All-Arthroscopic Falciform Portal Biceps Tenodesis
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ABSTRACT:
SUBMITTER: Makovicka J
PROVIDER: S-EPMC10907896 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:Tenodesis of the long head of the biceps tendon can be performed through arthroscopic and open techniques with various fixation methods and at different locations on the humerus. Many techniques have been described, with controversy surrounding the advantages and disadvantages of each. In this Technical Note, we describe an all-arthroscopic, intra-articular, single-portal, suprapectoral biceps tenodesis with an all-suture anchor. This technique also allows for suture passage through the biceps tendon before tenotomy to ensure proper maintenance of the length-tension relationship of the biceps musculotendinous unit.
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Project description:The purpose of this report is to describe our modification of the Verma-Trenhaile biceps tenodesis technique using a superior viewing portal that allows placement of the tenodesis site at the top of the pectoralis major tendon with interference screw fixation. The advantages of this technique include the following: (1) There is no need to exteriorize the tendon through the skin. (2) Viewing from superiorly allows a panoramic view of the groove all the way to the pectoralis major tendon insertion. (3) This panoramic view allows a more complete view of the biceps down to the muscle-tendon junction beneath the pectoralis major tendon. (4) The improved visualization permits the drill hole to be contained within the constraints of the groove. Short-term follow-up shows favorable results clinically, and no major complications have been associated with this technique.
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Project description:There are many methods for long head of the biceps tendon (LHBT) tenodesis, but a consensus on a superior method has yet to be met. In this article, we introduce a method for arthroscopic suprapectoral biceps tenodesis using a tenodesis screw in the bicipital tunnel. The intra-articular portion of the biceps tendon is transected. The subdeltoid space is then viewed via a lateral portal, and the tendon is mobilized from the bicipital tunnel. The tendon is retrieved through the anterior portal, and 5 whipstitch passes and a second distal stitch are placed. Three of the suture tails are passed through the tenodesis screwdriver, and the tendon is maneuvered to the previously reamed bone socket located 1.5 cm superior to the pec tendon, just inferior to the bicipital groove. Once the tenodesis screw is fixated in sufficient bone stock, 5 alternating half hitches reinforce the construct by creating a closed loop through the screw. This described technique allows full visualization of the LHBT dissection and tenodesis throughout the procedure. Additionally, this technique provides a method to incorporate whipstitching with an arthroscopic tenodesis screw to provide additional strength to tendon fixation.
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Project description:Biceps tenodesis is a common treatment for pathology of the long head of the biceps tendon. Several authors have described various arthroscopic and open techniques for biceps tenodesis. Open techniques have been associated with complications such as wound infection and nerve injury. Previously described arthroscopic techniques have placed the tenodesis site within the bicipital groove, which may lead to persistent pain. We describe an all-arthroscopic suprapectoral biceps tenodesis technique that places the tenodesis site distal to the bicipital groove. This technique potentially avoids the complications associated with open tenodesis surgery while still removing the biceps tendon from the bicipital groove.
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Project description:The portal of Willingboro is a unique portal designed as a means of all arthroscopic biceps tenodesis for biceps tendinopathy. The portal allows for tenodesis to be efficiently and effectively performed in the subgroove space with low technical demand. This Technical Note provides detailed descriptions of the anatomical structures and standard shoulder arthroscopy portals relevant to the location of the portal of Willingboro. The structures discussed include the standard anterior, posterior, and lateral shoulder arthroscopy portals along with the axillary and musculocutaneous nerves, subscapularis and pectoralis major tendons, axillary artery, and major bony anatomic landmarks of the shoulder region. These descriptions may be used as a guideline or reference for safe creation of the portal of Willingboro.
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Project description:Rotator cuff repair, acromioplasty, and biceps tenodesis operations have become some of the most common shoulder surgical procedures, evolving from open techniques to minimally invasive arthroscopic techniques. The use of many arthroscopic portals has been associated with surgical risks to many surrounding anatomic structures. We present an arthroscopic technique using a single anterolateral working portal for rotator cuff repair, acromioplasty, distal clavicle excision, and long head of the biceps tenodesis; this technique decreases the risk of injury to the surrounding neurovascular and musculotendinous structures, enables a faster recovery, and is minimally invasive.
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Project description:Long head of the biceps pathology is a common cause of shoulder pain and dysfunction. Surgical treatment can be either a tenotomy or a tenodesis. Long-term results may be similar in both surgical techniques; however, the latest systematic reviews indicate that tenodesis offers superior clinical and functional results in young patients and athletes. Considering the favorable results with the biceps tenodesis, we present this arthroscopic tenodesis in which the long head of the biceps is fixed in the bicipital groove with an all-suture anchor passed directly through the tendon, providing a stable and fast fixation without using penetrating grasper.
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Project description:Pain arising from the long head of biceps tendon can cause significant disability of the shoulder. In young and physically demanding patients, biceps tenodesis is advised, in which the biceps tendon is cut from the native origin and fixed distally. Many methods have been proposed for this. This Technical Note describes arthroscopic biceps tenodesis in the bicipital groove by a bicortical drilling technique. The far cortex is breached only once by a guide wire, and the reamers do not breach the far cortex. The tendon is fixed in the new position using a PopLok anchor. This technique is safe and easy to perform but presents a learning curve.
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Project description:Biceps tenodesis is a well-accepted surgical treatment to relieve pain and dysfunction about the shoulder. Multiple locations and methods of tenodesis have been described, with similar outcomes. Transosseous cuff repairs and tendon repairs have been used for decades as a tried and true fixation method. This technique describes an arthroscopic transosseous technique for biceps tenodesis in the suprapectoral location that is technically simple, fast, eliminates the cost of implants, avoids an incision in the axillae which may be prone to dehiscence or infection, and releases the biceps sheath, which may be related to pain generation. Moreover, the biceps length tension relationship is easily recapitulated using anatomical landmarks.
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Project description:The long head of the biceps (LHB) tendon is a common cause of shoulder pain. Biceps tenodesis is commonly used to address biceps and superior labrum pathology, reducing pain and restoring function. There are numerous techniques for biceps tenodesis, and it is unclear as to which single technique and approach provides significantly superior outcomes. In this technical note, we present an arthroscopic suprapectoral approach with release of the LHB from the bicipital groove and subsequent fixation with suture anchor. This technique simplifies the technique to be performed from standard arthroscopic portals and aims to maximize outcomes and minimize common complications associated with biceps tenodesis.
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