Failure Rates and Patient‐Reported Outcomes Are Similar Across 5 Arthroscopic, Suprapectoral Biceps Tenodesis Fixation Techniques

Purpose To compare failure rates and patient‐reported outcome measures (PROMs) across 5 arthroscopic, suprapectoral biceps tenodesis fixation techniques: tenodesis screw, tenodesis anchor, expanding tenodesis anchor, onlay with single all‐suture anchor, and soft tissue tenodesis in the bicipital groove with suture. Methods This was a retrospective cohort study approved by the Institutional Review Board, including patients age 18 years or older who underwent arthroscopic, suprapectoral biceps tenodesis between 2014 and 2024 with a minimum of 6 months of clinical follow‐up. Exclusion criteria included cervical pathology, chronic pain syndromes, revisions, and workers' compensation cases. Patients completed PROMs including pain Visual Analog Scale (VAS), the American Shoulder and Elbow Surgeons (ASES) survey, the Simple Shoulder Test (SST), and a site‐specific questionnaire. Clinical failures were recorded from clinic notes. Statistics were calculated using JMP Pro 18.0.1. Results In total, 351 patients were enrolled: 79 with tenodesis screw, 69 with tenodesis anchor, 74 with expanding tenodesis anchor, 55 with single all‐suture anchor, and 74 with soft tissue tenodesis. The average patient age was 61.7 ± 9.44 years for females and 61.8 ± 9.49 years for males. The average follow‐up was 4.70 ± 2.44 years for females and 4.82 ± 1.77 years for males. The clinical failure rate was 2.28% (n = 8: 2 females and 6 males) with no differences between fixation techniques ( P = .882). The overall rate of patient‐reported “Popeye” deformity was 4.84% (n = 17: 4 females and 13 males, P = .130). PROMs, including pain VAS, ASES, and SST scores, were comparable across techniques ( P = .280, .201, .095, respectively). Conclusions Patients had similar outcomes regardless of arthroscopic, suprapectoral biceps tenodesis fixation technique. Approximately 1 in 20 patients reported a perceived “Popeye” deformity with longer‐term follow‐up of 5 years. Level of Evidence Level III, retrospective comparative study.