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DVD-1075 | A | Sub-Pectoral Open Biceps Tenodesis

Augustus Mazzocca

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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Surgical Technique Videos

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

Vídeos de técnicas cirúrgicas

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

Videos de técnicas quirúrgicas

Sub-Pectoral Open Biceps Tenodesis

In the procedure. We will demonstrate in this program a simplified approach for biceps tenodesis of the proximal biceps tendon will be conducted on this 48 year old patient that has suffered persistent type three biceps tendinitis during the diagnostic arthroscopy of the glenohumeral joint and before the subacromial decompression, we cut the origin of the biceps at the glenoid. A 3 to 4 centimeter incision is made on the area of the pectoralis muscle tendon junction in the axilla. Now we'll just make a little dent in the undersurface of this fascia, and I'll take my finger. And underneath the pec I'll go over pointing towards the insertion of the pec onto the humerus. So now we will insert this curved home and retractor. I can feel the humerus underneath. You can feel you can see that pop as we pop through, and now we'll just retract that over. And as you can see it, it comes easily out. Since we've already done our tenotomy. And all we will do is take this periosteum off with a bovie. And that gives us a nice little area for us to tenodesis. And then you can take a little elevator to remove the soft tissue. We will once again take this guidewire with our Cannulated reamer will go over. We chuck it up short so that we have some control as we go into this wound, and I will place this through the anterior cortex of the humerus into just the beginning part of the posterior cortex. The next step is a eight millimeter cannulated reamer. Occasionally you can have your assistant apply some back pressure. We will go through this anterior cortex. Once we've performed the bone tunnel preparation, we'll move to the biceps tendon itself. And what we will do is we will start at start at about two centimeters from this area, and we will take about 12 to 15mm of Krakow suture or a locking suture with a number two FiberWire. The reason for that is that's the size of our screw. Then we will cut the tendon in a bullet type fashion. And then I will continue with those knots so that we have a nice secure whip stitch. And our tendon is appropriately fashioned. Now you can see the design of this screw is eight millimeters by 12mm. Put our number two FiberWire through the night and our wire. And then bring this through the cannulated part of the screw. What this will give us is after we have the interference fit of the screw and the tendon, it will also allow us to sew this so that we have a suture anchor type of fixation as well. We deploy the tenodesis driver down to the knot as close as we as we possibly can, and then we go approximately with the suture that goes through the cannulated portion of the screw, and we tie that around the teardrop handle of the tenodesis driver. This allows us to securely place the tendon into the bone tunnel, and have the screw come on the outside of it for appropriate interference. Screw fixation. You want to make sure that all the soft tissue is away from your bone tunnel, as some of that soft tissue can get caught up in the driver and obscure your view. The tip is inserted into the bottom of the tunnel, so that the tendon is securely fastened to the posterior part of that tunnel. The handle is held with the thumb and forefinger as the teardrop handle is rotated with the other hand. You'll notice that the tendon itself comes up superiorly over the top of the screw. As you get to the bottom part of the screw, you want to check to make sure that it becomes fully flush with the anterior cortex of the humerus. Once you're satisfied that the screw is now flush with the anterior cortex of the humerus, unwrap the suture from the teardrop handle and then withdraw the tenodesis driver from the cannulated portion of the screw. This will expose two sutures. The suture that you see here is the suture that is on the outside of the screw tendon interface. There's a suture that comes through the cannulated portion of the screw. These two sutures will be tied together, ensuring a suture anchor effect as well as an interference screw fixation effect. This is redundancy and allows for a higher load to fixation and desirable cyclic load characteristics that we've demonstrated in biomechanical testing.

Sub-Pectoral Open Biceps Tenodesis

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