffness after arthroscopic suprapectoral biceps tenodesis compared with open subpectoral biceps tenodesis [233]. ASPBT should be performed with consideration for a more permissive rehabilitation protocol focused on early restoration of shoulder range of motion to decrease the risk of arthrofibrosis and secondary procedures [202].

Fracture and Fixation Failure: The cumulative fracture rate after biceps tenodesis was 0.53% in the five studies that reported this complication, with a mean fracture rate of 1.0% ± 1.6% [210]. Humeral shaft fractures have been related to biceps tenodesis with interference screw fixation [197]. An early mode of failure with interference screws involves tendon damage by the screw threads during insertion [197]. A case series reported three patients with failures after undergoing arthroscopic biceps tenodesis with an interference screw [199]. Clinical outcomes of subpectoral proximal biceps tenodesis with an interference screw have been reported with failure rates between 0 and 3% [197]. Arthroscopic biceps tenodesis performed at the articular margin results in a low surgical revision rate and a low rate of residual pain [220]. Over 200 subpectoral biceps tenodesis procedures performed using a double-loaded suture anchor technique over four years resulted in no known failures [15]. Short-term follow-up of 20 subpectoral biceps tenodesis procedures using an all-suture anchor fixation showed no failure of fixation or residual biceps discomfort [83].

Revision and Reoperation Rates: A total of 171 patients (1.8%) underwent revision biceps tenodesis in a database analysis of 15,257 patients who underwent the procedure [72]. The most common reasons for revision biceps tenodesis were pain or cramping and rerupture [219]. Arthroscopic and open proximal techniques which do not address the biceps sheath have higher revision rates than techniques which release the biceps sheath or tenodese the tendon in a distal location [205]. All types of suprapectoral tenodesis share a risk for persistent pain in the bicipital groove because of ongoing synovitis, muscle cramping, and mechanical irritation, which may be a reason for revision procedures [206]. 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 [230]. Revision biceps tenodesis after previous failed tenodesis or tenotomy demonstrates high patient satisfaction (86%) and significant improvement in functional outcomes [224].

Other Considerations: Higher reoperation rates at one year were seen in patients who had concomitant biceps tenodesis compared to those who did not [86]. Reoperation rates were significantly higher in patients undergoing shoulder arthroscopy with biceps tenodesis than in patients undergoing shoulder arthroscopy without biceps tenodesis [228]. Patients undergoing primary rotator cuff repair with concomitant biceps tenodesis had 35% reduced odds of revision biceps tenodesis and 23% reduced odds of any all-cause revision within four years when compared with those without concomitant biceps tenodesis [214]. When adjusting for confounding factors, performing concomitant biceps tenodesis with rotator cuff repair does not lead to a difference in postoperative complication rate or risk for revision surgery [226]. Open subpectoral biceps tenodesis in patients over 65 years of age does not result in an increased rate of complications compared to patients under 65 [100]. In a cohort of 23 patients over 65 undergoing open subpectoral biceps tenodesis, two patients (8.7%) had biceps-related complications including one biceps tendonitis and one long head of biceps rupture [100]. In the same cohort of patients over 65, three patients (13%) had postoperative complications not strictly related to the tenodesis itself, including one wound infection and two cases of adhesive capsulitis [100]. Patients undergoing biceps tenotomy experienced longer hospital stays, higher readmission rates, and more serious adverse events compared to those undergoing tenodesis [225]. In a study of 89 patients undergoing biceps tenodesis for rotator cuff tears, 17 patients were excluded from analysis because they had an intact rotator cuff tear, an isolated subscapularis tear, or a rotator cuff tear that was not repaired [101].

Recovery

Complete recovery / outcome plateau (months): Patients can expect to attain clinically significant outcomes by 13 months postoperatively after isolated biceps tenodesis [8].

Other Considerations: Most patients are able to return to work at an average of 5.4 ± 2.8 months after biceps tenodesis [30]. The speed of recovery after arthroscopic rotator cuff repair was not influenced by concomitant biceps tenodesis [179].

Key Evidence

• [L4] Biceps tenodesis provided significant clinical improvement and high rates of survivorship 2 years postoperatively. [1] (10.1016/j.arthro.2021.12.014)
• [L4] Biceps tenodesis in patients less than 25 years of age yields excellent outcomes with two thirds of patients able to return to sport and a low revision rate. [2] (10.1177/2325967117s00116)
• [L5] Outcomes following surgical treatment vary depending on the method of treatment, associated pathology, and patient characteristics, with biceps tenodesis receiving increasing attention as a treatment option. [3] (10.1302/2058-5241.4.180033)
• [L4] This review discusses the different options for biceps tenodesis including outcomes and complications. [4] (10.1007/s12178-016-9362-7)
• [L4] At a short-term follow-up of 1 year, no patients had reoperations or revisions for failed biceps tenodesis. [5] (10.1016/j.xrrt.2021.02.003)
• [L4] When indicated, biceps tenodesis offers an alternative to SLAP repair in young patients. [6] (10.1016/j.arthro.2018.10.151)
• [L5] American Shoulder and Elbow Surgeons members favored biceps tenodesis over tenotomy for surgical management of long head of biceps tendon pathology. [7] (10.1007/s11420-017-9575-3)
• [L4] After isolated biceps tenodesis, patients can expect to attain clinically significant outcomes by 13 months postoperatively, with most patients achieving this between 5 and 8 months. [8] (10.1177/23259671221070857)
• [L3] Tenotomy and open tenodesis are both safe options for treatment of biceps pathology. [9] (10.1016/j.asmr.2024.100928)
• [L1] Biceps tenodesis in patients 35 years of age and younger yields a wide variability in reported return-to-sport rates, excellent clinical outcome scores, and low but variable reported rates of complications, reoperations, and failure. [10] (10.1016/j.arthro.2022.12.009)
• [L4] Superior clinical outcomes are seen in nonsmokers, those with only 1 tendon affected, and those who undergo tenotomy instead of tenodesis for a damaged long head of biceps tendon. [11] (10.1016/j.jse.2019.12.011)
• [L3] Primary biceps tenodesis offers increased effectiveness when compared with both primary SLAP repair and nonoperative treatment and lower costs than primary SLAP repair. [12] (10.1016/j.arthro.2018.01.029)
• [Paper] Over 200 subpectoral biceps tenodesis procedures have been performed at our institution using the described technique over the last 4 years, without any known failures to date. [15] (10.1016/j.eats.2013.02.005)
• [L4] However, whether such biceps surgery should be performed routinely and if so, whether tenotomy or tenodesis should be performed remains to be discussed. [16] (10.1016/j.jor.2020.03.033)
• [L5] Operative treatment is reserved for failure of nonoperative treatment, with biceps tenodesis gaining popularity due to encouraging functional outcomes and return-to-sport rates. [18] (10.1016/j.arthro.2022.08.005)
• [L4] Biceps tenotomy is well accepted by most patients with good overall results. [19] (10.1016/j.jse.2011.01.014)
• [L5] [20] (10.1097/00132589-200109000-00002)
• [L4] Anecdotally, the author has performed this technique in over 100 shoulders without evidence of biceps deformity or tenodesis failure. [25] (10.1016/j.eats.2022.06.005)
• [L3] The choice between biceps tenotomy and tenodesis for pathology of the proximal biceps tendon can continue to be based on surgeon and patient preference. [28] (10.1177/2325967115570848)
• [L5] There are currently no clear guidelines for the management of concurrent biceps tendon pathology in this setting. [29] (10.1016/j.xrrt.2024.08.003)
• [L4] After biceps tenodesis, most patients were able to return to work at an average of 5.4 ± 2.8 months. [30] (10.1016/j.arthro.2018.10.144)
• [Paper] All-arthroscopic tenodesis of the long head of the biceps provides a suitable option for improved functional outcomes in the treatment of labral and biceps pathology. [32] (10.1016/j.eats.2019.01.023)
• [L3] A primary biceps tenodesis for pathology of the LHBT provides a clinical and statistically significant improvement in shoulder outcomes with a reliable and efficient return to previous activity level and low risk for surgical complications. [35] (10.1177/2325967114s00019)
• [L1] Tenotomy and tenodesis of the long head of the biceps results in comparable postoperative clinical and functional outcomes. [36] (10.1016/j.jse.2021.02.002)
• [L1] There is currently no consensus regarding the use of tenotomy versus tenodesis for the treatment of lesions of the long head of the biceps brachii. [37] (10.1016/j.arthro.2011.10.017)
• [L1] High-quality randomized controlled trials comparing biceps tenotomy versus tenodesis during shoulder arthroscopy have largely demonstrated statistical noninferiority of clinical outcomes. [38] (10.1177/03635465261440392)
• [L4] Revision subpectoral biceps tenodesis is a viable procedure for addressing patients with persistent pain following initial proximal biceps tenodesis. [39] (10.1016/j.asmr.2023.100797)
• [L3] The results of biceps reinsertion are disappointing compared with biceps tenodesis. [40] (10.1177/0363546508330127)
• [L2] Concomitant biceps tenodesis appears to have a favorable effect on 1-year treatment success after total shoulder arthroplasty. [45] (10.1016/j.jse.2008.06.006)
• [Letter] The decision to perform tenotomy or tenodesis should be made preoperatively based on patient symptoms and concomitant pathologies, as macroscopic changes in the long head of the biceps tendon do not always correlate with symptoms and a normal arthroscopy does not exclude important symptomatic pathology. [50] (10.1016/j.arthro.2018.08.014)
• [L4] Biceps tenodesis is a reliable surgical option for the treatment of symptomatic LHBT pathology, particularly in patients who have failed non-operative treatment and those undergoing concomitant shoulder procedures. [51] (10.1016/j.jisako.2026.101168)
• [L5] SLAP repair and biceps tenodesis both present viable treatment options but come with specific advantages and disadvantages, with the decision ultimately made individually with the patient. [53] (10.1016/j.arthro.2019.02.026)
• [L3] The location of biceps tenodesis significantly differs between all-arthroscopic suprapectoral and open subpectoral techniques, and the open subpectoral method achieves fixation in a significantly narrower region of the humerus. [54] (10.1016/j.arthro.2016.03.101)
• [L4] Patient age should not be used as the sole criterion when deciding between biceps tenotomy and tenodesis. [57] (10.1016/j.arthro.2016.04.022)
• [Paper] [60] (10.1016/s0278-5919(05)70266-0)
• [L5] Clear indications have yet to be established for the use of single- versus double-row repair because evidence confirms neither is clinically efficacious than the other, though biceps tenodesis has proven more successful than tenotomy in non-isolated cuff tears. [63] (10.1016/j.arthro.2013.07.265)
• [L3] Arthroscopic biceps tenotomy and tenodesis effectively treats severe pain or dysfunction caused by an irreparable rotator cuff tear associated with biceps pathology. [64] (10.1016/j.arthro.2007.03.039)
• [L4] In patients with chronic long head biceps tendinopathy who underwent open subpectoral tenodesis, MRI and intraoperative assessment did not show significant structural abnormalities within the tendon despite significant histopathologic changes. [66] (10.1016/j.arthro.2018.01.021)
• [L5] Diagnosis and nonoperative management of long head of biceps tendon disorders are categorized as inflammation, instability, and rupture, requiring specific protocols. [67] (10.1016/j.csm.2015.08.006)
• [L5] These considerations underscore the need for further biomechanical and clinical evaluation. [68] (10.1002/atn2.70089)
• [L4] Biceps tenodesis is a more preferable choice for patients with biceps tendinopathies in all age and gender subgroups. [69] (10.1016/j.jos.2019.05.007)
• [L2] [72] (10.1177/2325967118825473)
• [L3] This suggests that patients undergoing open subpectoral biceps tenodesis may be managed using either early or delayed active motion protocols without compromising functional outcome. [73] (10.1177/23259671211026619)
• [L4] Both open and arthroscopic biceps tenodesis in the setting of rotator cuff repair show low complication rates, and the technique should be based on surgeon preference and patient factors. [74] (10.5435/jaaos-d-19-00252)
• [L1] Supra- and subpectoral repairs provide equivalent biomechanical strength when controlling for potential confounders. [75] (10.1177/0363546519876107)
• [L3] The IBTIS is a preoperative clinical and radiological score with 7 items for surgical treatment by arthroscopic tenotomy of the long head of biceps. [78] (10.1177/2325967121s00361)
• [L4] Subpectoral biceps tenodesis reliably relieves pain and improves function. [82] (10.1186/1471-2474-9-121)
• [L5] Short-term follow-up of 20 procedures has not shown any failure of fixation or residual biceps discomfort. [83] (10.1007/s00167-014-3348-z)
• [L3] Higher reoperation rates at 1 year were seen in patients who had concomitant biceps tenodesis compared to those who did not. [86] (10.1016/j.arthro.2017.01.030)
• [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. [90] (10.1016/j.eats.2023.04.002)
• [Paper] This technique offers an efficient method for anatomical biceps tenodesis with minimal dissection, resulting in a relatively decreased recovery period and decreased postoperative pain compared to other methods. [93] (10.1016/j.eats.2017.09.005)
• [Paper] This technique offers a viable alternative to the open subpectoral biceps tenodesis. [94] (10.1016/j.eats.2017.06.016)
• [Paper] The presented technique provides a simple, effective, and efficient method that simultaneously and securely addresses both proximal biceps tenodesis and subscapularis tendon repair. [95] (10.1016/j.eats.2017.07.020)
• [L5] Subpectoral biceps tenodesis is a valuable tool for the treatment of proximal biceps tendon pathology regardless of the specific location or technique used. [97] (10.1016/j.arthro.2020.04.010)
• [L4] [100] (10.1186/s12891-017-1780-1)
• [L3] [101] (10.1177/2325967116645311)
• [L4] LHB tenodesis does not dramatically alter glenohumeral position during dynamic motions, suggesting the risk for clinically significant alterations in glenohumeral kinematics after tenodesis is low in otherwise intact shoulders. [103] (10.1177/0363546511423629)
• [L5] Pain originating from the long head of biceps tendon induced an approximately 30% decrease of shoulder abduction and elbow flexion strength despite there being no structural or biomechanical abnormalities in this model. [104] (10.1016/j.jse.2018.05.008)
• [L5] Biomechanical studies indicate that the long head of the biceps contributes to stability of the glenohumeral joint in all directions, though in vivo studies have yet to establish this stabilizing effect and the physiologic load required remains unknown. [106] (10.1016/j.arthro.2010.10.014)
• [L5] Biceps tenodesis shows no deleterious effect on glenohumeral kinematics and stability in the presence of a SLAP lesion. [108] (10.1016/j.arthro.2011.03.010)
• [L5] The treatment option of biceps tenodesis is an appealing alternative to SLAP repair, but the indications and technique of biceps tenodesis in the elite pitcher still need to be defined. [123] (10.1016/j.arthro.2018.01.001)
• [L5] All three all-suture anchors are suitable fixation methods for subpectoral biceps tenodesis. [125] (10.1186/s12891-024-07503-0)
• [L5] The described proximal biceps tenodesis fixation is simple and cost-effective, with no need for additional anchors. [126] (10.1016/j.eats.2025.103634)
• [L4] Routine tenodesis of the biceps tendon, in association with arthroscopic subscapularis repair, may not be necessary to ensure at least satisfactory short term outcomes in subscapularis function. [129] (10.1016/j.arthro.2008.04.045)
• [L5] [131] (10.1097/corr.0000000000002448)
• [Paper] This technique offers a cost-conscious and clinically effective option to provide pain relief via biceps tenodesis while also avoiding common complications of hardware and axillary incisions. [132] (10.1016/j.eats.2020.03.010)
• [L5] Both tenotomy and tenodesis show good results with different indications; tenotomy offers faster recovery and less narcotic use, while tenodesis has a lower risk of Popeye deformity but lacks consensus on superior clinical outcomes in isolated biceps disease. [133] (10.1016/j.arthro.2022.01.014)
• [L4] Findings suggest double-row surgical fixation and concomitant biceps tenodesis may be superior to single-row fixation and leaving the biceps alone, warranting future prospective comparative studies. [136] (10.1016/j.arthro.2016.10.020)
• [Paper] This report describes an all-arthroscopic suprapectoral biceps tenodesis using suture anchor fixation. [141] (10.1016/j.eats.2023.09.017)
• [L3] Biceps tenodesis with concomitant RCR led to improved outcomes regardless of tenodesis fixation construct, location, or technique. [142] (10.1177/23259671231180173)
• [L5] The long head of the biceps has a pertinent biomechanical role in glenohumeral stability regardless of the condition of the superior labrum. [143] (10.1016/j.arthro.2025.05.022)
• [L5] This method has potential advantages over existing subpectoral biceps tenodesis techniques such as in situ biceps tendon fixation, creation of a smaller cortical defect, and subcortical attachment of a nonbioreactive device. [144] (10.1097/bte.0b013e3181a94599)
• [L3] Patients had similar outcomes regardless of arthroscopic, suprapectoral biceps tenodesis fixation technique. [147] (10.1002/ars2.70040)
• [L5] With placement of the tenodesis at the inferior aspect of the bicipital groove in conjunction with the musculotendinous junction, open subpectoral tenodesis of the long head of the biceps can be performed using bicortical button fixation without risk to the posterior nervous structures. [151] (10.1016/j.arthro.2014.03.026)
• [L4] Open subpectoral biceps tenodesis using a dual-fixation construct with no postoperative motion restrictions resulted in excellent outcomes with a low incidence of failure. [155] (10.1016/j.jse.2018.02.061)
• [L5] Although its use in proximal biceps tendon tenodesis is still emerging, DBM implant offers the potential to enhance enthesis formation and biomechanical strength at the tenodesis site, particularly in onlay constructs. [156] (10.1002/atn2.70167)
• [L5] Placement of a Bio-Tenodesis screw flush to the humeral cortex is preferred for maximum fixation strength in subpectoral biceps tenodesis. [160] (10.1016/j.arthro.2013.08.033)
• [L4] Biceps tenodesis provides a new, distal level of fixation for the tenotomized tendon and results in lower risk of cosmetic deformity or cramping in the biceps muscle. [161] (10.1016/j.csm.2015.08.011)
• [L5] The authors present a novel technique for suprapectoral, all-arthroscopic biceps tenodesis with an all-suture anchor, believing it offers advantages regarding implant size, tenodesis location, and the ability to tension the biceps while securing the tendon. [163] (10.1016/j.jses.2017.12.001)
• [L5] [169] (10.1016/j.eats.2023.02.008)
• [L4] The incidence of complications after subpectoral biceps tenodesis with interference screw fixation in a population of 353 patients over the course of 3 years was 2.0%. [175] (10.1016/j.jse.2010.01.024)
• [L3] Nonetheless, the speed of recovery was not influenced by the biceps tenodesis. [179] (10.1016/j.jseint.2019.12.010)
• [L4] Although this may be an effective strategy to address failed prior biceps surgery, the potential complication of persistent pain must be emphasized. [180] (10.1177/0363546519892922)
• [L1] This study found no difference in the functional outcomes or pain relief between proximal vs subpectoral biceps tenodesis. [185] (10.1177/2325967116s00195)
• [L5] Both tenotomy and tenodesis are effective in relieving pain from biceps tendon disorder in the presence of rotator cuff tears. [187] (10.1016/j.csm.2015.08.010)
• [L4] Postoperative imaging should be considered including either computed tomography low enough to visualize the tenodesis site or multiple views on plain radiography. [188] (10.1016/j.jses.2019.07.007)
• [L5] Additional care should be taken when operating on patients with previous biceps tenodesis to prevent perioperative fractures. [189] (10.5397/cise.2021.00528)
• [L2] Outcomes appear similar between biceps tenotomy versus tenodesis; however, the tenotomy group demonstrated greater incidence of cosmetic deformity but an earlier improvement in postoperative pain. [190] (10.1007/s00167-019-05682-1)
• [L3] Loop 'N' Tack biceps tenodesis and subpectoral biceps tenodesis techniques are reliable and effective procedures that can reduce pain scores and restore shoulder function when patients require surgical intervention. [196] (10.1016/j.jseint.2023.03.015)
• [L4] [197] (10.1007/s00402-017-2810-z)
• [L5] Biceps tendon pain in the absence of tears is associated with microscopic changes consistent with tendinopathy, which are often missed by MRI. [198] (10.1016/j.csm.2015.08.002)
• [L4] [199] (10.1016/j.arthro.2012.02.019)
• [L4] [202] (10.1177/03635465261426560)
• [L3] [205] (10.1016/j.arthro.2008.04.017)
• [L5] [206] (10.1016/j.eats.2021.11.023)
• [L5] Diagnosis of long head biceps tendon and subscapularis pathology in association with shoulder rotator cuff pathology can be challenging due to limitations in MRI and arthroscopic visualization; surgeons should maintain a high level of suspicion and utilize specific techniques to prevent missing pathology. [208] (10.1016/j.arthro.2017.09.005)
• [L4] The cumulative fracture rate after biceps tenodesis was 0.53% in the five studies that reported this complication, with a mean fracture rate of 1.0% ± 1.6%. [210] (10.1016/j.jor.2021.11.014)
• [L3] Patients undergoing primary rotator cuff repair with concomitant biceps tenodesis had 35% reduced odds of revision biceps tenodesis and 23% reduced odds of any all-cause revision within 4 years when compared with those without concomitant biceps tenodesis. [214] (10.5435/jaaosglobal-d-24-00046)
• [L4] An overall complication rate of 2.4% validates the hypothesis of a low complication rate after subpectoral biceps tenodesis. [217] (10.1016/j.jse.2013.07.007)
• [L1] This systematic review of 5 moderate risk of bias studies demonstrated that the most common reasons for revision biceps tenodesis were pain or cramping and rerupture. [219] (10.1016/j.arthro.2021.04.063)
• [L4] Arthroscopic biceps tenodesis performed at the articular margin results in a low surgical revision rate, a low rate of residual pain, and significant improvement in objective shoulder outcome scores. [220] (10.1016/j.arthro.2014.08.024)
• [L3] The overall complication rate of LHBT tenodesis was low. [223] (10.1016/j.jse.2018.09.005)
• [L4] The study demonstrates high patient satisfaction (86%) and significant improvement in functional outcomes with revision biceps tenodesis after previous failed tenodesis or tenotomy. [224] (10.1177/2325967118s00106)
• [L3] Although tenotomy was associated with shorter operative times, patients experienced longer hospital stays, higher readmission rates, and more serious adverse events compared to tenodesis, with these differences remaining significant after adjusting for demographics and comorbidities. [225] (10.1016/j.jseint.2024.04.003)
• [L4] When adjusting for confounding factors, performing concomitant biceps tenodesis with rotator cuff repair does not lead to a difference in postoperative complication rate or risk for revision surgery. [226] (10.1016/j.asmr.2020.05.010)
• [L3] Reoperation rates were significantly higher in patients undergoing shoulder arthroscopy with biceps tenodesis than in patients undergoing shoulder arthroscopy without biceps tenodesis. [228] (10.1016/j.jses.2019.08.002)
• [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. [230] (10.1016/j.eats.2021.12.029)
• [L3] Our results show a notably increased incidence of postoperative stiffness after arthroscopic suprapectoral biceps tenodesis compared with open subpectoral biceps tenodesis. [233] (10.1016/j.arthro.2014.03.024)

See Also

• Rotator Cuff Repair
• Rotator Cuff
• Total shoulder arthroplasty
• Fractures
• Shoulder Arthroscopy

References

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