Mini-Open Biceps Tenodesis Using an Onlay Technique With Enthesis Growth Augment

Acute ruptures of the long head of the biceps tendon are a frequent cause of anterior shoulder pain, weakness, and cosmetic deformity. Onlay constructs for long head of the biceps tendon tenodesis with suture anchors or buttons have shown comparable clinical outcomes to traditional inlay techniques. Complication rates with the onlay technique are generally low and are thought to result from failure of enthesis healing. This technique describes a biologically augmented onlay biceps tenodesis using a demineralized bone matrix enthesis implant (EnFix, Tetrous, Sherman Oaks, CA). The demineralized bone matrix implant provides osteoconductive and osteoinductive properties to enhance tendon-to-bone healing by promoting enthesis regeneration. This method offers a reproducible and biologically enhanced alternative for proximal biceps tenodesis that may optimize enthesis healing and reduce the risk of failure.