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Background <p>The long head of the biceps tendon is a frequent source of anterior shoulder pain, often treated with tenodesis. While anchor tenodesis is well established, it carries risks of implant-related complications. This study evaluates an implant-free “loop tenodesis” technique as a potentially safer and cost-effective alternative.</p> Methods <p>In this prospective, double-blinded, randomized exploratory study, 48 patients undergoing arthroscopic biceps tenodesis were randomized to either loop (<i>n</i> = 24) or anchor (<i>n</i> = 24) tenodesis. Clinical outcomes were assessed using ASES, Constant, and DASH scores, as well as range of motion, supination strength, satisfaction, aesthetic appearance, and return-to-sport. Statistical analysis was performed using the Mann-Whitney U and Wilcoxon signed-rank tests to compare non-parametric data.</p> Results <p>Both groups showed significant improvements with similar gains in functional scores. Supination strength recovery was greater in the loop group (103% vs. 93%). There were no significant differences in range of motion or complications. Notably, only the anchor group showed cases of Popeye deformity (2 patients). Return to sport was achieved in 95.3% of patients, typically within 3 months. No revision or implant-related issues occurred.</p> Conclusion <p>Loop tenodesis offers equivalent clinical outcomes to anchor-based techniques, with fewer aesthetic concerns and no implant-associated risks, making it a safe, reliable, and cost-effective alternative for biceps tenodesis.</p>

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Loop versus anchor tenodesis of the long head of the biceps tendon: a prospective randomized controlled pilot study

  • 期刊论文

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  • 发表日期：

    2026年5月24日

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  • Martin Bischofreiter,
  • Christina Kölblinger,
  • Michael Gattringer,
  • Alexander Azesberger,
  • Michael Stephan Gruber,
  • Felix Rittenschober,
  • Harald Kindermann,
  • Reinhold Ortmaier

摘要

Background

The long head of the biceps tendon is a frequent source of anterior shoulder pain, often treated with tenodesis. While anchor tenodesis is well established, it carries risks of implant-related complications. This study evaluates an implant-free “loop tenodesis” technique as a potentially safer and cost-effective alternative.

Methods

In this prospective, double-blinded, randomized exploratory study, 48 patients undergoing arthroscopic biceps tenodesis were randomized to either loop (n = 24) or anchor (n = 24) tenodesis. Clinical outcomes were assessed using ASES, Constant, and DASH scores, as well as range of motion, supination strength, satisfaction, aesthetic appearance, and return-to-sport. Statistical analysis was performed using the Mann-Whitney U and Wilcoxon signed-rank tests to compare non-parametric data.

Results

Both groups showed significant improvements with similar gains in functional scores. Supination strength recovery was greater in the loop group (103% vs. 93%). There were no significant differences in range of motion or complications. Notably, only the anchor group showed cases of Popeye deformity (2 patients). Return to sport was achieved in 95.3% of patients, typically within 3 months. No revision or implant-related issues occurred.

Conclusion

Loop tenodesis offers equivalent clinical outcomes to anchor-based techniques, with fewer aesthetic concerns and no implant-associated risks, making it a safe, reliable, and cost-effective alternative for biceps tenodesis.