Arthroscopic shoulder anchorless biceps tenodesis: a novel intracapsular technique

Pathology of the long head of the biceps tendon (LHBT) is a common source of anterior shoulder pain and is frequently encountered during arthroscopic shoulder surgery. Although biceps tenodesis is widely performed, many existing techniques rely on implants that increase cost and may be associated with bone- or fixation-related complications. This paper describes a novel arthroscopic intracapsular soft-tissue biceps tenodesis technique emphasizing efficiency, reproducibility, and implant minimization. The LHBT is pierced percutaneously using a spinal needle approximately 1 cm proximal and lateral to the anterior portal with the patient in the lateral decubitus position. A simple 1.8-mm nonabsorbable suture is passed through the needle and retrieved arthroscopically through the anterior portal. The suture limb that was advanced through the needle is then retrieved from the subacromial space through the anterior portal with a probe thus leaving both limbs of the suture exiting through the anterior portal. A sliding arthroscopic knot is then tied in a blind fashion through the incision of the anterior portal thereby securing the biceps to the capsule in the rotator interval above the superior border of the subscapularis. This technique provides stable fixation while preserving the native length-tension relationship of the biceps and avoids interference screws or humeral drilling. This technique may represent an efficient, cost-effective option for arthroscopic biceps tenodesis, particularly when performed in conjunction with other shoulder procedures. Further comparative studies with larger cohorts and longer follow-up are warranted.