Subpectoral Biceps Tenodesis

Subpectoral biceps tenodesis is a minimally invasive surgical technique that efficiently and reproducibly addresses long head of the biceps (LHB) tendon pathology. Indications for biceps tenodesis include traumatic and degenerative tearing, biceps instability, rupture, and failed surgery. Subpectoral tenodesis may be a preferred technique in the setting of complete LHB rupture, failed tenotomy, or prior tenodesis. The LHB tendon is tenotomized arthroscopically at its origin, and a miniopen subpectoral approach is used to identify the tendon distally. Fixation is performed deep and just proximal to the inferior margin of the pectoralis major muscle. Fixation in this area can be achieved through the use of bone tunnels, an interference screw, suture anchor(s), or a cortical button. Attention is given to maintain the native position of the LHB musculotendinous junction relative to the inferior border of the pectoralis major. This technique maintains the biceps length–tension relationship and addresses intertubercular biceps pathology by eliminating pain generators within the bicipital groove. Superior biomechanical properties are achieved using interference screw fixation, and a single suture is added for reinforcement. Complications may occur in approximately 2% of patients and include infection, fixation failure, cosmetic deformity, cramping, fracture, and nerve injury.