Mini-Open Subpectoral Biceps Tenodesis With an Onlay Knotless TensionTight Locking Button Technique

Although isolated long head of the biceps (LHB) pathology is relatively rare, it is commonly encountered in the treatment of concomitant intraarticular shoulder pathology such as subscapularis tear, SLAP tears, and coracoid impingement. Shoulder pain arising from the LHB generally occurs with overhead repetitive motion and activities of resisted pronation and supination of the forearm. Although there are several approaches to treatment and types of fixation used to address LHB tendon pathology, there is no clear superior method of surgical intervention. As opposed to intraosseous fixation with an inlay technique, an onlay technique fixes the tendon to the cortical surface with the advantage of decreased risk of torsional fracture and a smaller footprint with less bone loss. We describe our preferred technique for the treatment of the LHB tendon pathology using an all-knotless onlay TensionTight locking button technique with a mini-open subpectoral biceps tenodesis.