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Technique of Arthroscopic Suprapectoral Tenodesis of the Long Head of the Biceps With Interference Screw.

ABSTRACT: Tenodesis and tenotomy are the main surgical options to treat different pathologies of the long head of the biceps tendon. Maintaining the functionality of the tendon during tenodesis makes it more preferable surgical option. The consensus on the most advanced tenodesis technique has not been reached. The article presents the arthroscopic all-inside technique of suprapectoral tenodesis of the biceps tendon using the technique of "zone marking" with 2 spinal needles or pins.

SUBMITTER: Vetoshkin AA

PROVIDER: S-EPMC8085536 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Technique of Arthroscopic Suprapectoral Tenodesis of the Long Head of the Biceps With Interference Screw.

Vetoshkin Aleksandr Aleksandrovich AA Aghamalyan Hayk Hamlet HH Gurbannazarov Maksat Khemrakulievich MK

Arthroscopy techniques 20210322 4

Tenodesis and tenotomy are the main surgical options to treat different pathologies of the long head of the biceps tendon. Maintaining the functionality of the tendon during tenodesis makes it more preferable surgical option. The consensus on the most advanced tenodesis technique has not been reached. The article presents the arthroscopic all-inside technique of suprapectoral tenodesis of the biceps tendon using the technique of "zone marking" with 2 spinal needles or pins. ...[more]

PMID: 33981562

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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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An Arthroscopic Technique for Long Head of Biceps Tenodesis With Double Knotless Screw.

Project description:Tenodesis of the long head of the biceps (LHB) is a frequently performed procedure during shoulder arthroscopy for the treatment of degenerative, traumatic, or inflammatory lesions of the LHB tendon. Arthroscopic techniques for LHB tenodesis using knotless screw techniques offer the advantage of circumventing the need for arthroscopic knot tying. In 2012 Song and Williams described a novel tenodesis technique that does not require any knot-tying procedures by using a knotless anchor. However, a single-anchor configuration may not offer adequate stabilization of the LHB tendon. Therefore we propose a modified method that uses a double knotless anchor that offers advantages over the single knotless anchor, such as an increase in the contact area between the tendon and bone to facilitate tendon-to-bone healing and strengthening of the tenodesis construct.

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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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Project description: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.

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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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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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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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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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