Arthroscopic In Situ Biceps Tenodesis Using a Double Loop-and-Tack Knotless Suture Anchor

Abstract

The long head biceps tendon is a common culprit of anterior shoulder pain and dysfunction that can be surgically treated with tenotomy or tenodesis. Many techniques exist for tenodesis. This article submits an arthroscopic technique using two loop-and-tack sutures and a knotless suture anchor to tenodese the long head biceps tendon in the proximal bicipital groove in situ. The advantage of this technique is that it maintains the biceps in its native position by performing tenodesis before tenotomy. Most other techniques attempt to restore native position of the biceps through approximation. The transverse humeral ligament is also released to decompress the bicipital groove. This technique can be used to treat isolated biceps pathology or combined with rotator cuff and labral procedures.

Fig 1

The long head biceps tendon is marked on both sides with #0 Prolene sutures in the glenohumeral joint through the anterosuperolateral aspect of the rotator interval and out through the anterior portal cannula. Glenohumeral view from the posterior portal in a left shoulder in lateral decubitus position. BT, long head biceps tendon; HH, humeral head; RI, rotator interval; SSC, subscapularis.

Fig 2

The long head biceps tendon and bicipital groove are localized between the Prolene sutures in the subacromial space. Subacromial view from the posterior portal in a left shoulder in lateral decubitus position. BT, long head biceps tendon.

Fig 3

The long head biceps tendon is unroofed, and the transverse humeral ligament is released with a shaver. Subacromial view from the posterior portal in a left shoulder in lateral decubitus position. BT, long head biceps tendon; HL, transverse humeral ligament; SSC, subscapularis; SSP, supraspinatus.

Fig 4

The first loop suture is placed using an antegrade suture passer, while the long head biceps tendon is elevated with a tissue grasper. Subacromial view from the posterior portal in a left shoulder in lateral decubitus position. BT, long head biceps tendon; FS, first suture; SSP, supraspinatus.

Fig 5

The second loop suture is placed using an antegrade suture passer followed by a distal tack suture (not shown), while the long head biceps tendon is elevated by the first loop suture. Subacromial view from the posterior portal in a left shoulder in lateral decubitus position. BT, long head biceps tendon; FS, first suture; SS, second suture.

Fig 6

Both loop-and-tack sutures are complete. Subacromial view from the posterior portal in a left shoulder in lateral decubitus position. BG, bicipital groove; BT, long head biceps tendon; FS, first suture; SS, second suture.

Fig 7

An osseous punch is used to prepare the location of the suture anchor between the two sutures in the proximal bicipital groove. Subacromial view from the posterior portal in a left shoulder in lateral decubitus position. BT, long head biceps tendon; FS, first suture; SS, second suture.

Fig 8

The two loop-and-tack sutures are secured with a 4.75-mm biocomposite knotless suture anchor in the proximal bicipital groove in situ. Subacromial view from the posterior portal in a left shoulder in lateral decubitus position. BT, long head biceps tendon.

Fig 9

The arthroscopic in situ biceps tenodesis is complete and suture tails are cut. Subacromial view from the posterior portal in a left shoulder in lateral decubitus position. BT, long head biceps tendon; FS, first suture; SS, second suture.

Fig 10

The glenohumeral joint is revisited. Tenotomy of the long head biceps tendon is performed at the superior labrum using arthroscopic scissors, and excess tendon is debrided intra-articularly. Glenohumeral view from the posterior portal in a left shoulder in lateral decubitus position. BT, long head biceps tendon; G, glenoid; SSC, subscapularis.