Fast Arthroscopic Biceps Tenodesis Without Penetrating Grasper

ABSTRACT: 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. Technique Video Video 1 Under general anesthesia with previous interscalene plexus block, the patient is placed in the beach-chair position with the arm under 3 kg of traction. The procedure is performed completely arthroscopic in the glenohumeral joint. Through the posterior portal (A) with a 4.0-mm 30° arthroscope, the glenohumeral joint is visualized and the long head of the biceps tendon lesion is checked. An anterolateral working portal (D) is made. Through the anterolateral working portal and viewing the glenohumeral joint from the posterior portal (A portal), a Self-Punching All Suture-Anchor is inserted in the upper part of the bicipital groove penetrating the long head biceps tendon (in this step it is mandatory to avoid damage or tear of the LHBT). With this step, the sutures will already be passed through the biceps tendon. To manage the sutures and knot tying, only a suture grasper (suture manipulator) is necessary. With the suture manipulator, one of the sutures is grabbed and transported anteriorly to the biceps tendon, the suture is pushed to the space between the anterior glenoid rim and the subscapularis tendon, them, the suture is left there and the suture manipulator is pulled back. The suture manipulator is positioned posteriorly to the biceps tendon. The suture loop is lateralized with the suture manipulator. With the suture manipulator the loop is retrieved towards anteromedial until the loop is around the biceps. A lasso loop is made around the whole tendon passing the free limb through the Lasso and then, after retrieving both sutures, it is knotted over the anchor (the post is the suture where there is no lasso). The same procedure is done with the other suture and thus the LHBT is fixed with 2 lasso loops. Subsequently, the tenotomy is performed with a radiofrequency device. Finally, each lasso loop is knotted and in this way the tendon is completely fixed on the bicipital groove. (LHBT, long head of the biceps tendon.)

SUBMITTER: D’Orazio G 

PROVIDER: S-EPMC9939719 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature