 Arthroscopic Suprapectoral Biceps Tenedesis, or ASPBT, and Open Subpectoral Biceps Tenedesis, or OSPBT, are two well-described surgeries used to treat pathologies of the long head of the biceps tendon. According to a new study, these two procedures have comparable outcomes until at least two years after surgery. The findings are published in the American Journal of Sports Medicine. Injury, inflammation and degeneration of the long head of the biceps tendon, also called the LHBT, are common causes of anterior shoulder pain. Although non-surgical management is often possible, refractory cases of LHBT pathology may require surgical intervention such as tendon resection with reattachment. This procedure is called tenedesis. Retrospective studies have noted similar outcomes of ASPBT and OSPBT, which are two techniques used to conduct biceps tenedesis at two or more years of follow-up. In addition, a randomized controlled trial has confirmed that ASPBT and OSPBT yield similar benefits for up to one year. However, the outcomes past one year have not been verified in a controlled trial. To close this knowledge gap, researchers randomly allocated 85 patients undergoing biceps tenedesis for LHBT pathologies into an ASPBT group and an OSPBT group and analyzed clinical outcomes at 6, 12, and at least 24 months after surgery. Polyether-ether ketone interference screws were used for fixation in both groups. The outcome measures included American shoulder and elbow surgeon scores, constant subjective scores, and single assessment numeric evaluation scores. The mean final follow-up time for both groups was 2.9 years. There were no significant differences in outcome scores or complication rates between the groups at any time point, indicating that the two techniques resulted in comparable patient-reported outcomes. Furthermore, the clinical outcomes did not change from approximately one year until the final follow-up at two years or later, suggesting that the outcomes were stable. None of the patients underwent biceps revision surgery. Notably, many of the participants underwent other shoulder surgeries at the same time, which may have confounded the results, although the numbers of patients with concurrent surgeries did not differ between the groups. There was also a difference in screw size between the groups. All surgeries were performed by one surgeon with considerable experience in both techniques, which may limit the generalizability of the findings. Finally, other meaningful outcomes, such as return to sports and return to work, were not investigated. Although more studies are needed, the findings reveal that ASPBT and OSPBT, conducted with the interference screw technique, yield comparable results for at least two years among individuals who may also need concurrent shoulder surgery.