Options
Arthroscopic
- intra-articular
- suprapectoral
Open
- suprapectoral
- subpectoral
A. Arthroscopic Intra-articular
Concept
- suture biceps to superior capsule using figure 8 no 2 non absorbable
Technique
- anterior portal + portal of Wilmington
- debride capsule and biceps with shaver so will heal
- use curved suture passer with no 1 PDS
- suture shuttle no 2 fibre wire
- divide 90% biceps insertion so will rupture in time
- allows healing of biceps to capsule
Attempt Figure 8 Suture Configuration
B. Arthroscopic Suprapectoral Technique
1. Secure Biceps Tendon - allows tensioning and prevents losing tendon
A. Birds Beak Passer with 2 ethibond loop
- pass loop through intact tendon at entry through RC interval
- retrieve loop out through portal and lock
- this gives strong hold on tendon
B. Pass 18 G spinal needle through biceps tendon
- thread 1 PDS or nylon
- retrieve both suture ends via portal in rotator interval
- secure with half hitches
- pass 1 loop of PDS about entire tendon and tie again
2. Resect tendon with electrocautery at insertion
3. Make portal over biceps interval into subacromial space
- release biceps tendon with electrocautery or arthroscopic scissors
4. Secure tendon
- make drill hole
- insert tendon
- secure with biotenodesis screw
- multiple techniques with specifically designed equipment
C. Open Technique for Intact Biceps
1. Divide biceps arthroscopically
- may wish to place stay suture first to avoid retraction
- biceps normally has vinculae preventing complete retraction into arm
2. Suprapectoral
- deltoid split
- between anterior and middle parts
- find biceps in groove
- pull out of wound and whip stitch with heavy suture
- drill appropriate size tunnel for fixation screw
- multiple biceps tenodesis devices
- push the tendon into the hole, then fixate with screw
3. Subpectoral
- medial incision in arm
- below inferior edge of pectoralis major
- find biceps tendon
- whip stitch
- pass through drill holes / secure with screw / secure with anchor
D. Open Technique for Ruptured LHB / Popeye in young patient
1. Locate biceps
Options
A. Suprapectoral
- best to make deltopectoral approach
- biceps may be futher retracted
B. Subpectoral approach
2. Fixation