Biological mini-open subpectoral biceps tenodesis using press-fit bony plugs

Background: Disorders of the long head of the biceps tendon often require surgical intervention. This study evaluates a biological, implant-free technique for subpectoral biceps tenodesis using press-fit bony plugs harvested from the humeral head. The approach aims to provide a cost-effective, hardware-free alternative while maintaining biomechanical stability and promoting natural tendon healing. Purpose: This study evaluates clinical outcomes of a novel biological fixation technique for subpectoral biceps tenodesis utilizing autologous press-fit bony plugs, assessing its safety and functional efficacy. Methods: A prospective case series was conducted on 30 consecutive patients (17 female, 13 male) undergoing the procedure with a minimum 24-month follow-up. Surgical technique involved harvesting a cortico-cancellous bone plug from the humeral head’s bicipital groove region for subsequent subpectoral tendon fixation. Outcome measures included comparative analysis of preoperative and postoperative VAS pain scores, ASES, and Constant shoulder scores. Results: Patients demonstrated statistically significant improvements across all metrics: ASES scores increased from 52.2 to 95.53 (p=0.001), Constant scores improved from 32.33 to 95.9, and VAS decreased from 6.9 to 0.53. No instances of fixation failure, neurovascular compromise, or cosmetic deformity were observed during the study period. Conclusion: The mini-open subpectoral biceps tenodesis technique using press-fit autologous bone plugs proves to be an effective, biologically advantageous procedure with excellent functional outcomes while eliminating implant-related complications and reducing surgical costs.