The Lark Loop Used for Proximal Biceps Tenodesis: An All-Arthroscopic Technique

Abstract

Long head of the biceps tendinopathy is a common shoulder problem that is difficult to diagnose and treat. Biceps tenodesis is an effective surgical approach target for long head of the biceps tendon lesions. This article describes an all-arthroscopic proximal biceps tenodesis technique. This technique uses a high-strength suture to construct a tear-resistant loop; fixation is achieved with a suture anchor at the proximal aspect of the intertubercular groove or the greater tuberosity. This tenodesis fixation is simple, with no neurovascular injury or humeral fracture risk. In addition, our technique is cost-effective, with no need for specialty sutures.

Fig 1

Patient position and landmark identification (left shoulder). The patient is placed in the lateral decubitus position, with continuous affected-extremity traction. The bony landmarks are outlined, and the posterior, anterior, and anterolateral portals are marked.

Fig 2

The patient is positioned in the lateral decubitus position. (A) Intra-articular arthroscopic image of a left shoulder from the posterior viewing portal with a 30° arthroscope. A probe from the anterior working portal is used to evaluate the quality of the biceps tendon for an initial assessment. (B) An illustration summarizes the corresponding step. (BT, biceps tendon; G, glenoid; HH, humeral head.).

Fig 3

The patient is positioned in the lateral decubitus position. (A) Intra-articular arthroscopic image of a left shoulder from the posterior viewing portal with a 30° arthroscope. A FiberWire is folded in half to be placed at the superior aspect of the biceps tendon through the anterior working portal. (B) An illustration summarizes the corresponding step. (BT, biceps tendon; G, glenoid; HH, humeral head.).

Fig 4

The patient is positioned in the lateral decubitus position. (A) Intra-articular arthroscopic image of a left shoulder from the posterior viewing portal with a 30° arthroscope. Two suture strands are threaded through the loop inferior to the tendon, released, and grasped out of the capsule through the anterior working portal to construct a lark’s head knot. (B) An illustration summarizes the corresponding step. (BT, biceps tendon; G, glenoid; HH, humeral head.).

Fig 5

The patient is positioned in the lateral decubitus position. (A) Intra-articular arthroscopic image of a left shoulder from the posterior viewing portal with a 30° arthroscope. An 18-gauge spinal needle is inserted through the middle portion of the tendon, just distal to the knot, to advance a No. 0 PDS II (polydioxanone) suture. (B) An illustration summarizes the corresponding step. (BT, biceps tendon; G, glenoid.).

Fig 6

The patient is positioned in the lateral decubitus position. (A) Intra-articular arthroscopic image of a left shoulder from the posterior viewing portal with a 30° arthroscope. An overhand knot has been tied on the 2 strands of the FiberWire ends with the polydioxanone suture. The spinal needle is retrieved, and the polydioxanone suture inside is pulled out, helping to shuttle the 2 strands of FiberWire ends through the tendon. (B) An illustration summarizes the corresponding step. (BT, biceps tendon.).

Fig 7

The patient is positioned in the lateral decubitus position. (A) Intra-articular arthroscopic image of a left shoulder from the posterior viewing portal with a 30° arthroscope. Final completion of the lark loop is shown. (B) An illustration summarizes the lark-loop placement on the biceps tendon. (BT, biceps tendon; HH, humeral head.).

Fig 8

The patient is positioned in the lateral decubitus position. (A) Intra-articular arthroscopic image of a left shoulder from the posterior viewing portal with a 30° arthroscope. The LHBT is detached from its insertion site on the superior-labral junction with a punch forceps through the anterior working portal. (B) An illustration summarizes the corresponding step. (BT, biceps tendon; G, glenoid.).

Fig 9

The patient is positioned in the lateral decubitus position. (A) Arthroscopic image in the subacromial space of a left shoulder from the anterolateral viewing portal with a 30° arthroscope. The stump of the biceps tendon is pulled out of the articular cavity. (B) An illustration summarizes the corresponding step. (BT, biceps tendon; IG, intertubercular groove.).

Fig 10

The patient is positioned in the lateral decubitus position. (A) Arthroscopic image in the subacromial space of a left shoulder from the anterolateral viewing portal with a 30° arthroscope. The strands of the lark loop are co-anchored with the lateral row during rotator cuff repair with a 4.75-mm SwiveLock C anchor. (B) An illustration summarizes the strands of the lark loop firmly anchored at the intertubercular groove in the isolated biceps tenodesis with a 4.75-mm SwiveLock C anchor. (BT, biceps tendon; GT, greater tuberosity.).