Summary

This meta-analysis provides evidence that both onlay and inlay biceps tenodesis for long head biceps tendinopathy result in improved clinical and functional outcomes and few “Popeye” deformities, with no statistically significant differences between either method.

Abstract

Introduction

Proximal biceps tenodesis is a common surgical treatment for tendinopathy of the long head of the biceps tendon (LHBT). A biceps tenodesis can be performed in many ways, with two of the most common techniques incorporating onlay or inlay fixation methods. The purpose of this meta-analysis was to compare the clinical outcomes and complications between onlay versus inlay humeral fixation for biceps tenodesis for LHBT pathology.

Methods

A literature search was conducted using PubMed, Embase and Cochrane Library. Only studies reporting outcomes and complications following onlay and inlay biceps tenodesis were included.

Results

Six studies with 418 total patients (252 onlay utilizing suture anchors, 166 inlay utilizing an interference screw), with a mean age of 56.84 years were included. No significant difference in forward flexion or external rotation was found between techniques. VAS pain scores, Constant Score, and ASES did not differ. “Popeye” deformity was reported in both groups, with 17 patients (7.80%) in the onlay group and 15 patients (11.28%) in the inlay group (odds ratio, 0.28; p=.07), which was not statistically significant. No difference in postoperative cramping or failure rates were found. Failure of fixation was determined by MRI or ultrasound visualizing failure of the tendon fibers to trace longitudinally within the intertubercular groove at the insertion site.

Conclusion

This meta-analysis provides evidence that both onlay and inlay biceps tenodesis for long head biceps tendinopathy result in improved clinical and functional outcomes and few “Popeye” deformities, with no statistically significant differences between either method.