Editorial Commentary : Does a Knotted Versus Knotless Repair Really Matter for a Successful Long Head Biceps Tenodesis? Perhaps Not

Abstract

Biceps tenodesis is a commonly performed surgery to treat biceps labrum complex pathology and in conjunction with rotator cuff repair. A systematic review of recently published biomechanical studies concluded that knotted biceps tenodesis constructs had a slightly higher strength of fixation, as measured by ultimate failure load, than knotless constructs. However, the shoulder surgeon needs to consider other more clinically relevant factors in selecting the best surgical technique for their patient including location within the groove, arthroscopic or open, onlay or inlay, and choice of implant or no implant. Additionally, the recovery is just as important as the surgery, and duration of immobilization, rehabilitation cadence, and overall patient compliance are also important determinants of the end result.