Arthroscopic Proximal Subpectoral Tenodesis of the Long Head of the Biceps

Biceps tenodesis is a common treatment method for biceps pathology. When tenodesis is located in intra-articular or suprapectoral areas, the biceps is fixed proximally to the zone of degeneration and inflammation, which can cause residual pain as a possible postsurgical complication. The main advantage of this method is that this technique is comparatively easy and can be performed arthroscopically. Typically, in terms of professional athletes, the best post-biceps tenodesis results are observed after undergoing subpectoral tenodesis because of the solid fixation and localization distally to any kind of biceps tendon degeneration and inflammation zone. However, subpectoral tenodesis has several disadvantages, as it is an open procedure that can lead to possible scar and hematoma formation, infection, bioabsorbable screw reaction, neurovascular injury, and fractures. Soft-tissue tenodesis to the proximal part of pectoralis major tendon is a well-known step in shoulder arthroplasty surgery and shows acceptable results. We suggest a technique of proximal subpectoral arthroscopic tenodesis, which combines the advantages of the location in the subpectoral zone with an all-suture anchor and that of soft-tissue tenodesis to the pectoralis major tendon, which can be performed fully arthroscopically, improving results in terms of healing by increasing the contact area.