program committee for this opportunity to present our research. We have no pertinent disclosures. It's been well established that pathology related to the long head of the biceps tendon and superior labrum has been, it can be a major source of shoulder pain and dysfunction. While tenotomy is one surgical option, biceps tenodesis is more commonly performed with methods described by surgical approach, location, and method of fixation. Fixation can be performed with a variety of implants, both absorbable and non-absorbable, such as anchors, screws, and buttons, and can utilize either an onlay or inlay fixation of the tendon. Critically, all methods of fixation require, are at risk for neurovascular injury, fracture, or rupture, and those using hardware have specific complications and associated costs which can potentially be avoided with an implant-free technique. Our technique is an adaptation of the Caspari-Weber, which is an implant-free inlay fixation of the biceps tendon in a subpectoral location. To accomplish this, we drill a socket for the tendon with suture fixation tied over the tendon, compressed to the anterior humeral cortex. While this method has previously been described and tested biomechanically, there are limited case series reporting clinical outcomes. Therefore, the purpose of our study was to examine the outcomes and complication rates of the implant-free subpectoral biceps tenodesis in an active population. This was a retrospective review of all consecutive cases over a five-year period by two different surgeons who utilized both the same open subpectoral implant-free technique. All patients have a minimum of two-year follow-up. 182 patients were included, with over 70% being active-duty military members at the time of surgery. The average age was 46 years old, and the average follow-up was 4.3 years. Our overall complication rate was 4.4%, and our revision surgery rate was 0.5%. Of our entire cohort, only one patient did not achieve cosmetic satisfaction. Active-duty members comprised 70% of our population, with a similar complication rate and almost a 97% return to full duty. Our two major complications were the development of Popeye deformities, with one patient electing for a revision procedure. All six of our minor complications were superficial infections, which resolved with a single course of oral antibiotics. None of our 182 patients developed a deep infection, humeral shaft fracture, or a nerve injury. The rigors of active-duty military service, with deployments and annual physical fitness requirements, place significant demands on the shoulder. Return to active military duty rates has served as an analogous outcome measure for return to support rates in the civilian literature. Two recent studies, one featuring over 18,000 bicep tenodesis procedures completed by those in board collection, and the other comparing nearly 500 arthroscopic and open bicep tenodesis procedures, demonstrated complication rates that are similar to ours. From a cost perspective, a recently published paper looking at the cost analysis of the bicep tenodesis procedure determined that overall, an open approach translates to a cost savings of approximately 15% over an arthroscopic approach. Furthermore, though implant costs can change based on a number of variables, our implant-free technique undeniably will have a lower cost, since it requires only a number two permanent braided suture. Although our study is a non-randomized retrospective review, it is inclusive of all consecutive patients undergoing this procedure for primary bicep tenodesis, which thereby minimizes our selection bias. Additionally, we believe our decision to include all patient with with concomitant procedures improves the external validity of this study, as the majority of bicep tenodesis procedures are now performed not in isolation, but in combination with other shoulder procedures. This study represents the largest in VivoCase series to date, utilizing the open sub-pectoral implant-free bicep tenodesis technique, and it's been demonstrated to have high functional outcomes in a young active population with a low complication rate. This technique completed via familiar surgical approach, which allows for a relatively short learning curve for those who are already performing open tenodesis with another fixation method. Our failure rate and complication rates are in line with techniques using implants, but our technique represents a potential significant cost savings, particularly compared to those done arthroscopically. Thank you.

implant-free subpectoral biceps tenodesis technique

shoulder pain

shoulder dysfunction

suture fixation

complication rate