Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 23, Issue 2, pp 596–599 | Cite as

Subpectoral biceps tenodesis: a new technique using an all-suture anchor fixation

  • Wei-Ren Su
  • Florence Y. Ling
  • Chih-Kai Hong
  • Chih-Hsun Chang
  • Cheng-Li Lin
  • I-Ming JouEmail author


There are several options for LHB tenodesis; yet, there is no standard of care. This technical note describes an extramedullary all-suture anchor technique for LHB tenodesis that is similar to the extramedullary cortical button technique. The LHB tenodesis is performed by using the Y-Knot (1.3-mm; ConMed Linvatec, Largo, FL).The biceps tenotomy is completed arthroscopically, and a standard subpectoral approach is used for the tenodesis. A reamer is first used to drill through the anterior cortex of the humerus; subsequently, a 1.3-mm drill bit is used to drill through the posterior cortex. The Y-Knot anchor is passed through the bone tunnel and secured on the posterior cortical bone. A modified rolling hitch suture is placed 10 mm distal to the end of the LHB tendon by using one suture limb of the Y-Knot anchor. The other suture limb is pulled to shuttle the LHB tendon into the humerus, and the construct is fixed by tying down one limb to the other. This technical note describes an alternative method for subpectoral biceps tenodesis and uses a small drill hole, conserves bone, and minimizes trauma to the tendon.

Level of evidence V.


Subpectoral biceps tenodesis All-suture anchor Y-Knot anchor Cortical button 

Supplementary material

Supplementary material 1 (MPG 23148 kb)


  1. 1.
    Arora AS, Singh A, Koonce RC (2013) Biomechanical evaluation of a unicortical button versus interference screw for subpectoral biceps tenodesis. Arthroscopy 29:638–644PubMedCrossRefGoogle Scholar
  2. 2.
    Barber FA, Herbert MA (2013) Cyclic loading biomechanical analysis of the pullout strengths of rotator cuff and glenoid anchors: 2013 update. Arthroscopy 29:832–844PubMedCrossRefGoogle Scholar
  3. 3.
    Boileau P, Krishnan SG, Coste JS, Walch G (2002) Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation. Arthroscopy 18:1002–1012PubMedCrossRefGoogle Scholar
  4. 4.
    Dein EJ, Huri G, Gordon JC, McFarland EG (2014) A humerus fracture in a baseball pitcher after biceps tenodesis. Am J Sports Med 42:877–879PubMedCrossRefGoogle Scholar
  5. 5.
    Dwyer T, Willett TL, Dold AP, Petrera M, Wasserstein D, Whelan DB, Theodoropoulos JS (2013) Maximum load to failure and tensile displacement of an all-suture glenoid anchor compared with a screw-in glenoid anchor. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-013-2760-0 Google Scholar
  6. 6.
    Frost A, Zafar MS, Maffulli N (2009) Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps Brachii. Am J Sports Med 37:828–833PubMedCrossRefGoogle Scholar
  7. 7.
    Gartsman GM, Hammerman SM (2000) Arthroscopic biceps tenodesis: operative technique. Arthroscopy 16:550–552PubMedCrossRefGoogle Scholar
  8. 8.
    Hong CK, Chang CH, Chiang CH, Jou IM, Su WR (2014) Hamstring graft preparation using a modified rolling Hitch technique. Arthrosc Tech. doi: 10.1016/j.eats.2014.01.010 PubMedCentralPubMedGoogle Scholar
  9. 9.
    Koch BS, Burks RT (2012) Failure of biceps tenodesis with interference screw fixation. Arthroscopy 28:735–740PubMedCrossRefGoogle Scholar
  10. 10.
    Mazzocca AD, Bicos J, Santangelo S, Romeo AA, Arciero RA (2005) The biomechanical evaluation of four fixation techniques for proximal biceps tenodesis. Arthroscopy 21:1296–1306PubMedCrossRefGoogle Scholar
  11. 11.
    Mazzocca AD, Chowaniec D, Cote MP, Fierra J, Apostolakos J, Nowak M, Arciero RA, Beitzel K (2012) Biomechanical evaluation of classic solid and novel all-soft suture anchors for glenoid labral repair. Arthroscopy 28:642–648PubMedCrossRefGoogle Scholar
  12. 12.
    Mazzocca AD, Rios CG, Romeo AA, Arciero RA (2005) Subpectoral biceps tenodesis with interference screw fixation. Arthroscopy 21:896PubMedGoogle Scholar
  13. 13.
    Patzer T, Rundic JM, Bobrowitsch E, Olender GD, Hurschler C, Schofer MD (2011) Biomechanical comparison of arthroscopically performable techniques for suprapectoral biceps tenodesis. Arthroscopy 27:1036–1047PubMedCrossRefGoogle Scholar
  14. 14.
    Provencher MT, LeClere LE, Romeo AA (2008) Subpectoral biceps tenodesis. Sports Med Arthrosc 16:170–176PubMedCrossRefGoogle Scholar
  15. 15.
    Romeo AA, Mazzoca AD, Tauro JC (2004) Arthroscopic biceps tenodesis. Arthroscopy 20:206–213PubMedCrossRefGoogle Scholar
  16. 16.
    Sears BW, Spencer EE, Getz CL (2011) Humeral fracture following subpectoral biceps tenodesis in 2 active, healthy patients. J Shoulder Elbow Surg 20:e7–e11PubMedCrossRefGoogle Scholar
  17. 17.
    Snir N, Hamula M, Wolfson T, Laible C, Sherman O (2013) Long head of the biceps tenodesis with cortical button technique. Arthrosc Tech 2:95–97CrossRefGoogle Scholar
  18. 18.
    Wu PT, Jou IM, Yang CC, Lin CJ, Yang CY, Su FC, Su WR (2014) The severity of the long head biceps tendinopathy in patients with chronic rotator cuff tears: macroscopic versus microscopic results. J Shoulder Elbow Surg 23:1099–1106PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2014

Authors and Affiliations

  • Wei-Ren Su
    • 1
    • 4
  • Florence Y. Ling
    • 2
  • Chih-Kai Hong
    • 3
  • Chih-Hsun Chang
    • 3
  • Cheng-Li Lin
    • 1
  • I-Ming Jou
    • 1
    • 4
    Email author
  1. 1.Department of Orthopaedic SurgeryNational Cheng Kung University HospitalTainanTaiwan
  2. 2.University of Texas Health Science Center at San Antonio School of MedicineSan AntonioUSA
  3. 3.Department of MedicineNational Cheng Kung University College of MedicineTainanTaiwan
  4. 4.Medical Device Innovation CenterNational Cheng Kung UniversityTainanTaiwan

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