Arthroscopic Single Portal, Single Anchor Knotless Subscapularis Repair with Concomitant Tenodesis of the Long Head of the Biceps Tendon

Abstract

Anterior shoulder pathology involving the subscapularis is often associated with the biceps tendon because both anatomic structures intersect the lesser tuberosity. Standard procedures for such pathology often involve simultaneous subscapularis repairs and biceps tenodesis. Single anterior portal subscapularis repairs have been emerging in the past 5 years because of cost-effectiveness and efficiency. Biceps tenodesis is a common procedure performed both open and arthroscopically. This technique takes advantage of the close relation between the long head of the biceps tendon and subscapularis tendon to restore the functional length-tension relation and preserve function through fixation using a single portal and a single knotless suture anchor.

Combined, Single-Anchor Subscapularis Tendon Repair and Proximal Biceps Tenodesis Leads to Improved Function and Decreased Pain at 1 Year

“…Although arthroscopic SST repair is generally supported, 25 , 26 , 27 the clinical evaluation of specific or isolated tear patterns has become more relevant. 4 , 5 , 6 , 11 , 12 , 17 , 18 , 28 Injuries to the upper-third SST are of particular interest given its biomechanical importance and role in difficult-to-treat anterior shoulder dysfunction. 4 , 5 , 17 , 18 The use of single-anchor fixation is supported for isolated, complete SST tears containing up to 50% footprint disruption (Lafosse II-III).…”

“…Each patient, regardless of additional procedures performed, underwent arthroscopic combined single-anchor repair of SST tears and proximal biceps tenodesis using the LNT technique. 17 , 19 …”

“… 13 , 14 , 15 , 16 Currently, there are few combined single-anchor techniques reported in literature to address both pathologies. 4 , 5 , 17 , 18 The Loop ‘N’ Tack (LNT) tenodesis has been reported as an effective treatment for isolated proximal biceps disease across recent biomechanical and clinical studies. 19 , 20 , 21 , 22 Additionally, as outlined by Kim et al., 17 this simple, knotless, all-arthroscopic procedure can also accommodate repairs of the anterior RCT.…”

“… 4 , 5 , 17 , 18 The Loop ‘N’ Tack (LNT) tenodesis has been reported as an effective treatment for isolated proximal biceps disease across recent biomechanical and clinical studies. 19 , 20 , 21 , 22 Additionally, as outlined by Kim et al., 17 this simple, knotless, all-arthroscopic procedure can also accommodate repairs of the anterior RCT. However, the clinical outcomes of patients undergoing combined biceps tenodesis and SST repair using this technique are not well understood.…”

Arthroscopic Subscapularis Repair Using 18-Gauge Spinal Needle as a Suture Passer to Eliminate Iatrogenic Tendon Damage from Modern Suturing Devices

“…Several surgical techniques and configurations have been described, either by using an antegrade or retrograde suture passing device to aid subscapularis repair. 5,6,15,[19][20][21] The use of spinal needle for subscapularis repair helps to prevent further injury to the tendon. When comparing the modern retrograde suture passing devices available in the market, the diameter of the spinal needle is the smallest (Fig 4).…”