All-Arthroscopic Suprapectoral Long Head of Biceps Tendon Tenodesis With Interference Screw–Like Tendon Fixation After Modified Lasso-Loop Stitch Tendon Securing

Abstract

Arthroscopic suprapectoral techniques for tenodesis of the long head of the biceps tendon (LHB) are appropriate for the treatment of proximal biceps lesions. Several types of techniques and fixation devices have been described and evaluated in biomechanical studies regarding primary stability. In this technical note, we describe an all-arthroscopic suprapectoral technique using the 6.25-mm Bio-SwiveLock device (Arthrex, Naples, FL) for an interference screw-like bony fixation after having armed the tendon with a lasso-loop stitch. Both the interference screw fixation and securing of the lasso-loop tendon have been well described and approved in biomechanical tests concerning the primary stability. One advantage of this technique performed from the glenohumeral space, in addition to the strong and secure fixation with ingrowth of the tendon in a bony canal, is the avoidance of touching the soft tissue above the bicipital groove, which results in a smooth fitting of the tendon into its natural canal and therefore avoids mechanical irritation of the stump at the rotator interval. In conclusion, the all-arthroscopic suprapectoral LHB tenodesis performed from the glenohumeral space with the modified lasso-loop stitch for securing of the tendon and the 6.25-mm Bio-SwiveLock suture anchor for interference screw-like bony tendon fixation is an appropriate technique for the treatment of LHB-associated lesions.

Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodesis: A Comparison of Restoration of Length-Tension and Mechanical Strength Between Techniques

“…2 Numerous options for surgical approach, location, and method of fixation have been investigated for biceps tenodesis in both cadaveric and clinical studies. Long head biceps tenodesis can be performed with an open [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] or arthroscopic technique 9,18-33 and can be positioned high at the entrance of the bicipital groove, in the suprapectoral location just proximal to the pectoralis major tendon, 9,16,22,30,31,34 in a subpectoral location at or distal to the pectoralis major tendon, 6,10,12,15,16,34 or in other positions, including the conjoint tendon or soft tissue tenodesis sites. 27,32,33,35 Arthroscopic suprapectoral and open subpectoral techniques are 2 common distal techniques for biceps tenodesis.…”

A Simple, All-Arthroscopic, Knotless Suture Lasso Loop Technique for Suprapectoral Biceps Tenodesis

“…9,10 Although there have been several biomechanical analyses of differing tenodesis techniques, 6,7,11,12 compelling clinical data showing the superiority of one technique over another have not yet been presented. Patzer et al 7 described a similar technique with a lasso loop Orthocord suture (DePuy Mitek, Raynham, MA) and a SwiveLock anchor (Arthrex). However, in their technique, they discussed the need for knot tying and delivering a limb of tendon into the interference screw site.…”

“…1,2 Both open subpectoral and arthroscopic tenodesis techniques have been advocated in the literature. [3][4][5][6][7][8][9] In a biomechanical study comparing these 2 techniques, Mazzocca et al 6 found no difference in cyclic loading or yield to failure using different interference screw tenodesis strategies. In addition, no clinical difference has been found between arthroscopic suprapectoral biceps tenodesis and open subpectoral biceps tenodesis.…”

Die lange Bizepssehne als Schmerzgenerator der Schulter

“…Aus biomechanischer Sicht ist der Goldstandard die intraossäre LBS-Tenodese mit einer resorbierbaren Interferenz-Schraube (41, 42). Diese kann arthroskopisch proximal suprapektoral (42)(43)(44), distal suprapektoral (45,46) oder mini-open subpektoral (47)…”