Arthroscopic Tenodesis Through Positioning Portals

Authors: Ji Shen Qingfeng Gao Yao Zhang Yaohua He

Publish Date: 2014/09/20

Volume: 70, Issue: 3, Pages: 1499-1506

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Abstract

Arthroscopic biceps tenodesis is a good choice for treating proximal lesions of the biceps tendon However there are few descriptions of the surgical approach We introduce a technique for proximal biceps tenodesis using positioning portals and placing suture anchors Our patients had a minimum of 12 months of followup Between January 2010 and June 2012 a total of 49 patients 21 men 28 women underwent arthroscopic biceps tenodesis The pathology was mainly associated with proximal lesions of the biceps tendon with the diagnosis confirmed in all patients Patients were evaluated preoperatively and then up to and including the final followup Their pain and conditions were assessed using the Constant American Shoulder and Elbow Surgeons ASES and University of California at Los Angeles UCLA scores for pain range of active forward flexion and active range of motion All data were analyzed statistically All patients were operated on successfully They achieved good healing during the followup mean 14 months range 12–34 months Before surgery the ASES Constant and UCLA scores were 170 394 and 154 respectively After surgery they were 336 891 and 312 respectively The scores had significantly improved ASES scores from 170 to 336 P  005 Constant scores from 394 to 891 P  005 UCLA scores from 154 to 312 P  005 Arthroscopic tenodesis through positioning portals to treat proximal lesions of the biceps tendon produces satisfactory clinical outcomes This technique is convenient and safeDisorders of the proximal biceps tendon are common causes of shoulder pain and dysfunction 1 Many authors believe that the long head of the biceps brachii tendon is a major contributor to shoulder pain 2 3 4 because it spans an intraarticular portion and an extraarticular segment leading to multiple possibilities for pathology of the tendon itself 5 Patients who develop disorders of the proximal biceps experience persistent anterior shoulder pain and have flexion or extension deficit These disorders seriously affect the quality of life Treatment of disorders of the proximal biceps therefore should not be delayed Because traditional surgical treatment does not address the intraarticular portion of the tendon 6 arthroscopic biceps tenodesis has been proposed for treating disorders of the proximal bicepsPrevious reports have not described where to place the portals When the biceps tenodesis is performed through a completely arthroscopic technique however portal selection is one of the most important factors that affect the success or failure of the operation The portals should provide safe convenient placement sites for suture anchorsBecause we were familiar with the technique of arthroscopic repair of rotator cuff tears using suture anchors we were able to develop a new way to make portals for proximal biceps tenodesis The standard arthroscopic portals—anterior posterior anterolateral lateral and Neviaser—do not allow proximal biceps tenodesis We therefore introduced the most appropriate portals required for proximal biceps tenodesis using positioning portals to apply suture anchors

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