Biceps Tendinitis: Open Repair Technique With Soft Anchors or Metal Buttons

Biceps Tendinitis: Open Repair Technique With Soft Anchors or Metal Buttons

This cadaveric surgical demonstration is of a biceps tendon repair called the tenodesis, where the biceps tendon is cut from its normal attachment site at the shoulder socket and reattached elsewhere on the upper arm. This demonstration will show the repair completed through a small incision referred to as a mini-open approach next to the armpit. Let's get started.

Here we have a right shoulder. The surgeon has used skin marker to plan the incision. They will make a 2 to 3 centimeter incision just on the outside of the armpit. The soft tissue is dissected and metal retractors are placed so the surgeon can see. In this video, the biceps tendon has already been cut from its normal attachment site while completing another shoulder procedure arthroscopically.

The surgeon will identify the long head of the biceps tendon that has already been cut and retrieve it outside of the skin. The surgeon will use suture to gain control of the biceps tendon and remove the damaged biceps tissue above the suture. The next steps in the procedure will vary slightly depending on what exact implant is used. In general, the suture will be loaded into an implant, either a metal button or soft anchor, allowing the biceps tendon to be secured back down to the bone at the end of the procedure.

In this video, the surgeon is using a metal button implant to secure the tendon to the upper arm bone. They will thread the suture into the metal button implant in preparation for placement. Next, the surgeon will identify where to drill for the anchor placement. A cannula is placed on the bone at the identified spot and a hole is prepared. The cannula stays in place so the surgeon does not lose their spot on the bone.

The button with the suture is introduced into the prepared hole. The button is released from the tip of the inserter and the free end of suture is pulled to help flip the button. By flipping the orientation of the button, it will now sit up against the bone on the other side of the prepared hole. Now that the button is in place, the suture around the biceps tendon can be tensioned by pulling on the free end to bring the biceps tendon back on top of the bone.

This button has a one way trapdoor mechanism that allows the suture and biceps to be tensioned but not loosened so no knots need to be tied. At the end of the case, the remaining suture is cut and the procedure is complete.