InfraPectoral Biceps Tenodesis

Mike Walton@mrmikewalton mikewalton@shoulderdoc.co.uk

Santander 2015

Tenotomy or Tenodesis?

• No evidence in literature to support tenodesis

• Essentially cosmetic procedure

An Evidenced Based Decision

• Functional Loss - Power (De Carli, 2012)

Significant difference between operated and non-operated sides but no difference between tenotomy and tenodesis groups

An Evidenced Based Decision

• Functional Loss - Biceps Muscle Cramps

• Lim, 2011 - 10% with tenotomy

• Duff, 2012 - 19% with tenotomy

• Slenker, 2012 - 19% with tenotomy, 24% with tenodesis

SubPectoral TenodesisOrthopedics. 2015 Jan 1;38(1):37-41. doi:10.3928/01477447-20150105-04. Open subpectoral biceps tenodesis: reliable treatment for all biceps tendon pathology. Kane P, Hsaio P, Tucker B, Freedman KB

SubPectoral Tenodesis• How should I do it??

• Interference Screw - not keen in diaphysis

SubPectoral Tenodesis• How should I do it??

• Interference Screw - not keen in diaphysis

SubPectoral Tenodesis• How should I do it??

• Bicortical Fixation with Endobutton?

J Shoulder Elbow Surg. 2015 Jan;24(1):138-42. doi: 10.1016/j.jse.2014.06.038. Epub 2014 Sep 3. Safety of open suprapectoral and subpectoral biceps tenodesis: an anatomic assessment of risk for neurologic injury. Sethi PM1, Vadasdi K2, Greene RT2, Vitale MA2, Duong M2, Miller SR2

SubPectoral Tenodesis• How should I do it??

• Anchors?

• No interossesous tendon fixation• Weaker construct• Not strong enough for sports population

SubPectoral Tenodesis• Optimal technique

• Strong to allow early mobilisation

• Direct Vision

• Interosseous tendon

• No diaphyseal stress riser

• QUICK AND EASY

• Beach chair Position

• Biceps tenotomy

• Small incision at lower boarder of pec major

• LHB easily palpable

• Small incision at lower boarder of pec major

• LHB easily palpable

Get Tension Right

• FibreLoop whip stitch

• Approx 5 passes

• Approx 2cm

• 5-7mm Reamer hole

• 2.5mm prox drill hole

6/7mm Reamer

2.5mm Drill

• 5-7mm Reamer hole

• 2.5mm prox drill hole

• Suture passer from proximal to distal and deliver FibreLoop

• Tie over EndoButton

Rehabilitation

• As little change as possible

• Elbow ROM as comfort allows

• No strengthening 6 weeks

• No weight training 3 months

Rehabilitation

• As little change as possible

• Elbow ROM as comfort allows

• No strengthening 6 weeks

• No weight training 3 months