Name: Subpectoral Biceps Tenodesis on the Proximal Aspect of the Biceps
Uploaded: 2013-05-06T00:00:00Z
Channel: Arthrex
Description: Thomas Hackett, MD, (Vail, CO) demonstrates his technique for a subpec proximal biceps tenodesis using the BicepsButton and Tension Slide Technique. He details proper location, tunnel drilling, button loading and insertion as well as commenting on his recent research on the proximity of the radial and axillary nerve to the drill hole.

<p>Thomas Hackett, MD, (Vail, CO) demonstrates his technique for a subpec proximal biceps tenodesis using the BicepsButton and Tension Slide Technique. He details proper location, tunnel drilling, button loading and insertion as well as commenting on his recent research on the proximity of the radial and axillary nerve to the drill hole.</p>

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VID1-0591-EN | A | Subpectoral Biceps Tenodesis on the Proximal Aspect of the Biceps

Thomas Hackett

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.

Operationstechnikvideos

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

Subpectoral Biceps Tenodesis on the Proximal Aspect of the Biceps

This is doctor Tom Hackett from the Steadman Clinic in Vail, Colorado, and the video you're about to see is for a sub pectoral biceps tenodesis on the proximal aspect of the biceps through an open incision. What you can see here is the setup. This is in a lateral position and the arm is being taken out of traction. This can easily be done in a beach chair position as well. The incision can be placed within the axillary fold, and in some cases this can even be brought more around to the inside of the arm for a better cosmesis through skin and soft tissues. The pectoralis major fascia is typically easily identified, as you can see here, underneath the subcutaneous tissue and directly underneath that lies the biceps tendon. The tendon can typically be delivered through a either digital exploration or with a hemostat, and here, with the arm free, you can move the arm back and forth to identify the ideal location for truncation of the tendon to prevent excess traction on the construct. Here the tendon is being whip stitched. The whip stitch typically starts around the musculotendinous junction within the muscular tissue, and then more distally to the approximately two centimeters along the length of the tendon. The stitches then cut, and the tendon can be truncated to the appropriate length. The stitches then placed through and through the BicepsButton through one side and out the other, and then the second suture is placed going in an opposite direction from the first, and this then allows for the button to be deployed and slid. At this point, the location of the proximal drill hole is created. This is directly beneath the end of the bicipital groove on the flat spot of the humerus. That's a seven millimeter tunnel, and this is then followed up with a spade tip. This allows control of the posterior tunnel being drilled very carefully. The studies we've done on the location of the radial and axillary nerve in regards to its proximity to this spot, place them over two centimeters away. The BicepsButton is then deployed through the first drill hole across the second. This is done by feel, and then once the button is deployed with the flick of the thumb, the biceps tendon can be delivered into the seven millimeter tunnel. This is then fixed into place with standard arthroscopic knot passer, and the sutures are placed through the first tunnel against the second posterior tunnel in an intramedullary position, and once this is then finished, the screw is backing up the construct and you can see this screw going into place. You can use a bioabsorbable screw or a peak screw, and it's typically line to line with a seven by 10 or 15 millimeter screw. If the biceps tendon is particularly large, we use a slightly smaller screw. We have found that there is no requirements for immobilization with this. As long as a rotator cuff or labral work has not been done concurrently. We typically move these with active and passive full range of motion immediately after surgery and resistance work can be started in approximately one month.

Subpectoral Biceps Tenodesis on the Proximal Aspect of the Biceps

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