The proximal portion of the long head of the biceps is a recognized cause of anterior shoulder pain. This article presents a novel technique for tenodesing the proximal biceps tendon. The tendon is evaluated and tenodesed in the same anatomic position beneath the pectoralis tendon, and is removed entirely from the bicipital groove. The proximal portion of the long head of the biceps tendon is marked near its origin and lysed arthroscopically. The skin incision for the subpectoral open biceps tenodesis is made in the axilla exposing the inferior border of the pectoralis major muscle. The tendon is withdrawn from the joint and out of the incision. A Krackow or other type of interrupted tendon whipstitch is placed in the 10 to 15 mm of tendon proximal to the musculotendinous junction. A bone tunnel is created within the bicipital groove. The tendon/tenodesis driver complex is positioned to create a secure fit within the bone tunnel. Our current series includes 22 cases with short-term follow-up of 2 to 10 months. None of the repairs has pulled out and none of the patients reports persistent pain or loss of function. The subpectoral approach with interference screw fixation appears to be a promising, reproducible technique for tenodesing the biceps.

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