Restoring the anatomic tension relationship of the long head of the biceps during tenodesis: A prospective, randomized controlled trial

Introduction Long head of the biceps (LHB) tendinopathy a common source debilitating shoulder pain. Biceps tenodesis is reserved for patients who fail conservative management, but the optimal tensioning technique remains unclear. This study compared outcomes following standard anatomic landmark-based versus patient-specific anatomic tensioning. We hypothesized that anatomic tensioning would yield decreased pain and superior patient outcomes. Methods A single-blinded randomized control trial (RCT) was conducted at a level-1 trauma center between October 2020 and December 2022. One hundred and sixty patients (56% male) were randomized to undergo standard landmark-based (control, 81) or patient-specific anatomic tensioning techniques (intervention, 79). American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) pain score, and range of motion (ROM) were compared at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year, postoperatively. Results At final postoperative follow-up, ASES scores, VAS scores, forward flexion, external rotation were similar between cohorts ( p = . 604, 0.308, 0.171, and 0.726, respectively). At 6 weeks, the intervention group demonstrated higher ASES scores (mean difference, 9.1; 95 CI: [0.1, 18.0]; p = . 048). Discussion Both biceps tenodesis tensioning techniques are acceptable in the management of LHB tendinopathy. Patient-specific tensioning may provide earlier functional improvement for patients desiring accelerated rehabilitation.