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Loop versus anchor tenodesis of the long head of the biceps tendon: a prospective randomized controlled pilot study
Martin Bischofreiter1,2, Christina Kölblinger3,4, Michael Gattringer3,5,4
1Department of Orthopedic Surgery (Teaching Department of the Paracelsus Medical University Salzburg), Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopedic Excellence, 4020, Linz, Austria. m.bischofreiter@utanet.at.
Background:
The long head of the biceps tendon is a frequent source of anterior shoulder pain, often treated with tenodesis. While anchor tenodesis is well established, it carries risks of implant-related complications. This study evaluates an implant-free "loop tenodesis" technique as a potentially safer and cost-effective alternative.
Methods:
In this prospective, double-blinded, randomized exploratory study, 48 patients undergoing arthroscopic biceps tenodesis were randomized to either loop (n = 24) or anchor (n = 24) tenodesis. Clinical outcomes were assessed using ASES, Constant, and DASH scores, as well as range of motion, supination strength, satisfaction, aesthetic appearance, and return-to-sport. Statistical analysis was performed using the Mann-Whitney U and Wilcoxon signed-rank tests to compare non-parametric data.
Results:
Both groups showed significant improvements with similar gains in functional scores. Supination strength recovery was greater in the loop group (103% vs. 93%). There were no significant differences in range of motion or complications. Notably, only the anchor group showed cases of Popeye deformity (2 patients). Return to sport was achieved in 95.3% of patients, typically within 3 months. No revision or implant-related issues occurred.
Conclusion:
Loop tenodesis offers equivalent clinical outcomes to anchor-based techniques, with fewer aesthetic concerns and no implant-associated risks, making it a safe, reliable, and cost-effective alternative for biceps tenodesis.