Editorial Commentary: Does Size Matter: Drill Holes in Subpectoral Biceps Tenodesis?

Abstract

Proximal humerus fracture after subpectoral tenodesis (SPBT) of the long head of the biceps tendon is a rare but serious complication. Examination of the biceps tendon diameter after preparation for SPBT in vivo suggests that the use of a smaller tenodesis screw is technically possible. However, questions remain about the biomechanical strength of the tenodesis construct with a smaller interference screw and about whether or not the size of a drill hole is the predominant factor in determining the risk of fracture. At this point, it remains premature to abandon or alter a technique with such a proven track record for successful outcomes and with so few complications as SPBT with a unicortical interference screw.