Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: May 2 2021

Arthroscopic Biceps Tenodesis

Preoperative Patient Care
Operative Techniques
D

Simulation

1

Cadaveric demonstration of surgical approach and therapeutic skill

2

Sawbones demonstration of proper instrumentation

E

Preoperative Plan

1

Evaluate radiographs and MRI

  • Biceps tendon or labral pathology (SLAP tear) that indicates a tenodesis procedure.

2

Perform exam under anesthesia

3

Execute surgical walkthrough

  • describe steps of the procedure verbally to the attending prior to the start of the case
  • describe potential complications and steps to avoid them
F

Room Preparation

1

Make sure tower working

  • 30° arthroscope
  • fluid pump system
  • standard arthroscopic instruments
  • suture passing devices
  • suture retrieving devices
  • knot tying devices
  • arthroscopic shavers and burrs
  • radiofrequency (RF) ablation wand
  • suture anchors

2

Room setup and Equipment

  • standard OR table for lateral decubitus position

3

Patient Positioning
(lateral)

  • place patient in the lateral decubitus position
  • pad any prominences of the extremities
  • position the head and neck in neutral alignment
  • support the head with a foam head cradle
  • protect the eyes with tape
  • place an axillary role under the upper chest to protect the lower shoulder and axilla
  • ensure the entire scapula is free from the edge of the table
  • support the arm with the Meisel mitten in the arthroscopy position with 10 pounds of traction
  • prep and drape the arm in the usual fashion for shoulder arthroscopy
G

Scope Insertion

1

Outline landmarks

  • Outline the acromion, distal clavicle, coracoid process and biceps tendon

2

Place posterior portal

  • Mark portal 2 to 3 cm distal and 1 to 2 cm medial to the posterior lateral tip of the acromion
  • Make 4mm skin incision
  • Place scope cannula with a blunt trocar into the incision and enter the joint.
  • use lateral traction to avoid damage to the articular surface
  • Place the 30° arthroscope.

3

Place anterior portal

  • Halfway between acromioclavicular joint and the lateral aspect of the coracoid
  • Pierce the anterior fibers of the deltoid and enter the joint in the interval between the supraspinatus and subscapularis
H

Diagnostic Arthroscopy

1

Perform diagnostic arthroscopy

  • 1. Biceps tendon and biceps anchor
  • 2. Posterior labrum and posterior capsular pouch
  • 3. Inferior capsular pouch and inferior aspect of the humeral head (? osteophyte)
  • 4. Glenoid articular cartilage
  • 5. Articular surface of the rotator cuff and rotator cuff crescent
  • 6. Posterior rotator cuff attachment and bare area of the humeral head (?Hill-Sachs lesion)
  • 7. Biceps Tendon
  • 8. Anterior superior labrum and rotator interval
  • 9. Subscapularis tendon and Middle Gleno-Humeral ligament
  • 10. Anterior-Inferior labrum and ligaments

2

Insert the scope in the anterior portal and perform the final 5 points of the 15-point exam

  • 11. Posterior labrum and posterior inferior capsule
  • 12. Posterior superior capsule and posterior rotator cuff tendon
  • 13. Anterior inferior labrum and ligaments
  • 14. Subscapularis tendon and subscapularis recess medial to the glenoid
  • 15. Anterior surface of the humeral head and subscapularis attachment

3

Debride tissues

  • Debride synovitis and cartilage lesions
I

Intra-Articular Biceps Management

1

Start tenodesis in glenohumeral compartment

  • pierce biceps tendon with spinal needle coming into the joint from the anterior lateral acromial border, though the rotator cuff interval, and through the biceps tendon
  • after pierced and held, cut tendon at anchor with curved scissors.
  • leave spinal needle in place to the end of the procedure to hold and anchor the tendon
  • debride tendon stump and labrum with shaver
J

Subacromial Space Management

1

Perform subacromial bursectomy

  • Move trocar into SAS
  • slide the trocar under the acromiom over the posterior rotator cuff
  • sweep under the acromiom through the lateral gutter to break up adhesions

2

Identify the CA ligament

  • found on the anterior aspect of the subacromial space

3

Reposition the anterior cannula

  • Push the trochar through the anterior portal, slide anterior cannula over, insert camera, now camera and ant trochar in subacromial space.

4

Perform a Bursectomy

  • Use the shaver to perform a lateral and anterior bursectomy through anterior portal
K

Tendon Preparation

1

Move camera to posterior lateral portal

  • Use spinal needle to make a posterior lateral portal just off the acromion.
  • this allows for visualization down into the bicipital groove in the humerus

2

Make stab incision

  • use switching sticks to place camera into posterior lateral portal, place canula into the original posterior portal

3

Localize biceps tendon in groove and create a portal over tendon

  • use pre-operative biceps marking as guide
  • make stab incision approximatly 1/2 down to axilla

4

Insert shaver for further bursectomy

5

Measure for passport cannula

  • Measure and place passport cannula centered over tendon in groove

6

Release the roof of the bicipital grove

  • Use shaver or RF to feel the tendon, and start by releasing lateral
  • careful to not cut tendon itself

7

Size the tendon

  • Use tendon sizer
  • most common size is 7mm & 8mm

8

Isolate tendon medially

  • Use tendon sizer to push tendon medial and place a spinal needle into it to hold position
L

Implant Fixation

1

Drill Potting hole

  • Use a piloted reamer that is 5mm larger than the selected implant

2

Remove spinal needle holding tendon medially

  • Tendon will return to position above the hole

3

Implant biceps specific forked screw and tendon

  • Push forked screw implant into passport and down onto tendon above the hole
  • Place tension with forked implant
  • Implant until screw is flush with cortex
  • will have tension via proximal spinal needle holding it
  • Remove the proximal spinal needle
  • Screw down implant and fix tendon

4

Debride the remaining tendon

  • Use curved scissors to cut remaining tendon and remove with grasper through passport
  • Use shaver or RF to debride down remaining stump
N

Wound Closure

1

Closing the portals and dressing the incisions

  • withdraw the instruments

2

Close the incisions with a single subcuticular stitch

  • use 4-0 monocryl suture

3

Apply steristrips

4

Place dressings

  • place Prowicks sponges that are primed with liquid betadine solution over the incisions
  • place and wrap Prowick dressings over the incision
  • cut the arm portion of the wrap to relieve pressure around the axilla and upper humerus.

5

Place sling

  • support the patients arm in an regular sling.
Postoperative Patient Care
Private Note