Introduction

Authors have described multiple tenodesis techniques. They can be grouped into open or arthroscopic according to surgical approach, and into subpectoral or suprapectoral according to location of fixation. The purpose of this meta-analysis is to critically analyze the current evidence with regard to comparing two methods of biceps tenodesis, viz subpectoral vs suprapectoral tenodesis.

Methods

Primary electronic search was conducted on MEDLINE (PubMed), Embase, Scopus, and Cochrane Library databases for published literature from year of inception to August 2024. The current review included any prospective or retrospective English studies that evaluated the outcomes of suprapectoral versus subpectoral. Primary outcomes of interest were American shoulder & elbow society (ASES) score, constant score(CS), UCLA score, SST score, VAS, and complications. The secondary outcomes of interest was range of movements.

Results

13 studies were included in our quantitative analysis, comprising three RCTs and ten non-randomized comparative studies. ASES score was slightly higher in most of studies in favour of sub-pectoral tenodesis (P>0.05). We found no statistically significant difference between the two groups (P=0.81), although the subpectoral tenodesis group had slightly higher mean CS. Our meta-analysis found a slightly higher SST in suprapectoral tenodesis group, while higher UCLA scores in the subpectoral group (P>0.05). Higher overall complication rate was noted with suprapectoral tenodesis group (P=0.0002)

Conclusion

The surgeons can expect comparable functional outcome and shoulder range of motion in patients undergoing either suprapectoral or subpectoral LHBT tenodesis. Increased complication rate can be expected with the suprapectoral tenodesis technique.