Long head of the biceps tendon pathology is a common source of pain and dysfunction related to shoulder pathology because of concomitant conditions that increase secondary tendinopathy, such as rotator cuff tears, subscapularis tears, impingement, and glenohumeral arthrosis. Surgical management of long head of the biceps tendon complaints is controversial among orthopaedic surgeons, with the literature supporting tenotomy and tenodesis. Tenodesis techniques vary based on location, open or arthroscopic, fixation methods, interosseous or extraosseous, and tendon-suture interface configurations. A biomechanical study published by the senior author of this video reported that the Krakow tendon-suture interface configuration afforded superior ultimate and fatigue strength compared with simple suture and lasso loop configurations.

To maintain the biomechanical advantage of a locked-loop suture and to aid in operating room efficiency, an arthroscopic-assisted, locked-loop suprapectoral (anterolateral ligament) biceps tenodesis technique was developed. A retrospective review of all patients who underwent anterolateral ligament tenodesis between January 2018 and April 2019 identified 47 patients with a follow-up of at least 3 months, with a mean follow-up of 6.5 months. Partial biceps tendon tears were the most common indication for tenodesis (36.2% or 17 of 47 patients). Of the 47 patients, 45 (96%) underwent concomitant rotator cuff repair at the time of tenodesis. At last follow-up, no patients reported anterior shoulder pain, a Popeye deformity, or biceps cramping. In addition, no postoperative complications were identified and no revision procedures were performed. The advantages of this anterolateral ligament tenodesis technique are biomechanically confirmed strength of the suture configuration, easily reproducible and efficient procedure with consistent pain relief and cosmetic appearance, and a high success rate without the need for a secondary open incision and/or an increased risk for injury to the neurovascular structures.