Tenodesis of the long head of the biceps-when and how exactly?

Pathologies of the long head of the biceps are a common cause of shoulder pain and are frequently associated with other lesions such as rotator cuff tears. Adequate management of these lesions is crucial for successful treatment of patients. In addition to tenotomy, which can be associated with Popeye deformities, muscle cramps and loss of strength, many different procedures have been developed for tenodesis of the long head of the biceps. These differ regarding location (suprapectoral vs. subpectoral), fixation technique (onlay vs. inlay), implants used (soft tissue tenodesis, anchor, interference screws, flip button, etc.) and surgical technique (open vs. arthroscopic). Overall, most techniques can be performed easily and are characterized by high primary stability. So far, there is no evidence that one distinct technique is superior to others. However, for patients with high functional demands, tenodesis with high primary stability seems to be advantageous and tenotomy may be preferable in elderly patients with low functional demands.