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Soft Tissue Tenodesis Technique

Suture tenodesis to soft tissue has been advocated due to its simplicity. Two methods have been described. One involves open treatment of suturing the biceps tendon to the transverse humeral ligament and the arthroscopic technique involves suturing the tendon to the CHL or the anterior supraspinatus tendon.

The arthroscopic suture tenodesis technique begins with standard glenohumeral arthroscopy. Any associated pathology is treated appropriately. An anterosuperior portal is made for introduction of a suture passing device or alternatively a spinal needle can be used to pass PDS suture through the biceps after passing the needle through the rotator cuff through an anterolateral portal.

If the tendon is of poor quality, racking sutures provide better purchase on the tendon. A second suture can then be placed in a similar manner. The biceps is then released from its attachment to the labrum and supraglenoid tubercle. This is accomplished with a radiofrequency device or arthroscopic scissors.

The edge of the superior labrum is smoothed. After the tendon is released from the labrum, it retracts slightly and the sutures are passed through the CHL or anterior supraspinatus with a penetrating suture device such as the Penetrator or Bird Beak (Arthrex, Inc. Naples, FL). If a spinal needle was used with #1 PDS, the sutures are already passed through the supraspinatus. The camera is then directed into the subacromial space, the sutures retrieved through the lateral cannula and are then securely tied.

This anchors the biceps to the supraspinatus or the CHL. The authors seldom perform this soft tissue tenodesis technique, but rather prefer to securely anchor the biceps to bone. The senior author (SSB) uses this technique only in the case of extremely degenerative tendon. In such cases, BioTenodesis interference fixation is sometimes not secure, and two racking sutures in the degenerative biceps provide relatively secure purchase on the tendon.

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