All Arthroscopic Suprapectoral Biceps Tenodesis.doc

Introduction : To describe the technique of all arthroscopic suprapectoral biceps tenodesis. Pathology of long head of biceps (LHB) is varyingly found in patients with rotator cuff pathology, adhesive capsulitis and labral tears (SLAP) and is shown to be a significant pain generator in the shoulder. Materials & Methods: LHB pathology was observed in 19 patients who were undergoing arthroscopy for cuff tears, ac joint arthritis and adhesive capsulits between April to Sept 2013. Patients aged above 60 years and with low-demands underwent tenotomy. Younger and, active patients underwent tenodesis with this technique. Patients were assessed with Constant score. Technique: Arthroscopy was performed in lateral decubitus, intrarticular and subacromial procedures were done. From the anterior portal, stay sutures were passed into the biceps tendon and a tenotomy was performed. From anterior and anterolateral subacromial portals, biceps tendon was exposed in the groove, traced down to pectoralis major tendon and a tunnel of 20x7 mm was reamed at this level from a low anterior portal. The forked end of the swivel-lock anchor is used to grasp and push the tendon into the tunnel and the anchor was screwed in, while maintaining counter tension with the stay sutures to maintain ideal length-tension. Results: All patients had good pain relief. The scores improved from 38 to 67. No one had cramps, fatigue pain or “popeye” deformity. Conclusion: This technique saves time as it obviates the need to exteriorize the tendon for applying sutures and is useful in younger and active patients.