Restoring the anatomic tension relationship of the long head of the biceps during tenodesis: A prospective, randomised controlled trial
Shoulder & Elbow · 21 Jul 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Biceps tenodesis is common and lacks a standardised tensioning technique, so evidence on whether a more meticulous patient-specific method actually improves outcomes helps surgeons decide if the extra technical effort is worthwhile.
The evidence
This RCT of 160 patients undergoing biceps tenodesis (mostly with concomitant rotator cuff or other shoulder procedures) compared a standard landmark-based tensioning technique to a patient-specific anatomic tensioning technique. At final follow-up (mean 19.6 months), ASES scores, VAS pain, forward flexion, and external rotation were statistically similar between groups (p=0.604, 0.308, 0.171, 0.726 respectively), though the intervention group had significantly higher ASES scores at 6 weeks (mean difference 9.1, 95% CI 0.1-18.0, p=.048) and, oddly, significantly lower ASES scores at 12 months (mean difference -16.8, 95% CI -33.1 to -0.5, p=.044).
ASES score at final follow-up: Mean difference 2 (95% CI -5.7 to 9.8; ASES). The interval includes no difference. This does not establish equivalence or rule out an important effect.
Why this rigour score?
RCTDesign starting point: 59.5
Raised the score
- Adequately powered+6
- Prospectively registered+5.1
Lowered the score
- Unblinded assessment of a subjective outcome−9.3
- Only 3 months of follow-up−9
Score capped at 40. The conclusions are not supported by the reported results.
Methods at a glance
Recorded assessment- Outcome assessors blindedNot met
- Allocation concealedNot reported
- Random sequence generatedNot reported
- Intention-to-treat analysisNot reported
- Adequate statistical powerMet
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 59.5
- Compared against current standard of care
- +3.4
- Unblinded assessment of a subjective outcome
- −9.3
- Only 3 months of follow-up
- −9
- 4% loss to follow-up
- +0.5
- Adequately powered
- +6
- Prospectively registered
- +5.1
- No correction for multiple comparisons
- −3.4
- Journal prior (not an observed method)
- +0.4
- Methodological cap
- −13.1
- Final rigour score rounded
- 40 / 100
Study design sets the starting point and a ceiling of 96. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.The primary outcome (ASES at final follow-up) was not significant, yet a significant result appeared at 6 weeks and an unexplained significant worse result appeared at 12 months among six time points tested without correction for multiplicity: how much of this is chance given multiple comparisons?
2.If you perform tenodesis routinely, does a possible early (6-week) functional advantage with patient-specific tensioning change your technique, given no advantage was seen at 3, 6, or 12 months, or at final follow-up?
Original publication title
Restoring the anatomic tension relationship of the long head of the biceps during tenodesis: A prospective, randomized controlled trial