All-Arthroscopic Falciform Portal Biceps Tenodesis

Abstract

Biceps tenodesis has been proven to be an effective treatment for biceps tendon and superior labral pathology. Many techniques including both open and arthroscopic approaches have been reported. Open techniques afford management of the entire proximal biceps tendon but are limited by wound healing issues, increased bleeding, and increased surgical time. Arthroscopic tenodesis offers benefits in terms of surgical efficiency, cosmesis, and bleeding risk. However, standard arthroscopic tenodesis only addresses intra-articular biceps pathology. In this report we describe an all-arthroscopic biceps tenodesis technique at the suprapectoral region of the humerus using knotless suture anchor fixation.

Fig 1

This figure demonstrates the important landmoarks and portal placement in the right shoulder of a patient placed in the lateral decubitus position. A triangle is drawn between the lateral midline portal and the anterosuperior portal (black arrows). A cannula is placed in the falciform portal (green arrow), which is established using a spina needle for localization starting at the tip of the drawn triangle (dotted lines). The falciform portal overlies the bicipital groove. The standard posterior viewing portal is established first for diagnostic arthroscopy followed by the lateral subacromial viewing portal for the duration of the biceps tenodesis.

Fig 2

Arthroscopic view of the patient's right shoulder from a lateral subacromial portal looking from superior to inferior down the biceps tendon (B) with the humerus (H) and pectoralis major tendon (P) in view.

Fig 3

Arthroscopic view of the patient's right shoulder from a lateral subacromial portal looking from superior to inferior demonstrating the biceps sheath being opened up with an ablator looking from superior to inferior down the biceps tendon (B) and pectoralis major tendon (P) in view.

Fig 4

Arthroscopic view of the patient's right shoulder from a lateral subacromial portal looking from superior to inferior demonstrating the spinal needle location and trajectory for falciform portal creation with the biceps tendon (B) with the humerus (H) and pectoralis major tendon (P) in view.

Fig 5

Arthroscopic view of the patient's right shoulder from a lateral subacromial portal looking from superior to inferior demonstrating biologic preparation with a rasp with the biceps tendon (B) in view before suture anchor placement.

Fig 6

Arthroscopic view of the patient's right shoulder from a lateral subacromial portal looking from superior to inferior of suture anchor placement after biologic preparation with the biceps tendon (B) and humerus (H) in view.

Fig 7

Arthroscopic view of the patient's right shoulder from a lateral subacromial portal looking from superior to inferior after suture anchor placement through the falciform into the humerus (H) portal before passage around the biceps tendon.

Fig 8

Arthroscopic view of the patient's right shoulder from a lateral subacromial portal looking from superior to inferior of passing the working stitch circumferentially around the biceps tendon with a Scorpion device (Arthrex) with the biceps tendon (B) and humerus (H) in view.

Fig 9

Arthroscopic view of the patient's right shoulder from a lateral subacromial portal looking from superior to inferior of the second pass of the working stitch (2) after passing of the first stitch (1) midway through the biceps tendon with a Scorpion device (Arthrex) with the biceps tendon (B) and humerus (H) in view.

Fig 10

Arthroscopic view of the patient's right shoulder from a lateral subacromial portal looking from superior to inferior of retrieving the white sutures through the anterior portal with the biceps tendon (B) in view.

Fig 11

Arthroscopic view of the patient's right shoulder from a lateral subacromial portal looking from superior to inferior of the biceps tendon securely cinched down to bone with the biceps tendon (B) and pectoralis major tendon (P) in view.

Fig 12

Arthroscopic view of the patient's right shoulder from a lateral subacromial portal looking from superior to inferior of scissors being used to remove the proximal aspect of the biceps tendon (B) by cutting a few millimeters proximal to anchor placement.