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An All-Arthroscopic, Length-Tensioned Suprapectoral Biceps Tenodesis Technique.

ABSTRACT: Biceps tenodesis remains a popular choice for treating anterior shoulder pain in the setting of primary biceps tendinitis or biceps pain due to concomitant glenohumeral joint pathology. A variety of surgical approaches and fixation construct options are available for biceps tenodesis. The advantages of an all-arthroscopic biceps tenodesis include anatomic maintenance of the length-tension relation with strength preservation and improved cosmetic results. This technique can be technically challenging but allows for a minimally invasive approach to anchor the biceps. In this Technical Note, we describe a suprapectoral biceps tenodesis using an all-arthroscopic approach in the setting of concomitant rotator cuff repair. This technique offers a viable alternative to the open subpectoral biceps tenodesis.

SUBMITTER: Rao AJ

PROVIDER: S-EPMC5709792 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

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An All-Arthroscopic, Length-Tensioned Suprapectoral Biceps Tenodesis Technique.

Rao Allison J AJ Bernardoni Eamon E Verma Nikhil N Trenhaile Scott S

Arthroscopy techniques 20170918 5

Biceps tenodesis remains a popular choice for treating anterior shoulder pain in the setting of primary biceps tendinitis or biceps pain due to concomitant glenohumeral joint pathology. A variety of surgical approaches and fixation construct options are available for biceps tenodesis. The advantages of an all-arthroscopic biceps tenodesis include anatomic maintenance of the length-tension relation with strength preservation and improved cosmetic results. This technique can be technically challen ...[more]

PMID: 29354480

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All-Arthroscopic Suprapectoral Biceps Tenodesis.

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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Arthroscopic Suprapectoral Biceps Tenodesis With Tenodesis Screw.

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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Arthroscopic Suprapectoral Biceps Tenodesis: A Knotless, Onlay, All-Suture Anchor Technique.

Project description:Anterior shoulder pain is a common complaint often caused by pathology of the long head of the biceps such as biceps tendinitis, partial biceps tears, biceps instability, and SLAP lesions. Surgical treatment of biceps pathology includes tenotomy versus tenodesis, with tenodesis being favored in young, active patients owing to less cramping pain and superior outcomes in terms of shoulder function and cosmesis. Various surgical techniques for tenodesis of the long head of the biceps exist, with varying indications. Subpectoral biceps tenodesis is primarily indicated for zone 2 to 3 tendon pathology and revision biceps tenodesis. Secondary indications include overhead athletes, chronic biceps tendinopathy, and rotator cuff repair. Proximal arthroscopic biceps tenodesis performed "high in the groove" has been shown to preserve biceps length and reduce Popeye deformity compared with tenotomy. Knotless techniques are becoming popular; they provide low-profile fixation that limits knot abrasion and is not reliant on knot security for fixation. We present a variation of suprapectoral biceps tenodesis using knotless fixation in an onlay technique.

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Transosseous Suture-Based Arthroscopic Suprapectoral Biceps Tenodesis.

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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Arthroscopic Suprapectoral Biceps Tenodesis Using Standard Portals.

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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Arthroscopic suprapectoral biceps tenodesis utilizing the subacromial locking stitch anchor (SALSA) technique.

Project description:Biceps tenodesis is an accepted treatment option for various pathologies of the long head of the biceps tendon and labrum. Many techniques have been published, both arthroscopic and open, that utilize various fixation techniques and locations of the tenodesis, yet none has been proven to be superior. We introduce a novel method, the SALSA (subacromial locking stitch anchor), an all-arthroscopic suprapectoral biceps tenodesis utilizing a running locking stitch from a double-loaded biocomposite anchor. This technique provides a reliable method of multipoint fixation including the transverse humeral ligament that avoids many of the potential complications encountered with other techniques.

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A Simple, All-Arthroscopic, Knotless Suture Lasso Loop Technique for Suprapectoral Biceps Tenodesis.

Project description:A variety of pathology of the long head of the biceps tendon can contribute to anterior shoulder pain in adults that can be managed with either arthroscopic tenotomy or tenodesis when conservative treatment fails. Biceps deformity or the Popeye sign is a major concern in patients after tenotomy. Biceps tenodesis can be performed in a variety of ways with different sized anchors and at different locations (suprapectoral or subpectoral). Several studies have shown that patient outcomes and complication rates are similar between all-arthroscopic suprapectoral biceps tenodesis and open subpectoral biceps tenodesis. We describe a simple, knotless, arthroscopic intra-articular biceps tenodesis technique using a 1.5-mm LabralTape lasso loop technique and a 2.9-mm PushLock anchor.

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Surgical technique for arthroscopic onlay suprapectoral biceps tenodesis with an all-suture anchor.

Project description:The long head of the biceps is a frequent pain generator in the shoulder. Tendinopathy of the long head of the biceps may be treated with biceps tenodesis. There has been great debate about the optimal technique for biceps tenodesis, without a clear distinction between different techniques. Biceps tenodesis fixation may include interference fixation, suspensory fixation, all-suture anchors, and soft tissue fixation. In this technical note, we describe an all-arthroscopic onlay suprapectoral biceps tenodesis with an all-suture anchor.

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Lateral Decubitus Position for Arthroscopic Suprapectoral Biceps Tenodesis.

Project description:The purpose of this report is to describe arthroscopic suprapectoral biceps tenodesis in the lateral decubitus position. Many technique descriptions for this procedure emphasize the beach-chair position to obtain optimal anterior subdeltoid visualization of the relevant anatomy. This is not required and may be less desirable or comfortable for a shoulder arthroscopist who prefers the lateral decubitus position. Therefore, the aim of this report is to show that the relevant anatomy may be readily and safely accessed, and the procedure effectively performed, in the lateral decubitus position.

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Arthroscopic suprapectoral tenodesis of the long head biceps: reproducing an anatomic length-tension relationship.

Project description:Tenodesis is an accepted treatment option in the management of pathology involving the long head of the biceps (LHB). Among the common causes for revision surgery after tenodesis are residual pain within the bicipital groove, cramping, early biceps fatigue, and biceps deformity. Most technical descriptions of arthroscopic biceps tenodesis involve fixation of the LHB tendon within or proximal to the intertubercular sulcus and thus fail to address the described sources of pain within this proximal anatomic location. Suprapectoral tenodesis offers the surgeon the ability to remove the LHB from within the bicipital groove by fixating the biceps more distally. Cramping, early fatigue, and biceps deformity have been described when the appropriate length-tension relation of the biceps tendon has not been restored after LHB tenodesis. Our described procedure allows for a more consistent restoration of the anatomic length-tension relation of the LHB, therefore reducing the symptoms associated with this variable. This all-arthroscopic, suprapectoral biceps tenodesis with interference fixation addresses the most common causes for revision surgery and offers a comprehensive solution for LHB pathology.

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