Restoring the anatomic tension relationship of the long head of the biceps during tenodesis: A prospective, randomized controlled trial

This RCT of 160 patients undergoing arthroscopic shoulder surgery with biceps tenodesis compared a standard landmark-based tenodesis technique to a newer patient-specific method for restoring the biceps tendon's natural length-tension relationship. At final follow-up (mean 19.6 months), ASES functional scores, pain scores, and range of motion were statistically similar between groups (e.g., ASES mean difference only 2.0 points, p=.604), though the patient-specific group had modestly higher ASES scores at 6 weeks (mean difference 9.1, p=.048) that did not persist.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersSince biceps tenodesis tensioning technique has never had a defined gold standard, this trial helps reassure surgeons that meticulous anatomic tensioning is not required for good long-term outcomes.

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• ?The study tested outcomes at six time points without any stated correction for multiple comparisons, and only two of those twelve tests (ASES at 6 weeks and at 12 months, favoring opposite groups) reached significance; how much should we trust these isolated findings given the multiplicity problem and lack of blinded outcome assessment?
• ?Given that final-outcome scores were statistically and clinically similar between techniques, does the added technical complexity of intraoperative patient-specific tensioning (leaving arthroscopic cannulas in place, precise marking, avoiding limb repositioning) offer enough practical benefit to justify routine adoption over the simpler landmark-based approach?