Where to tenodese the biceps: proximal or distal?
BACKGROUND
The best location for biceps tenodesis is controversial as surgeons have begun to question whether tenodesis location affects the incidence of residual bicipital postoperative pain. An open distal tenodesis technique has been previously proposed to eliminate remaining symptoms at the bicipital groove.


OBJECTIVE
We asked the following questions: (1) Does a higher tenodesis in the biceps groove result in postoperative pain? And (2) can the tenodesis location be successfully moved more distally ("suprapectoral tenodesis") by an arthroscopic technique?


METHODS
We retrospectively reviewed 17 patients undergoing arthroscopic biceps tenodesis and evaluated their tenodesis location, either within the upper half of the groove (five) or in the lower half of the groove or shaft (12). Patient outcomes were assessed with visual analog scale scores for pain, American Shoulder and Elbow Surgeons scores, and Constant-Murley scores. Minimum followup was 12 months (mean, 28 months; range, 12-69 months).


RESULTS
Two patients had persistent pain at 12 months; both had a tenodesis in the upper half of the groove. The overall American Shoulder and Elbow Surgeons and Constant-Murley scores were improved at latest followup.


CONCLUSIONS
Arthroscopic suprapectoral biceps tenodesis represents a new technique for distal tenodesis. Our preliminary observations suggest a more distal tenodesis location may decrease the incidence of persistent postoperative pain at the bicipital groove, although additional research is needed to definitively state whether the proximal location is in fact more painful.


METHODS
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Department of Orthopaedic Surgery, Mount Sinai Hospital, 5 East 98th Street, Box 1188, New York, NY 10029, USA.
David M
DM
Lutton
Konrad I
KI
Gruson
Alicia K
AK
Harrison
James N
JN
Gladstone
Evan L
EL
Flatow
D001132:Arm; D001182:Arthroscopy / Q000009:adverse effects; D006801:Humans; D009519:New York City; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D053656:Tenodesis / Q000009:adverse effects / Q000379:methods*; D013717:Tenosynovitis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome