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

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not reported in abstract

• Primary Outcome: Functional scores (ASES, Constant, DASH) showed similar improvements in both groups

• Nnt Or Sensitivity: Supination strength recovery: Loop 103% vs Anchor 93%; Return to sport: 95.3% overall

• Confidence Interval: Not reported

Clinical Application

Loop technique appears technically feasible for arthroscopic surgeons, potentially reducing operative costs by eliminating implant requirements Relevant to Australian orthopaedic practice where PBS considerations favour cost-effective procedures. Loop technique may reduce overall healthcare costs while maintaining clinical outcomes Patients with long head biceps tendon pathology requiring tenodesis, particularly those concerned about implant-related complications or cost considerations

Abstract

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.

References

1. 1.Bischofreiter, M., Kölblinger, C., Gattringer, M., Azesberger, A., Gruber, M. S., Rittenschober, F., Kindermann, H., & Ortmaier, R. (2026). Loop versus anchor tenodesis of the long head of the biceps tendon: a prospective randomized controlled pilot study. Archives of Orthopaedic and Trauma Surgery. https://doi.org/10.1016/j.asmr.2022.07.004