Treatment options for long head of biceps tendon tenodesis

The long head of the biceps tendon (LHBT) is frequently described as a primary "pain generator" in anterior shoulder pain. While both tenotomy and tenodesis are commonly employed for LHBT pathologies, no consensus exists on the optimal procedure, as neither has demonstrated clear superiority. It is widely recognized, however, that tenotomy is associated with a risk of "Popeye" deformity and aesthetic concerns, whereas tenodesis mitigates these issues. The tenodesis literature reveals a variety of LHBT fixation methods, which differ primarily in the location of fixation, the choice of implants, and the suturing technique. This article classifies these techniques into two main groups (subpectoral and non-subpectoral tenodesis) to provide an overview of the surgical techniques and to contrast their advantages and disadvantages, thereby assisting surgeons in individualized decision-making based on factors such as tendon quality, bone density, economic considerations, injury type, cosmetic concerns, and surgeon experience.