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Subpectoral versus suprapectoral biceps tenodesis yields similar clinical outcomes: a systematic review
  1. John W Belk1,
  2. Stephen G Thon1,2,
  3. John Hart1,2,
  4. Eric C McCarty, Jr.1,
  5. Eric C McCarty1,2
  1. 1 Department of Orthopaedics, University of Colorado at Boulder, Boulder, Colorado, USA
  2. 2 Department of Orthopedics, University of Colorado Denver School of Medicine, Aurora, Colorado, USA
  1. Correspondence to Dr Eric C McCarty, Orthopaedics, University of Colorado at Boulder, Boulder, CO 80309, USA; eric.mccarty{at}


Importance Arthroscopic suprapectoral biceps tenodesis (ABT) and open subpectoral biceps tenodesis (OBT) are two surgical treatment options for relief of long head of the biceps tendon (LHBT) pathology and superior labrum anterior to posterior (SLAP) tears. There is insufficient knowledge regarding the clinical superiority of one technique over the other.

Objective To systematically review the literature in order to compare the clinical outcomes and safety of ABT and OBT for treatment of LHBT or SLAP pathology.

Evidence review A systematic review was performed by searching PubMed, the Cochrane Library and Embase to identify studies that compared the clinical efficacy of ABT versus OBT. The search phrase used was: (bicep OR biceps OR biceps brachii OR long head of biceps brachii OR biceps tendinopathy) AND (tenodesis). Patients were assessed based on the American Shoulder and Elbow Surgeons Score, the visual analogue scale, the Single Assessment Numeric Evaluation, Constant-Murley Score, clinical failure, range of motion, bicipital groove pain and strength. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and both the Cochrane Collaboration’s and Risk of Bias in Non-randomised Studies - of Interventions (ROBINS-I) risk of bias tools were used to evaluate risk of bias.

Findings Eight studies (one level I, seven level III) met inclusion criteria, including 326 patients undergoing ABT and 381 patients undergoing OBT. No differences were found in treatment failure rates or patient-reported outcome scores between groups in any study. One study found OBT patients to experience significantly increased range of shoulder forward flexion when compared with ABT patients (p=0.049). Two studies found ABT patients to experience significantly more postoperative stiffness when compared with OBT patients (p<0.05).

Conclusions Patients undergoing ABT and OBT can be expected to experience similar improvements in clinical outcomes at latest follow-up without differences treatment failure or functional performance. ABT patients may experience an increased incidence of stiffness in the early postoperative period.

Level of evidence III.

  • shoulder
  • outcome studies
  • sports medicine research
  • orthopaedic sports medicine
  • orthopaedic procedures

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. n/a.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. n/a.

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  • Contributors Conception and design: all authors; administrative support: JH, ST, ECM and JWB; provision of study materials or patients: JH, ST, ECM and JWB; collection and assembly of data: JH, ST, ECM and JWB; data analysis and interpretation: JH, ST, ECMC and JWB; manuscript writing: all authors; final approval of manuscript: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer There are no competing interests for any author. There was no funding required for this project. There was no ethical approval required for this project. There are no acknowledgements for this project. All data were available to all authors for the entirety of this project.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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