Editorial Commentary: Outcomes of Shoulder Biceps Tenotomy Versus Tenodesis Are Difficult to Determine From Nonrandomized Studies Due to Selection Bias: Tenodesis Is More Commonly Performed on Younger Males.

The long head of the biceps tendon is a common source of anterior shoulder pain, frequently addressed during rotator cuff repairs. Surgical management typically involves either tenotomy or tenodesis, each offering distinct advantages and disadvantages. Tenotomy, a straightforward procedure with a short rehabilitation period, is well suited for low-demand patients but carries a higher risk of Popeye deformity and cramping pain. In contrast, tenodesis, which reattaches the long head of the biceps tendon, minimizes these risks and is preferred for younger, active patients. Randomized controlled trials have shown equivalent functional outcomes for both techniques, with tenotomy associated with a higher risk of cosmetic deformity. The choice of a specific technique often reflects patient age, activity demands, and cosmetic concerns. Surgeons are more likely to select tenodesis for younger, male patients. Thus, nonrandomized studies introduce confounding variables and selection bias that can obscure clear recommendations based on the literature.