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Knotless TensionTight-Button

Der TensionTight-Button wird für die knotenlose Onlay-Bizepstenodese verwendet, bei der entweder ein arthroskopischer suprapektoraler oder ein offener subpektoraler Zugang genutzt wird. Ein Spannmechanismus im Button erlaubt die Durchführung einer knotenlosen Bizepstenodese. Die Fixierung der Bizepssehnenrekonstruktion mit einer Loop 'N' Tack-Naht ermöglicht eine komplett arthroskopische suprapektorale Onlay-Tenodese.

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Gautam Yagnik, MD (Miami, FL), demonstrates a distal biceps tendon repair using the TensionTight™ button.

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Distal Biceps Tendon Repair Using the TensionTight™ Button

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Suprapectoral Biceps Tenodesis With the TensionTight™ Locking Button

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Shoulder and Elbow - Next Generation in Repair and Reconstruction 2024

Matthew Provencher, MD (Vail, CO), demonstrates an arthroscopic suprapectoral onlay biceps tenodesis using the knotless TensionTight™ button.

Suprapectoral Biceps Tenodesis Using the TensionTight™ Button

This is a demonstration of the tension tight locking button done with an all arthroscopic Super Pectoral technique. So I'm now in the subacromial space, and you can see we've got a pretty good rotator cuff. We've got the rotator cuff area here, and then we've got the deltoid fascia. And you can see here's the spinal newly inserted. And this helps immensely to help you find that biceps groove. You can also look at where the cannula is which is way down here right there. And that's another good landmark that's usually just lateral to the cannula in order to find the biceps. But we know we've speared the biceps here. And that's going to be our really nice landmark to help us start dissecting down the transverse ligament. We have our spinal needle that's holding the tendon in place right at the top of the biceps groove, as the long head of the biceps exits the joint and makes that killer turn. We have the transverse ligament fully released, and we see the bottom of the transverse humeral ligament right about here where the cannula is. And that's going to be our fixation location. So at this point I'm going to mark the location of where we're going to put the tension tight locking button. I do this with an Apollo wand. This also clears off the periosteum. Another thing I like to do is a little bit of a bone cutter shaver, just to lightly decorticate the area, because this is an onlay biceps technique. I would like to have some healing elements just distal to where I'm going to fix this with the tension tight locking button. You can use a Scorpion passer to do the loop and tack construct. The first loop is around the biceps tendon, and now we're going to do the tack stitch about 5 to 7mm distal to the initial loop. It is important to make sure you're in the center of the biceps tendon so you get maximal biomechanical hold. So this is the tension tight locking button. It comes with a suture loader. The key to this is not to pass a lot of suture, because this is a very thick number five. So that the locking mechanism and the button can work well. So in general I pass about 1 to 2in through the suture loader. And the key thing here is you don't want to engage the double suture until you're ready to lock this down. And it's in bone until you have that double suture in the tension tight locking button. You can slide it back and forth until that button will fully engage with the thicker suture. We're then going to use the three seven spade tip drill in the location that we previously marked. This is drilled in a bicortical fashion. We do not pass this all the way across the humerus, as the button will be docked on the anterior cortex. So there's a laser line on the inserter, and you want to have that facing superior. Here you can see the locking mechanism. We still have the single suture in place before the double strand engages. This locking mechanism. So the button is deployed and the inserter is still in. One thing I like doing is just gently tensioning this end of the tension tight suture, just to make sure that the button flips before taking out the inserter. You see it very nicely sitting under the biceps groove. Now in a uni cortical fashion. One final thing to ensure adequate fixation of the button to the suture and the tendon construct is through the loop. Out here I put my finger and just tension individually, the two limbs of suture, to make sure that this is fully down. There are two more steps. Now we just have to cut the suture with a suture cutter and then remove the biceps tendon, cutting it superior to the loop intact. Construct. At this point you can remove the spinal needle. And then the last part is removing the remaining proximal stump of the long head of the biceps tendon. Here's the empty biceps groove and the tendon line right at the bottom of the biceps groove. In an onlay technique, fix with a tension tight locking button.

Matthew T. Provencher, MD (Vail, CO), demonstrates a knotless onlay subpectoral biceps tenodesis using the TensionTight™ locking button. A locking jaw in the TensionTight button lets the suture slide easily in one direction to reduce the tendon while locking in the opposite direction to secure the tendon against the humerus.

Subpectoral Biceps Tenodesis With the TensionTight™ Locking Button

A 2 to 3 centimeter incision is used just inferior to the border of the pectoralis major, which is easily palpated in the axilla. I generally make this just lateral to the midaxillary line, and it can be made very cosmetic so that you don't even see the incision once it's fully healed. Curved Metzenbaum scissors are then used to go through the first layer of fascia. You can easily palpate the long head of the biceps tendon as it goes underneath the pectoralis major. And then there's a shallow groove in the humerus, which is really nice because it allows for anatomic placement of the button. I use an army, navy or a small Hohmann and put it right under the pectoralis major tendon from the lateral side. In general, I don't use a medial retractor in order to stay away from any of the neurovascular structures, but for this demonstration purposes, we'll just gently put a retractor here to help us identify the long head of the biceps tendon. The long head of the biceps is shown in the biceps groove just underneath the pectoralis major, with the tendon retrieved out of the incision. You can identify the muscle. Tendon junction. The muscle tendon junction lives right at the bottom of the pectoralis major insertion. Here you can see the pectoralis major tendon coming in right here. The pectoralis major is about five centimeters. And this is the bony groove in which the long head of the biceps has previously traveled. The first part of the loop and tack is to place the luggage tag stitch around the long head of the biceps again, about 1 to 2cm away from the muscle tendon junction. This is the loop part of the loop and tack construct, and then we'll pass the suture just distal through the center portion of the tendon. The needle that comes in the kit with the nitinol loop is loaded. And then the tack part of the construct is just distal to the loop. And you pass this for the final loop and tack construct. If need be, you can tidy up each of the two ends to make sure that you have a very solid loop and tack construct. I then trim the extra tendon, leaving about 5 to 8mm of tendon just proximal to the loop. I then use an elevator to gently raise the periosteum and other soft tissue that is on the long head of the biceps groove. It's important to get the preparation in the right position to make sure that you get the length tension relationship of the long head of the biceps. Correct. Again, it's been well worked out that the muscle tendon junction and the long head of the biceps is right about at the bottom of the pectoralis major. And I generally put it at about one centimeter above the most inferior portion of the pectoralis major. The number five FiberLink is then loaded into the nitinol pastor of the tension tight locking button. When I pass the number five FiberLink through the locking cortical button, I try to keep this at the single strand so that I can pass it a little bit easier through the 3.7mm spade tip drill tunnel before moving on with a 3.7mm bone tunnel preparation. I put a hemostat on the single limb of the FiberLink and then put the tension tight locking button down near the elbow in the previously prepared area. I just double checked that I like the final fixation location. I then take the cannula from the kit, and I'm able to pass this through the wound in the area that I want to place the final button. The cannula is slotted so you can leave this in place while you drill with the 3.7mm spade tip, and then you can put the button in removing this. After you get the button inside and flipped, the spade tip is drilled into the first cortex. You do not want to drill through the second cortex. And one of the things that's important about this is you want to make sure you have drilling through cortex, and then you'll have some empty space where the cancellous portion is, and then you'll hit the next cortex. This guarantees a good trajectory for your locking cortical button and make sure that it easily flips. I then removed the spade tip, keeping the cannula in place and then switch this over to the locking button. It's important that the line on the cortical button inserter goes straight up, because it allows for flipping of the button and overall passage. So with the black line straight up, we then insert the anchor through the cannula. The anchor is then inserted through a uni cortical fashion. Occasionally a gentle tap with a mallet will facilitate passage. The button is inserted and you can see under fluoroscopy that it's placed in a uni cortical fashion. The locking cortical button is then deployed by unscrewing this metal inserter holder. The cannula is removed from the shoulder and then the button is flipped through, pulling the suture. The number five FiberLink suture is then tensioned down by first pulling the single limb until the double limbs are fully dunked in, and you can see the tendon actually translate up to the final fixation. A final check of the of the fixation of the locking cortical button can be achieved by pulling both of the double limbs individually. I just put my hand in like this and pull both individually, and you can see we get excellent uni cortical fixation. At this point the sutures are then cut. There is no need for a knot as this is a completely knotless configuration. Post-operative rehabilitation generally consists of the rate limiting step of the procedure that you're performing. Often this is a rotator cuff repair or some other procedure around the shoulder. If it's just an isolated biceps tenodesis with other debridement around the shoulder, I generally use a sling for 2 to 3 weeks. Given that this is a very strong construct. I allow gentle active assist motion of the elbow right away, but not lifting more than 5 to 10 pounds actively on the biceps for a total of six weeks. They return to full activities around three months.

With the TensionTight™ button, perform a knotless onlay biceps tenodesis using an arthroscopic suprapectoral or open subpectoral approach. The button’s locking jaw lets the suture slide easily in one direction to reduce the tendon to the bone while locking in the opposite direction to secure the tendon against the humerus.

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Subpectoral Biceps Tenodesis Using the TensionTight™ Button

Make a 2 to 3 centimeter incision in the axilla at the inferior border of the pectoralis major. Bluntly dissect to identify the pectoralis major and the long head of the biceps tendon. Retrieve the previously surmised biceps tendon through the incision. Create a loop and tack whip stitch by cinching the number five FiberLink around the tendon approximately two centimeters from the musculotendinous junction, and then passing the tail through the tendon distal to the loop. Load the tail of the FiberLink into the button loader. Pull the tab to shuttle the suture through the button, stopping just before the loop enters the locking jaw. Place the drill at the desired location on the bony surface of the proximal humerus, and drill a cortical tunnel using the 3.7mm spade tip drill. Insert the button into the tunnel. Turn the threaded inserter counterclockwise to release the button. Remove the threaded inserter. Pull on the suture to flip the button in the canal. Remove the inserter shaft. Once the button is deployed against the near cortex, pull on the free suture limb to reduce the tendon under the bone. Cut the excess suture to complete the tenodesis.

Knotless TensionTight-Button

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Subpectoral Biceps Tenodesis Using the TensionTight™ Button

Subpectoral Biceps Tenodesis With the TensionTight™ Locking Button

Suprapectoral Biceps Tenodesis With the TensionTight™ Locking Button

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Shoulder and Elbow - Next Generation in Repair and Reconstruction 2024

Operationsanleitungen (1)

Suprapectoral Biceps Tenodesis With the TensionTight™ Locking Button

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Subpectoral Biceps Tenodesis Using the TensionTight™ Button

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Distal Biceps Tendon Repair Using the TensionTight™ Button

Suprapectoral Biceps Tenodesis Using the TensionTight™ Button

Subpectoral Biceps Tenodesis With the TensionTight™ Locking Button

Wissenschaftsupdate (3)

Biceps Tenodesis: When and Where Scientific Update

Biceps Tenotomy Versus Tenodesis Scientific Update

Biceps Tenodesis: Options for Fixation Scientific Update

Related Products (2)

AR-2350

AR-4068LNT