Suprapectoral Onlay Biceps Tenodesis With Metal Button or Soft-Body Anchor Is Safe and Effective During Total Shoulder Arthroplasty

INTRODUCTION: A well-documented association exists between long head of the biceps tendon (LHBT) pathology and glenohumeral arthritis. Given this association, the LHBT is often managed with tenodesis during total shoulder arthroplasty (TSA). Many LHBT tenodesis techniques exist, including soft-tissue tenodesis or anchor fixation. No literature currently compares fixation techniques for onlay LHBT tenodesis; thus, the purpose of this study was to compare onlay fixation with a metal button and soft-suture anchor. MATERIALS AND METHODS: This retrospective study included patients undergoing primary TSA by a single surgeon between January 2021 and June 2024. Patient demographic information, medical comorbidities, type of biceps fixation, implant information, and complications were recorded. Patients were organized to two groups based on biceps fixation. Outcomes collected included Popeye deformity, persistent bicipital pain, humeral fractures, infection, and instability. RESULTS: Five hundred ninety-one patients were included in the study. Of these, 315 patients underwent LHBT tenodesis with a metal anchor, while 276 had a soft-body anchor. The average patient age was 69.59 ± 9.16 years, and the average body mass index was 29.39 ± 5.88. The two cohorts did not differ regarding medical comorbidities or demographic characteristics. Three (0.5%) patients developed a Popeye deformity, while 18 (3.0%) patients had persistent bicipital pain. CONCLUSION: Suprapectoral biceps tenodesis during TSA using an onlay technique has good outcomes and low rates of overall and biceps-related complications. Similar results were seen between a metal button and soft-body anchor.