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The 360 Double Lasso Loop for Biceps Tenodesis: Tips and Tricks.

ABSTRACT: The management of the intra-articular portion of the long head of the biceps tendon (LHB) is a recurring topic in every discussion about shoulder pain. In massive rotator cuff tears or in tears of the superior third of the subscapularis tendon, our approach is to systematically perform a tenodesis of the LHB. In this Technical Note, we present our arthroscopic technique for LHB tenodesis at the articular margin of the humeral head using a single anchor and a 360 double lasso loop. This technique guaranties a strong and efficient fixation of the biceps tendon and is reproducible when following the steps and tips and tricks outlined herein.

SUBMITTER: Lafosse T

PROVIDER: S-EPMC8355195 | biostudies-literature |

REPOSITORIES: biostudies-literature

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The "Double Lasso-Loop" Technique Used for Arthroscopic Proximal Biceps Tenodesis.

Project description:Disorders of the long head biceps tendon are among the most challenging of shoulder problems to diagnose and manage. In this Technical Note, we introduce an arthroscopic technique for proximal biceps tenodesis high in the groove at the articular margin of the humeral head using a single anchor and 2 self-cinching loops followed by 5 alternating half-hitches to secure the construct. This method is simple and enables stable fixation of the biceps tendon.

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Arthroscopic Tenodesis of the Long Head Biceps Tendon Using a Double Lasso-Loop Suture Anchor Configuration.

Project description:Multiple different techniques exist for performing a biceps tenodesis, and the literature has yet to define a particular technique as superior with respect to outcomes. Factors as the center of various clinical and biomechanical studies include analyzing arthroscopic versus open techniques, optimal fixation sites, and the use specific fixation devices (i.e., anchor, screw). This article details an all-arthroscopic approach for proximal tenodesis of the long head of the biceps tendon (LHBT) using a 2-portal method in a minimally invasive manner. Optimal biomechanical fixation of the LHBT is achieve by using 2 suture anchors in the creation of a dual lasso-loop configuration at the level of the bicipital groove. Technical pearls with respect to optimal arthroscopic viewing, efficient identification of the LHBT and subsequent release from the bicipital groove, and appropriate use of suture anchors for lasso-loop creation are presented for review. Two specific technical advantages of this technique include 2 fixation points for the LHBT to minimize failure risk, and smaller drill holes when compared with commonly performed tenodesis screw techniques to theoretically limit humeral fracture risk.

| S-EPMC6948130 | biostudies-literature

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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Arthroscopic On-Lay Biceps Tenodesis: The Loop-Lock Technique.

Project description:The biceps tendon is a common pain generator in the shoulder. Long head of the biceps tendon pathology occurs in a variety of different ways. There are several different treatment options available to address the long head of the biceps. With advances in arthroscopy, all-arthroscopic tenodesis is becoming a more popular choice to address biceps tendon pathology. We describe an all-arthroscopic technique, termed "the loop-lock," for performing a biceps tenodesis.

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All-arthroscopic suprapectoral long head of biceps tendon tenodesis with interference screw-like tendon fixation after modified lasso-loop stitch tendon securing.

Project description:Arthroscopic suprapectoral techniques for tenodesis of the long head of the biceps tendon (LHB) are appropriate for the treatment of proximal biceps lesions. Several types of techniques and fixation devices have been described and evaluated in biomechanical studies regarding primary stability. In this technical note, we describe an all-arthroscopic suprapectoral technique using the 6.25-mm Bio-SwiveLock device (Arthrex, Naples, FL) for an interference screw-like bony fixation after having armed the tendon with a lasso-loop stitch. Both the interference screw fixation and securing of the lasso-loop tendon have been well described and approved in biomechanical tests concerning the primary stability. One advantage of this technique performed from the glenohumeral space, in addition to the strong and secure fixation with ingrowth of the tendon in a bony canal, is the avoidance of touching the soft tissue above the bicipital groove, which results in a smooth fitting of the tendon into its natural canal and therefore avoids mechanical irritation of the stump at the rotator interval. In conclusion, the all-arthroscopic suprapectoral LHB tenodesis performed from the glenohumeral space with the modified lasso-loop stitch for securing of the tendon and the 6.25-mm Bio-SwiveLock suture anchor for interference screw-like bony tendon fixation is an appropriate technique for the treatment of LHB-associated lesions.

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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: The "Double Secure Loop Technique" Using an All-Suture Anchor and an Arthroscopic Suture Passer.

Project description:Although the long head of the biceps tendon is known to resist superior movement of the humeral head in the shoulder joint and assist flexion and supination of the elbow joint, its exact function remains unclear. Moreover, the ideal treatment of lesions of the long head of the biceps tendon such as tendinitis, subluxation, dislocation, and partial or complete rupture remains controversial. Various tenodesis methods have been introduced by many authors. This technique-based article aims to discuss tenodesis as an option for biceps tendon fixation.

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The Loop 'N' Tack Biceps Tenodesis: An All-Arthroscopic, Intra-Articular Technique.

Project description:Tenodesis and tenotomy of the long head of the biceps are treatment options for a wide range of pathologies without clear superior technique or site of fixation. Clinical outcomes comparing numerous techniques for tenotomy versus tenodesis have resulted in similar pain relief; however, tenotomy may result in a cosmetic "Popeye" deformity and fatigue pain. We present a quick, simple, and knotless technique for tenodesis of the long head of the biceps at the proximal aspect of the bicipital grove that can be completed entirely arthroscopically. This technique uses suture to secure a tenotomized proximal biceps tendon to a knotless anchor just proximal to the subscapularis tendon at the proximal biceps groove. The tensionless repair allows the biceps to scar within the biceps groove, thereby reducing subsidence and formation of a "Popeye" deformity and fatigue pain in the biceps seen with tenotomy alone while eliminating the ability to overtension.

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Biceps Tenodesis: Anatomic Tensioning.

Project description:Biceps tenodesis is a commonly employed surgical intervention for refractory symptoms related to the biceps-labral complex, those intra-articular and those within the extra-articular bicipital tunnel. While a litany of surgical techniques exists, the optimal method for ensuring an anatomic length-tension relationship during tenodesis remains elusive. Appropriate tensioning may limit undesirable outcomes such as cramping or cosmetic deformity. We describe herein our technique as a simple and efficient means to establish patient-specific, anatomic tensioning of the long head of the biceps during tenodesis.

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Tenoscopic Suprapectoral Biceps Tenodesis.

Project description:Existing arthroscopic techniques of proximal biceps tenodesis may be complicated by difficulty of tendon identification, restoration of length-tension relation, cosmetic deformity, persistent biceps pain, and shoulder stiffness requiring surgical revision in a relevant proportion of cases. In this context, biceps tenoscopy, an emerging discipline of shoulder endoscopy, offers major benefits. Tenoscopy comprises endoscopic treatment of tendons and tendon sheaths. The presented technique of tenoscopic suprapectoral biceps tenodesis (TSBT) substantially facilitates tendon identification and reduces invasiveness by avoidance of unnecessary surgical involvement of the deltoid space and bursa. TSBT enables effective treatment of the biceps tendon and surrounding tissues (biceps tendon sheath, tenosynovium, transverse humeral ligament) being consistently involved in proximal biceps pathologies. The physiological length-tension relation of the musculotendinous unit is reliably maintained. Technically, the procedure of tenodesis is simplified and accelerated by redundancy of tendon exteriorization. The aforementioned benefits of TSBT may lead to superior clinical and cosmetic outcomes and lower incidences of persistent proximal biceps pain and postoperative shoulder stiffness compared with conventional techniques of arthroscopic biceps tenodesis.

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