A comprehensive review of dynamic anterior stabilization of the long head of the biceps.

Abstract

Dynamic anterior stabilization (DAS) using the long head of the biceps tendon (LHB) is an arthroscopic option for recurrent anterior shoulder instability, especially with subcritical glenoid bone loss. This narrative review synthesizes biomechanical, technical, and clinical literature from PubMed, Embase, and Cochrane (2014-2025). LHB-based DAS augments an arthroscopic Bankart repair by transferring the patient's LHB to the anterior glenoid, creating a dynamic "hammock-sling-bumper" effect that resists anterior translation in vulnerable positions. Contemporary techniques use minimally morbid arthroscopy with onlay or inlay fixation. Clinical series report low recurrence (0%-13%) at 1-5 years. Functional outcomes improve substantially: Rowe scores typically rise from ~21-36 preoperatively to ~90-95 postoperatively, American Shoulder and Elbow Surgeons scores exceed 90, and WOSI improves by roughly 959 points. Return-to-sport rates reach 85%-95%, with range of motion generally comparable to standard Bankart repairs. In patients with subcritical bone loss (~10%-20% of glenoid width), DAS appears to enhance stability versus isolated soft-tissue repair while avoiding the complication profile of bone-block procedures (e.g., Latarjet). Suggested indications include recurrent instability with subcritical bone loss, failed prior soft-tissue repair, young high-demand athletes, and concomitant SLAP lesions. Contraindications and optimal thresholds for bone loss require clarification. Evidence remains limited by nonrandomized designs and short follow-up. Long-term outcomes beyond five years and high-quality comparative or randomized trials are needed to define durability, refine indications, and position LHB-based DAS within the broader algorithm for anterior shoulder instability management.