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VID1-003554-en-US | A | Subpectoral Biceps Tenodesis

Peter J. Millett

Human

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

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Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

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Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

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Subpectoral Biceps Tenodesis

So we'll take a look now at his biceps tendon. You can see he's got a lot of tenosynovitis there. So we're just going to release the biceps here and do a tenodesis on his biceps. He has a lot of symptoms there over his biceps and it looks very inflamed. I do tenodesis on frequently on rotator cuff repairs. Just release it here. There it goes. Make sure it goes down the down the groove. So we're going to demonstrate now is pectoral biceps. Tenodesis. We've marked this preoperatively. We've marked the the pec major here. And then we marked the axillary crease here. So that's our that's our landmark. Do a sub pectoral indicis. We cut it. Arthroscopically already? We'll put our Put our incision right here. Good. And Gordon will come in with a center retractor laterally. Good. Good. And the key. Key step is really to find this interval here between the pec and the the short head of the biceps. And there's a fascia layer right here that you have to cut. And once you cut that then you should go right down to bone. Which we've done here. So I'll put let me get that little bleeder. [00:01:40] Good job. Good. So again here's our landmark. The pec here. The short head of the biceps right here. We'll put a retractor in now. Army. Navy. Retractor. Okay. So what we're going to do is this Gordon is retracting the pec major. And this is the short head of the biceps, which we're going we're going to retract down. And then right here you see the long head of the biceps tendon right here. And that's a key. That's key. Just find that. And then I use a right angle clamp. Go in and grab it and retract it. Good. He's got an early hourglass deformity here where it's widening out. Good. So what we'll do next is take a number two FiberWire. Basically, you go about two centimeters up from the muscle tendon junction right here, and we'll whip stitch it. There's a fast stitching device you can use as well. I usually just whip stitch it four stitches up and four back. Pull it towards you. So there's the bicipital groove right here. My finger is on the groove. It's a flat spot. And what I'll do is I'll take a bovie. So this is the. He's retracting the pack. This is the short head of the biceps right here. And then this is the bicipital groove. So I'm just opening the bicipital groove or clearing the soft tissues off of it. And I'll use an elevator next or clear off the periosteum there. So you can see the bone. Yes. Great. Then we'll use an eight millimeter tenodesis driver here and a soft tissue sleeve which is on it. We've modified this a little bit, so we just use a soft tissue sleeve without putting the guidewire in. So we put that right where I want it, slide the soft tissue guide over it and then drill perpendicular to the to the bone. Here my finger is on the medial side of the humerus, so I don't skive medially. Good. His bones real hard. See, there's the hole we've created. So it's going to be real important to get the tendon right in that hole and seated. So we'll take our eight millimeter. This is our eight millimeter peak tenodesis screw on our tenodesis driver with the wire in it. We'll pass the wire through or pass one of the limbs of the suture through with the passing wire. And then it's real important to secure it here on the tip of the, of the driver. So we've secured that, secured our suture. Now what we'll need to do is make sure that the tendon goes into that hole that we've created, which it has. Okay. It's it's in the hole. And then we will hold the thumb drive and advance. Advance our screw. And again this guy has really hard bones. So we're going to get a great bite. It's a ten millimeter screw. So we'll advance at about ten millimeters. I can look here. And I can also get a feel for the bite I'm getting. Because you get a progressive bite because the screw is tapered. Then what I'll do is I'll take the driver off partly part way, or I'll spin this thumb, drive back and feel that the screws down. Secure. Which it is. I can take this off and again feel it. If you leave that suture on, then you can rethread it if you have to. And then we'll just tie these sutures over the top. Here. Scissor, please. Just to add additional strength to the construct. So the only way this can fail is either the tendon cuts or the whole construct pulls out. So it's nice and strong. And if you look right there, you can see the tendon. Fixed in the fixed in the bicipital groove. Buried into a hole with an interference screw.

Subpectoral Biceps Tenodesis

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