Comparison of Clinical Failure Rates After 2 Techniques of Subpectoral Mini-Open Biceps Tenodesis: Sequence and Suture Passage Technique Matter

BACKGROUND A number of techniques are available for performing biceps tenodesis, the majority of which result in good or excellent outcomes. However, failure may result in pain and/or dissatisfying biceps deformity. PURPOSE To compare the clinical failure rates of 2 methods of suture passage in subpectoral biceps tenodesis with suture anchors performed by the senior author. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective chart review was conducted of patients who underwent biceps tenodesis under the care of the senior author. Operative notes were used to determine whether the procedure was performed with a BirdBeak (BB) suture passer or a free needle (FN). Each subsequent clinical follow-up note was used to determine participation in physical therapy and duration, follow-up duration, and whether clinical tenodesis failure had occurred. Biceps tenodesis failure was defined as either cosmetic deformity ("Popeye" sign), pain at the tenodesis site, or need for revision. RESULTS Overall, 163 patients met the inclusion criteria (BB, n = 112; FN, n = 51). Mean follow-up was 5.3 months and 4.1 months in the BB and FN groups, respectively. Significantly more tenodesis failures occurred in the BB group (BB, 12%; FN, 2%, P = .042). Among all BB patients, 10% experienced failure due to cosmetic deformity, 2% required revision, and 4% had postoperative pain at the tenodesis site by latest follow-up. The 1 patient in the FN group who experienced failure presented with cosmetic deformity postoperatively. CONCLUSION Biceps tenodesis with the use of an FN to pass the suture resulted in a significantly lower clinical failure rate compared with the use of a BB suture passer.