Arthroscopic Tenodesis of the Long Head Biceps Tendon Using a Double Lasso-Loop Suture Anchor Configuration

Abstract

Multiple different techniques exist for performing a biceps tenodesis, and the literature has yet to define a particular technique as superior with respect to outcomes. Factors as the center of various clinical and biomechanical studies include analyzing arthroscopic versus open techniques, optimal fixation sites, and the use specific fixation devices (i.e., anchor, screw). This article details an all-arthroscopic approach for proximal tenodesis of the long head of the biceps tendon (LHBT) using a 2-portal method in a minimally invasive manner. Optimal biomechanical fixation of the LHBT is achieve by using 2 suture anchors in the creation of a dual lasso-loop configuration at the level of the bicipital groove. Technical pearls with respect to optimal arthroscopic viewing, efficient identification of the LHBT and subsequent release from the bicipital groove, and appropriate use of suture anchors for lasso-loop creation are presented for review. Two specific technical advantages of this technique include 2 fixation points for the LHBT to minimize failure risk, and smaller drill holes when compared with commonly performed tenodesis screw techniques to theoretically limit humeral fracture risk.

The Loop ’n’ Tack Knot: Biomechanical Analysis of a Novel Suture Technique for Proximal Biceps Tenodesis

“…Several other all-arthroscopic biceps tenodesis techniques have been described. 1,9,10 The first technique utilizes a transtendinous all-suture anchor with a suture wrap technique to secure the tendon for fixation. 10 Compared with the Loop 'n' Tack, this technique is similar in that operative time is reduced, but the wrapping suture technique requires knot tying over the long head of the biceps (LHB) tendon, which can lead to irritation.…”

“…1 Theoretical advantages include multiple points of fixation, but this technique leads to increased operative time and carries a risk of overtensioning. 1 The Loop 'n' Tack stitch helps to avoid this, as its simple technique helps to decrease operative time, and its use of 1 free suture end for fixation assists in tensioning. The mode-of-failure analysis did demonstrate different mechanisms of failure when comparing the Loop 'n' Tack configuration with the double half-racking and Krakow stitch.…”

“…The last all-arthroscopic tenodesis technique utilizes a “lasso-loop” suture configuration, which requires 2 anchors placed roughly 3 to 5 cm apart within the intertubercular groove. 1 One end of the suture is used to form the lasso loop around the LHB tendon, while the other pierces directly through the tendon itself. The free ends of the suture are externalized, and knots are tied using an arthroscopic knot pusher.…”

Biceps Tenodesis Combined With Rotator Cuff Repair Increases Functional Status And Elbow Strength In Both Operated And Contralateral Arms

“…Arthroscopic suprapectoral biceps tenodesis has distinct advantages including minimal soft tissue dissection, less scar formation, lack of need of an assistant for soft tissue retraction compared to open subpectoral biceps tenodesis [12]. When tenodesis is performed, many different factors affect tendon repair including tendon quality and strength of the stitch.…”

“…For improving strength, Laffoseet al introduced a new technique named Lasso stitch in 2006 [13], which showed superior biomechanical properties against load to failure compared to compressive rivet and interference screw [14]. Some authors also stated that the Lasso loop technique has less humeral fracture risk theoretically associated with drilling than interference screw [12].…”