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.

Fig 1

The patient is placed in the beach-chair position. Right shoulder with the standard arthroscopic portals: A, posterior standard portal; B, posterolateral portal; C, lateral portal; D, anterolateral portal; and E, anterior portal.

Fig 2

Anatomical model of the humeral head. The Self-Punching All Suture-Anchor (black arrow) is inserted through (penetrating) the long head of the biceps tendon (white arrow).

Fig 3

Anatomical model of the humeral head. The Self-Punching All Suture-Anchor completely inserted into the bicipital groove (white arrow), and the sutures stay in the long head of the biceps tendon (black arrow).

Fig 4

Suture management and knot-tying (step by step) in a left shoulder. A, With the suture manipulator (white arrow), one of the sutures is grabbed and transported anteriorly to the biceps tendon. B, The suture is pushed to the space between the anterior glenoid rim and the subscapularis tendon. C, The suture is left there and the suture manipulator is pulled back. D, the suture manipulator is positioned posteriorly to the biceps tendon. E, The suture loop is lateralized with the suture manipulator. F, With the suture manipulator the loop is retrieved towards anteromedial until the loop is around the biceps. G, The lasso loop is made around the whole tendon passing the free limb through the lasso. H, The lasso loop is knotted after retrieving both of the sutures of the same color, and in this way the tendon is completely fixed to the bicipital groove (black arrow). Then, the same procedure is repeated with the other color sutures.

Fig 5

Beach-chair position is shown. Right shoulder: intra-articular view through the posterior portal (A portal) of the biceps tenodesis. The long head of the biceps tendon is completely fixed on the bicipital groove (white arrow).