Arthroscopic Bicortical Biceps Anchorage: An Arthroscopic-Assisted Technique for Subpectoral Biceps Tenodesis

Long head of the biceps tendon pathology is a frequent cause of anterior shoulder pain. Tenotomy is technically simple but may lead to cosmetic deformity and muscle cramping, whereas tenodesis better preserves the biceps contour but involves a more complex procedure. Multiple surgical techniques and fixation methods are available. No single technique has emerged as clinically superior, and no gold standard has been established. Among the various techniques and fixation sites, subpectoral placement within cancellous bone has been proposed as a favorable option for long head of the biceps tendon tenodesis. This technical note describes a surgical approach-arthroscopic bicortical biceps anchorage-which combines subpectoral positioning, arthroscopic execution, and inlay fixation using a bicortical button. Nevertheless, the surgical technique is associated with a substantial learning curve and may involve a theoretical risk of neurovascular injury related to bicortical drilling. These considerations underscore the need for further biomechanical and clinical evaluation.