Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodesis: Radiographic Characteristics

Area of Science:

• Orthopedic surgery
• Shoulder arthroscopy
• Biceps tendon pathology

Background:

• The long head of the biceps (LHB) tendon is a common source of shoulder pain.
• LHB tenodesis is a surgical procedure to address LHB tears or instability.
• Techniques for LHB tenodesis include open subpectoral and all-arthroscopic suprapectoral approaches.

Purpose of the Study:

• To compare the radiographic location of tenodesis tunnels created with an all-arthroscopic suprapectoral technique versus an open subpectoral technique.
• To analyze differences in tunnel placement relative to anatomical landmarks on the humerus.

Main Methods:

• A prospective cohort of patients undergoing all-arthroscopic suprapectoral LHB tenodesis was compared to a retrospective cohort undergoing open subpectoral LHB tenodesis.
• Postoperative anteroposterior radiographs were analyzed to measure distances from the tenodesis tunnel sites to the humeral head and bicipital groove.
• Key measurements included distance to the inferior border of the bicipital groove and humeral diameter at the tenodesis site.

Main Results:

• The open subpectoral group had tenodesis tunnels placed significantly more distally (mean 28 mm) compared to the all-arthroscopic suprapectoral group (mean 33.7 mm).
• The humeral diameter was significantly narrower at the tenodesis site in the open subpectoral group.
• While most tunnels were distal to the bicipital groove in both groups, the open technique utilized a significantly narrower humeral region for fixation.

Conclusions:

• There are significant differences in tenodesis tunnel location between all-arthroscopic suprapectoral and open subpectoral techniques.
• The open subpectoral method results in fixation within a narrower region of the humerus compared to the arthroscopic approach.