Our disclosures can also be found online. We're all aware of the fact that the long head of the biceps contributes to symptoms of anterior shoulder pain. Surgical techniques have been described as mini-opened and arthroscopic. Open may confer a higher risk of catastrophic injury. Arthroscopic is more technically challenging. Fixation devices such as all suture anchors and interference screws have been utilized. In vitro biomechanical studies have been performed, but in vivo data is needed. We recently published a randomized control trial looking at supra versus sub-pectoral biceps tenodesis with an interference screw. We found no significant clinical differences at a 2.9-year follow-up, suggesting that whether it's arthroscopic or mini-open outcomes will be equivalent. Our biomechanical work comparing all suture anchors to interference screws to conventional suture anchors demonstrate that there's less construct elongation with the interference screws. The all suture suture anchors have about a centimeter more elongation, but torsionally they're stronger as there's less violation of the cortex. The purpose of this study is to utilize radiostereometric analysis of the biceps tenodesis construct and to compare an arthroscopic versus open techniques with interference screws and single suture, all suture anchors. The secondary outcome was PROs. This is a non-randomized prospective cohort study. It was a consecutive series of patients performed over a year and a half. Our inclusion criteria were for patients over 18 with clinically symptomatic biceps pathology. We excluded patients with ruptures with subscapularis tears in previous surgeries. This is our flow diagram. You can note that there's about 30 patients in each group. To summarize briefly, there's two groups that are arthroscopic and two that are mini-open. The mini-open groups had either one single all suture anchor or an interference screw, and the arthroscopic groups were an interference screw and two all suture, single suture anchors. A bead fixation with this tantalum bead, which is radiopaque, was performed under direct visualization for the open procedures. Arthroscopically, with the interference screw technique, you could actually extract the tendon as I'll show you here in this video. So, this is the arthroscopic technique. We'll march along. Tendon is whip stitched in its usual manner. The socket is drilled about a centimeter and a half above the superior border of the pec major tendon. And we'll speed along here. Standard whip stitch, and there's a tantalum bead just distal to the screw. We're more familiar with the subpectoral technique, and we can speed along here. Nothing unique, aside from placement of that tantalum bead. We obtained AP radiographs immediately post-op at one week and at three months. We placed a marker on the films to allow for normalization secondary to magnification. We obtained PROs preoperatively and at final follow-up, and throughout their evaluation in the first three months, we obtained constant scores, same scores, promised scores, and we looked at achievement of MCID, SCB, and PASS. Statistical analyses that utilized standard tests, Fisher-Exact, Kruskal-Wallis, Inova, and Chi-Square. With respect to the demographics, there were differences in mean age, dominant side, workers' compensation claim status, along with concurrent glenohumanoid joint abreviations. With respect to bead migration, there was significantly less migration with the interference screw construct with both the open and arthroscopic techniques. These are pairwise comparisons that are performed at one week. I'll draw your attention there to the red box. There was five-fold more migration with the open and arthroscopic single suture, all suture anchor technique. There were no differences when you used an interference screw, whether it was open or arthroscopic. You can see there's about one to two with the interference screws, and about seven or eight millimeters with the suture, all suture anchors. At three months, we performed pairwise analyses, and the only outlier here is a three-fold increase in migration with the open technique in a single all suture, suture anchor. There were no differences in PROs at any time points between the four groups. We had complications, revision surgeries in two patients who underwent tinnitus with the all suture, suture anchors, and three who underwent surgery with the interference screw. There were no surgeries performed for biceps tinnitus failure. They were performed for primarily symptoms of stiffness. There were no Popeyes in the interference screw groups. There were three Popeyes in the open group with one all suture, suture anchor, and there was one Popeye in the group with two all suture, suture anchors. The migration was about six to 10 centimeters in those patients who developed Popeyes. This study had limitations. There were differences in concurrent surgical procedures. There was a 10-year difference. Patients with an open technique and a single suture all suture anchor were 10 years younger. We mitigated errors in radiographic capture with normalization. The RSA analysis at three months may not represent the ultimate endpoints that could be further investigated. The rehab compliance was also not assessed. In conclusion, arthroscopic and open tinnitus with an interference screw has the least migration and equivalent outcomes and no Popeye deformities. At three months follow-up, an open technique with a single suture all suture anchor had significantly greater migration versus the other groups. Despite these differences, there were no differences in clinical outcomes at almost three years. Most patients achieved CSOs in all arms. If you had a Popeye, there was about seven centimeters of migration. The clinical implications are that interference screws are stiff. You should avoid over-tensioning when utilizing them and try to place the socket about a centimeter distal to the proximal border of the pec major tendon. And if you use a single suture all suture anchors, consider using two or consider using a double-loaded anchor. Thank you so much.

surgical techniques

anterior shoulder pain

long head of the biceps

arthroscopic procedure

mini-open procedure