Arthroscopic All-Inside Biceps Tenodesis: Technique and Outcomes

Abstract

The long head of the biceps tendon (LHBT) is a frequent source of disorders and pathology in the shoulder. Significant evidence is available on the management of disorders of the LHBT in the literature, and the LHBT is frequently addressed intraoperatively when involved in shoulder pathology. An all-arthroscopic, intra-articular biceps tenodesis with suture anchor fixation has several advantages that have not been well described previously, and it does not add significant morbidity to arthroscopic surgery to treat the rotator cuff or other sources of pain. Intra-articular LHBT tenodesis in the bicipital groove thus has advantages of less surgical time and a decreased bone footprint.

Fig 1

View from the posterolateral portal in the lateral decubitus position in a right shoulder. The long head of the biceps tendon (BT) is visible with significant tendinosis extending from the anchor (A) into the bicipital groove (BG) at the articular margin (B). (AL, anterior labrum; G, glenoid; HH, humeral head; PL, posterior labrum.)

Fig 2

The position for the tenodesis site is identified prior to biceps tenotomy at the edge of the articular margin superior to the bicipital groove (BG). This area is decorticated using a shaver. (BT, biceps tendon; HH, humeral head.)

Fig 3

(A) A BirdBeak suture passer is used to first puncture the long head of the biceps tendon (BT) and pass the suture through the tendon. (B) The tendon is passed back around the BT in luggage-tag fashion. (BG, bicipital groove; FS, first suture; HH, humeral head; SS, second suture.)

Fig 4

Two total luggage-tag sutures are passed through the long head of the biceps tendon (BT). (BG, bicipital groove; FS, first suture; HH, humeral head; SS, second suture.)

Fig 5

Both luggage-tag sutures are passed through a SwiveLock anchor (A); the anchor is placed into bone after punching and tapping. (BT, biceps tendon; FS, first suture; HH, humeral head; SS, second suture.)

Fig 6

The included eyelet sutures are tied into a knot on top of the anchor (A) to reinforce the tenodesis. (BG, bicipital groove; BT, biceps tendon; HH, humeral head.)

Fig 7

The tenodesis of the long head of the biceps tendon has been completed, thus preserving the length-tension relation of the tendon. The long head of the biceps tendon is then tenotomized using an electrocautery wand. (BG, bicipital groove; BS, biceps tendon stump; HH, humeral head.)

Fig 8

(A) The long head of the biceps tendon stump is debrided with an electrocautery wand and shaver to clean the labrum. (B) Appearance of the proximal biceps stump (PBS) and glenoid (G) at the end of the procedure. (AL, anterior labrum; PL, posterior labrum.)