An All-Arthroscopic Simple Double 360° Lasso Loop Technique for Supraopectoral Biceps Tenodesis

Abstract

In many shoulder joint diseases, there is often a combination of long head biceps tendon（LHBT）pathology. Biceps pathology is one of the main causes of shoulder pain, and it is effectively managed with tenodesis. Biceps tenodesis can be performed in a variety of ways with different fixation and at different locations. This article introduces an all-arthroscopic suprapectoral biceps tenodesis technique with a 2-suture anchor. Double 360° Lasso Loop is used to fix the biceps tendon, and only one puncture of the biceps tendon was required, which caused little damage to the tendon and was not easy for the suture to slip and fail.

Fig 1

Location of arthroscopic portals (right shoulder). Suprapectoral biceps portal is at the level of the apex of the axillary fold (red arrow).

Fig 2

(A-I) Patient’s right shoulder positioned in the lateral decubitus and viewing through a lateral portal. (A) Through the suprapectoral-biceps portal a 4.5-mm 2-suture anchor (Depuy, Healix) is placed at the upper margin of the pectoralis major and slightly posterior to the bicipital groove through the suprapectoral biceps portal. (B) The different strands of the two sutures are placed on each side of the biceps tendon with a probe or suture grasper (Smith & Nephew) from the suprapectoral-biceps portal. (C) From the suprapectoral-biceps portal a penetrating grasper (Smith & Nephew) is used to puncture the biceps tendon near the proximal position above the anchor. (D) After the tip of the penetrating grasper passed through the midportion of the biceps tendon, one of the two sutures on each side of LHBT with different colors is retrieved by using the jaw of the penetrating suture grasper (Smith & Nephew), respectively. (E) Pull out the captured two sutures, but not completely through, leaving two loops of suture exiting the superior surface of the tendon. (F) A suture grasper (Smith & Nephew) is passed through the two loops from the anterolateral portal to grasp the free end of the suture in front of the biceps tendon, which is the same suture limb used to create the loops. The suture limb is pulled through the double loops. (G) Repeated the same procedure from the front of the double loops to grasp another free limb of the suture behind the biceps tendon through the suprapectoral-biceps portal, which is another strand used to create the loops. (H) The ends of all four sutures are tightened. (I) After two nonsliding knots are tied on both side of the biceps tendon, the double 360° lasso loop configuration is achieved.

Fig 3

(A-H) Illustrations summarizing the steps required to create the double 360° lasso loop. (A) A 4.5-mm 2-suture anchor is placed at the upper margin of the pectoralis major and near the bicipital groove. (B) The different strands of the two sutures are placed on each side of the biceps tendon. (C) A penetrating grasper is used to puncture the biceps tendon near the proximal position above the anchor. (D) One of the two sutures on each side of LHBT with different colors is retrieved by using the jaw of the penetrating suture grasper, respectively. And leaving two suture loops above the surface of the tendon. (E) A suture grasper is passed through the two loops from the front of the double loops to grasp the free end of the suture behind the biceps tendon, which is the same suture limb used to create the loops. The suture limb is pulled through the double loops. (F) The same procedure is done from the rear of the biceps tendon to grasp another free limb of the suture in front of the biceps tendon, which is another strand used to create the loops. (G) The ends of all four sutures are tightened. (H) Tied two nonsliding knots on both sides of the biceps tendon, the double 360° lasso loop is finished.