Operative Techniques in Sports Medicine Suprapectoral Biceps Tenodesis

Tendonosis of the long head of the biceps (LHBT) is a common etiology of anterior shoulder pain. Management of LHBT pathology should begin with nonoperative treatment consisting of nonsteroidal anti-inflammatory medication, physical therapy, activity modification, and injections. However, operative intervention may be considered in patients who fail conservative treatment. Multiple operative techniques have been described in the literature, but tenodesis procedures have become an attractive option over tenotomy for its improved postoperative cosmesis and strength. The arthroscopic suprapectoral biceps tenodesis technique is a minimally invasive approach in treating LHBT tendonosis while still providing a strong, reliable method of fixation. It has improved upon some of the initial challenges encountered with earlier all-arthroscopic proximal tenodesis procedures by further defining relevant anatomy for bone tunnel placement and methods of fixation. These advancements in the suprapectoral technique have resulted in patient-reported outcomes that are equivalent to other tenodesis procedures. This article will review the arthroscopic suprapectoral biceps tenodesis technique and describe key technical pearls to provide a safe and dependable surgical option for treating LHBT pathology. In addition, the article will discuss risks related to the procedure and patient outcomes after surgery.