Onlay Technique for Biceps Tenodesis Leads to Less Revisions

When an onlay technique instead of an inlay technique is used during arthroscopic biceps tenodesis, the revision rate is lower, according to a new study.

“In the study, “Arthroscopic Biceps Tenodesis Outcomes: A Comparison of Inlay and Onlay Techniques,” published online on September 14, 2020 in The American Journal of Sports Medicine, the researchers compared postoperative healing and functional outcomes of arthroscopic biceps tenodesis high in the groove performed using an onlay technique versus an inlay technique.

Inlay and onlay techniques are both anchor-based fixation options for biceps tenodesis. Onlay has become more popular in recent years because of ease of use, but there has been little research comparing the two techniques.

The retrospective study included patients who underwent the procedure at a single center over a two-year period. During the first year of the cohort study, an inlay technique using an interference screw was performed. Then in the second year, an onlay technique using a knotless suture anchor was performed instead. All outcomes, including tendon healing, elbow flexion strength, functional outcome, and complications, were evaluated at a minimum of one year postoperative.

Data on 37 patients in the inlay group and 53 patients in the onlay group were analyzed. There was no difference observed in range of motion, functional outcome scores, or elbow flexion between the groups.

However, 27% of the patients in the inlay group had a postoperative Popeye deformity compared with 9.4% of the onlay group (p = .028).

There was also a difference in revision rates. Four patients (10.8%) in the inlay group required revision surgery compared with 0% in the onlay group (p = .015).

The researchers wrote, “An onlay technique using a knotless suture anchor for arthroscopic biceps tenodesis at the top of the articular margin is an acceptable alternative to an inlay technique using an interference screw. The onlay technique was associated with lower rates of postoperative Popeye deformity and revision surgery as compared with the inlay technique.”