Biceps Tendon Pathology With Arthroscopic Techniques | Orthopedic Lecture, Training | Dr. Ticker

Highlights from the 53rd Annual Meeting of the SBOT

At the 53rd Annual SBOT Meeting, Jonathan Ticker, MD shared a practical, experience-based look at how he evaluates and treats biceps tendon pathology, both as an isolated problem and when it occurs alongside rotator cuff tears. His talk combined evidence, arthroscopic technique, and real-world decision-making, making it especially relevant for surgeons navigating these common  though, at times, complex cases.

A Thoughtful, Patient-Centered Approach:

Dr. Ticker emphasized that treating the biceps tendon is rarely about choosing a single “best” procedure. Instead, successful outcomes depend on balancing:

  • Patient age and activity level
  • The presence of associated rotator cuff or subscapularis tears
  • The severity of biceps pathology
  • And, importantly, the patient’s preferences and expectations

He reinforced that shared decision-making plays a critical role, especially since studies show similar functional outcomes at one year between common treatment options like tenotomy and tenodesis.

Biceps Treatment Options Reviewed:

During his presentation, Dr. Ticker walked through the full spectrum of surgical options, including:

  • Arthroscopic biceps tenodesis, using either anchors or socket (inlay) fixation
  • Suprapectoral tenodesis techniques, with detailed tips on portal placement and groove identification
  • Soft tissue tenodesis, including the PIT technique
  • Biceps tenotomy, often favored in older or lower-demand patients
  • Rare cases of biceps preservation, when anatomy and tissue quality allow

He highlighted that fixation method (anchor/onlay vs. socket/inlay) has not shown significant differences in outcomes, reinforcing flexibility in technique based on surgeon comfort and anatomy.

Managing Biceps Pathology with Rotator Cuff Tears:

A major focus of the talk was how Dr. Ticker currently treats the biceps when it is involved in rotator cuff pathology. His preferred approach in most cases is to:

  • Incorporate the biceps tendon directly into the rotator cuff repair
  • Use sutures passed through and around the biceps and adjacent soft tissue
  • Proceed with single-row or double-row cuff repair
  • Transect or Remove the intra-articular portion of the tendon

This method allows for secure fixation while avoiding unnecessary additional implants, and his case examples demonstrated strong healing and reliable functional outcomes.

Key Takeaways from Dr. Ticker’s Philosophy:

  • The less emphasis placed on the biceps, the more proximal the treatment (ie, tenotomy).
  • The more emphasis placed on the biceps, the more distal and structured the fixation.
  • In rotator cuff tears, biceps incorporation into the repair is now his most common approach.
  • Outcomes are best when treatment decisions are individualized and patient-driven

A Practical Message for Shoulder Surgeons:

Dr. Ticker’s presentation offered more than technical instruction, delivered a clear, adaptable framework for treating biceps tendon pathology. By combining evidence-based medicine with decades of surgical experience, his approach underscores the importance of flexibility, efficiency, and patient-centered care in modern arthroscopic shoulder surgery.