Journal: Arthroscopy Techniques
Article Title: Ultrasound-Guided Suprapectoral Tenodesis of the Long Head of the Biceps Brachii
doi: 10.1016/j.eats.2020.08.039
Figure Lengend Snippet: The long head of the biceps tendon is arthroscopically evaluated to determine the need for tenodesis. If tenodesis is to be performed, the tendon is first tagged with a suture. A 90° SutureLasso is placed through the midsubstance of the tendon, and a FiberStick is passed. The tendon is tagged directly in front of the cannula to facilitate proper tensioning of the biceps during fixation. Once tagged, the biceps tendon is tenotomized. A linear ultrasound probe is used to identify the biceps tendon in short axis and its location with respect to the bicipital groove and pectoralis major. Starting proximally, we can see the biceps tendon seated in the bicipital groove. As the transducer is moved distally, the groove disappears. Continuing distally with the probe, the pectoralis major comes into view superficial to the biceps tendon. Returning proximally, the bicipital groove reappears. The locations for the portals and subsequent tenodesis are below the groove and above the pectoralis major. The portals are made approximately 1 cm medial and lateral to the center of the probe, which is centered over the biceps tendon. The probe can be reapplied to ensure the markings are in the correct position. Once the medial and lateral suprapectoral portals have been created, a closed, curved Kelly clamp is inserted; pushed down to bone; oriented toward the opposing portal; and then opened and spread to create a working space under the deltoid and above the biceps tendon. This technique is performed through both portals. A shaver and ablation wand can be used to clear tissue for better visualization—caution should be exercised for 2 arteries: The anterior circumflex artery that runs along the superior border of the pectoralis should be avoided, and the ascending branch of this artery that rises lateral to the biceps should be addressed as it often requires cauterization. The biceps tendon is mobilized medially and held to the side with a spinal needle. A 7.5-mm Pilot Headed Reamer angled perpendicular to the bone surface is used to create a socket along the anatomic course of the biceps and distal to the groove but above the pectoralis major. The spinal needle is removed, and the original stay suture is pulled so that it reaches the anterior cannula where the tendon was originally tagged. This returns the biceps to the normal position and sets the tendon and muscle to the appropriate tension and length. A 7.0-mm Forked Tip BioComposite SwiveLock Tenodesis screw is used to fix the tendon into the socket. The stay suture can be removed from the proximal tendon, and the anchor can be seen flush with the humerus, completing the ultrasound-guided suprapectoral biceps tenodesis procedure.
Article Snippet: A 7.0 × 19.5–mm Forked Tip BioComposite SwiveLock Tenodesis screw (Arthrex) is used to fix the tendon into the socket ( and ).
Techniques:
