Editorial Commentary: Aim High or Go Low? Outcomes Are Equivalent for Arthroscopic Suprapectoral and Mini-open Subpectoral Biceps Tenodesis

Abstract

The contemporary management of biceps-labral pathology has increasingly transitioned toward primary treatment of the long head of the biceps tendon, largely in response to more consistent outcomes relative to SLAP repair and so-called benign neglect. Accordingly, there has been renewed interest in evaluating relevant differences between varying operative techniques and constructs for biceps tenodesis, including an array of subacromial, intra-articular, suprapectoral, and subpectoral methods. Among these, arthroscopic suprapectoral tenodesis and mini-open subpectoral tenodesis remain in contention for "best in show," albeit with distinctly different merits and risks. Important considerations with either technique include restoration of the native length-tension relation, avoidance of perioperative complications, surgical-site morbidity, and technical ease. Dogma aside, surgeons facile with both techniques can confidently counsel their patients on the comparable short-term results after suprapectoral or subpectoral biceps tenodesis.