Outcomes Following Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodesis at Short- to Midterm Follow-up: A Systematic Review

Abstract

Background:

Biceps tenodesis (BT) is performed to address symptomatic tendinopathy, partial tears, and instability of the long head of the biceps tendon to provide pain relief and improve function. Debate persists regarding which technique is optimal: arthroscopic suprapectoral BT (ASPBT) or open subpectoral BT (OSPBT).

Purpose:

To systematically review the literature to evaluate clinical and patient-reported outcomes (PROs), complications, and reoperations after ASPBT versus OSPBT.

Study Design:

Systematic review; Level of evidence, 4

Methods:

Studies published in the PubMed, Embase, and Cochrane Library databases reporting outcomes of OSPBT or ASPBT from inception to August 2025 were identified. Inclusion criteria included studies reporting patients undergoing BT with lesion cause, surgical technique, concomitant procedures, complications, reoperations, and any PROs.

Results:

A total of 43 studies, consisting of 11,113 patients undergoing BT, with a weighted mean follow-up of 23.8 months (range, 0.7-133.20 months), were identified. The weighted mean patient age was 54.3 years (range, 16-91 years), and 66% of the patients were male. OSPBT was performed in 53.9% (5987/11,113) of patients, while 46.1% (5126/11,113) underwent ASPBT. A significantly higher percentage of superior labrum anterior to posterior (SLAP) lesions were reported in OSPBT patients (33.1%; 403/1217) (P < .001). Rotator cuff repair and subacromial decompression were the most common concomitant procedures. Fixation with interference screws was most common during OSPBT (69.9%; 2449/3503) and ASPBT (65.7%; 1548/2357), while suture anchor fixation was utilized in a higher percentage of ASPBT procedures (21.9% [517/2357] vs 11.6% [407/3503]; P < .001). Both techniques resulted in improvement in various PROs. Complications were reported in 5.6% (496/8784) of patients, with postoperative stiffness most frequent, occurring in a significantly greater proportion of ASPBT patients (2.5% [103/4048] vs 1.4% [66/4736]; P < .001). OSPBT was associated with a higher percentage of wound infections (1.1% [51/4736] vs 0.5% [22/4048]; P = .006) and nerve-related complications (1.1% [50/4736] vs 0.2% [7/4048]; P < .001). No significant differences were reported between groups in the incidence of “Popeye” deformities, implant failures, or overall complications. Reoperations were performed more frequently after ASPBT (1.9% [77/4048] vs 1.1% [52/4736]; P = .002).

Conclusion:

This systematic review of 43 studies found that both ASPBT and OSPBT were associated with improvement in a variety of PROs, while complication rates were comparable between techniques. While ASPBT is associated with a higher incidence of postoperative stiffness and a greater rate of reoperations, OSPBT was reported to lead to a higher incidence of wound infections and iatrogenic nerve injuries.