Download Soft Tissue Biceps Tenodesis – KY

Soft Tissue Biceps Tenodesis – KY
-Standard posterior portal; slightly superior anterior portal (mid interval).
-Grasp biceps with tissue grasper and pull into the joint and then pass a spinal
needle into the posterior aspect of the tendon (through the transverse humeral
ligament and the interval tissue) and feed a prolene suture and grab it out the
anterior purple cannula. Tie the “shuttle single/double knot” and pass a fiberwire
through the tissue and biceps tendon and pull out the anterior cannula. Grab the
fiberwire that is coming out of the anterior cannula about 10 cm from cannula
opening (this fiberwire has already been placed in the tendon) and place it back into
the joint, pass it over the top of the biceps and carefully retrive it from underneath
with a suture grasper (this loops the stitch around the biceps). Snap these two
limbs together (to tie them down later or you get confused).
-Repeat this step again except place the spinal needle more anterior this time. Feed
a prolene suture and grab it out the anterior purple cannula. Tie the “shuttle
single/double knot” and pass a fiberwire through the tissue and biceps tendon and
pull out the anterior cannula. Grab the fiberwire that is coming out of the anterior
cannula about 10 cm from cannula opening (this fiberwire has already been placed
in the tendon) and place it back into the joint, pass it over the top of the biceps and
carefully retrive it from underneath with a suture grasper (this loops the stitch
around the biceps). Again snap these two together.
-You should have 2 fiberwires now that are looped around the biceps (4 strands of
fiberwire suture should be coming out of the skin). Now tenotomize the biceps and
turn attention to the subacromial space.
-Establish a lateral portal and place the anterior portal into the subacromial space.
Now do a bursectomy and concentrate anteriorly to identify the sutures and
retrieve them out the portals (two at a time to tie them together). This ties the
biceps to the interval tissue.
-Keener technique (open) is to drill a 6-7mm hole in tenodesis site, place Krackow
stich in the biceps and then use 2mm drill on both medial and lateral sides of the
tenodesis hole to pull the sutures through. This pulls the biceps tendon into the
tunnel and then tie over the bone bridge.