"Triple-Fix" Arthroscopic Biceps Tenodesis: Indications and Technique

Pathology of the long head of the bicep tendon is a common cause of anterior shoulder pain and frequently is treated surgically using either tenodesis or tenotomy. Tenodesis often is the preferred technique for younger, more active patients and laborers, especially when cosmesis and preservation of function are clinical priorities. However, the security of the tenodesis varies with fixation methods and techniques, and failure of the tenodesis can have both cosmetic and symptomatic consequences. Traditional arthroscopic tenodesis also can be technically challenging, as it usually requires extra-articular identification of the bicep tendon within the bicipital groove. The arthroscopic surgical technique described is an approach that has been routinely employed by the senior author for approximately 8 years that allows for accurate and reproducible exposure of the biceps tendon within the bicipital groove along with secure, anatomic tenodesis of the long head of the bicep tendon.