Mini-Open Subpectoral Biceps Tenodesis Using a Suture Anchor with Bone-Bridge Backup

Pathology of the long head of the biceps tendon is a known cause of anterior shoulder pain. Current surgical management options include tenotomy and tenodesis. Tenodesis can be performed arthroscopically or as an open procedure. Arthroscopic tenodesis typically uses a suprapectoral attachment, which may fail to address tendon pathology in the bicipital groove. Open tenodesis carries iatrogenic risk to neurovascular structures and a fracture risk while drilling, as well as the morbidity of an open procedure. This technique paper describes a mini-open subpectoral approach using a suture anchor and bone bridge backup for dual fixation. Use of a suture anchor instead of an interference screw reduces drill hole diameter reducing the risk of iatrogenic humeral fracture. Dual fixation provides a robust repair which may be of use for athletic patients desiring an accelerated recovery.
Technique Video Video 1 Mini-open subpectoral biceps tenodesis using a suture anchor with a bone-bridge backup. The patient is positioned in a beach-chair position for the right shoulder for posterior portal visualization. The biceps anchor shows significant fraying at the superior labrum. The biceps tendon has avulsed from the anchor and is adhered to the anterior capsule of the glenohumeral joint. Through an anterior portal, a shaver is introduced to debride the superior labrum and any adhesions holding the biceps tendon to the anterior capsule. An incision is made at the anterior axillary space at the inferior border of the pectoralis major. While retracting the pectoralis major tendon superiorly, the long head of the biceps tendon (LHBT) can be palpated within the bicipital groove. After releasing the LHBT from the groove with electrocautery, the tendon is whipstitched with a FiberLink suture. The inferior bicipital groove is prepared with electrocautery and a Cobb elevator, and a 5.5-mm reamer is drilled unicortically at the approximated location of the tenodesis. Proximally, a 2.4-mm drill is used to create the bone bridge hole 5 mm superior to the tenodesis hole. The LHBT is sized using with a sizer on the 5.5-mm SwiveLock Anchor, the tails of the suture are loaded into the anchor. One tail is passed from the distal to proximal hole and the other tail is passed from the proximal to distal hole using a suture passing flag or nitinol micro suture lasso. With tension on the suture tails, the SwiveLock anchor is inserted and placed into tenodesis hole. Using a free needle, the suture tails are passed through the LHBT multiple times and are tied down, securing the tendon onto the tenodesis site.