The biceps tendon has long been recognized as a pain generator in the shoulder. There are several surgical treatment options including tenotomy or tenodesis. Biceps tenodesis has been recommended over tenotomy because it avoids biceps muscle cramping, maintains elbow flexion and supination strength, and improves cosmesis. Indications for biceps tenodesis include biceps tears involving more than 50% of the tendon, medial biceps subluxation, some superior labral tears, and biceps subluxation combined with a subscapularis tear.
In our arthroscopic technique, we perform a tenodesis in its in situ position at the inferior portion of the bicipital groove with the biceps tendon still attached proximally, thereby maintaining the tendon's in situ length-tension relationship. In addition to this feature of our tenodesis, another difference between our technique and other described techniques using suture anchor fixation is that we release the transverse humeral ligament. In this article, we describe our technique and explain its advantages and limitations.