Name: Subpectoral Biceps Tenodesis Using a FiberTak® Button
Uploaded: 2020-08-20T00:00:00Z
Channel: Arthrex

<p>Paul M. Sethi, MD (Greenwich, CT), demonstrates a bicortical subpectoral biceps tenodesis using an all-suture FiberTak<sup>®</sup> button. The button is a reinforced 2.6 mm-diameter sheath preloaded with two 2-0 FiberLink™ sutures that are used to shuttle the whipstitch limbs through the sheath. The all-suture button can be used in lieu of traditional metal buttons for unicortical and bicortical tension-slide techniques.</p>

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VID1-000783-en-US | B | Subpectoral Biceps Tenodesis Using a FiberTak® Button

Paul Sethi

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.

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

Videos de técnicas quirúrgicas

Subpectoral Biceps Tenodesis Using a FiberTak® Button

Today I'm going to talk about different options for sub pectoral biceps tenodesis. We've got a right shoulder the acromial process as you bring the arm up. And I do this in every case I can see the pectoralis and I can see the short head of the biceps, and I can see the long head of the biceps. And this interval right here is right where I'm going to make my incision in my approach. That's all we really need for a clinical situation. Today we're going to just go a little bit farther to demonstrate but not really over accentuate it. I'm going to slowly lift up. Just just not hard at all right there. Gently pull it down. I can see the pectoralis tendon coming across very nicely over here just underneath the pectoralis tendon. I can see the short head, and I'm going to slowly make this interval up into the short head. I may reach up with my finger and feel and identify the biceps using a sharp instrument or sometimes a blunt instrument. I'm going to lift this up and I'll pull down the short head very gently. That's where all the trouble structures are. And here you can see the biceps will be sitting. Right over here. A little tug and the biceps tendon comes out of the joint. And now we're going to whip stitch the biceps tendon up. I want to start the whip stitching closer to the musculotendinous junction, and come about 2.5cm after the musculotendinous junction. Basically what I want to happen is I want this muscle belly to insert right in above here so I can maintain the patient's bicipital contour. This part right here is called the swedge. That's where the suture is welded together. And the swedge does not like to go through any type of button. It's a thicker, more unwieldy portion of this, but I'm going to take advantage of that thicker, unwieldy portion and put it actually on the native tendon itself. And by putting on the native tendon itself, I'll take advantage of that. And I'm not going to worry about myself getting jammed up. I'll throw about five throws. I'll throw about five throws through this. There's four good throws. That's probably all I need. What I may do on the fifth row is come back in back of where I was and just lock it up and pull it all the way through. At this point in time, I'm going to make two. There's two things I'm going to. One. Cut it. Give it a good pull to make sure that I have a good fixation. And I'm going to use a measuring device. As I run it down to six, I see it goes through pretty easily. As I run it down to five, it doesn't fit that well. So I think for me this will be A55. And quite honestly, I don't think I ever go above A55 because as you get more distal in the groove, the tendon does thin out and have a more consistent shape, as opposed to some very pathological tendons that can be nines and tens and elevens. More. Approximately. One last little trick that I do is I pass a suture through this. At the end of the case, I'm going to want to lock this into place, and instead of having to reach into the biceps or reach into the hole, I have a suture shuttle pass, and I'll pass that right at the base of my of my limb, and I'll leave that in place. And by leaving that in place, I can later reach back in and and shuttle through with my, with my whipstitch. And that will become more clear in just a few more minutes. But there it is for good throws with one additional locking throw sized up. In this case, it's going to be A55, which is a size that I'm comfortable with. I'm going to head back into the into the sub pectoral region as I reach back, just once again appreciating the anatomy even more clearly. Here I can see the pectoralis tendon. I can see the short head. I remember all the trouble structures under the short head. I remember lifting up my pectoralis is going to be my entry point into the joint, so I'll lift that up over here. I'll sweep this down over here. Place the Army Navy into here. Now here I'm looking at some shine of latissimus tendon. So I know that I'm a little bit too internal. So I'll externally rotate just a little bit and boom, set myself up. So I'm looking right at where my bicipital groove is right over here. The next thing I'm going to do is take a guide pin and I'm going to drill through. In this case, since I'm going to use a FiberTak button, all I want to do is prepare my proximal cortex. I want to be sure. And this is important for any type of proximal biceps tenodesis that I stay central in the canal. So as I come through, I want to feel myself drilling. I get through the first cortex. And once I get through the first cortex, I don't need to. I don't need to penetrate. But there you see how I get that feel now I know I'm central and I haven't skived if there's any concern about fracture or the risk of fracture, it's really associated with skiving or making tunnels above seven millimeters. So if we can stay at the five five range, which is what we measured in this case, and we can say central without a skive, it will be beneficial. So here I'm just going to go through the near cortex. Spin it up one two. And I didn't drill my my guide pin through. So there I am through and my guide pin came out with me. The next trick that I want to do is take this guide, drop it through. And I'm on my far cortex as I go to drill this through the far cortex. I don't need to go all the way through the distance to bottom this out. I only need to get through the cortical bone, because this anchor is going to capture on the far cortex. This is a 2.6 spade tip. This is lined up inside my hole, and all I need to do is get through my far cortex. Boom. Through the far cortex. I'm going to keep this in place because this is lining me up to get my my button. This is going to allow me to get my button all the way through. The other important point is that I don't need to see my my button all the way against the base of this, because I don't have as far a distance. So I'm going I'm going to get through. As I get through, I'm going to sort of see if I can get some finger sensation of coming through. And then once I engage with my finger, a couple of light taps. In this case, I made a purple mark to estimate where I think I need to get through to. And just a couple light taps. And there it is. You can sort of see how it just how it gives me a little bit of a give right there. I can feel that come through. I'll release the grommet, bring this out. Bring this out. And in this case, I'll gently pull back on all of them to set my anchor. And now to sort of feel really comfortable about it. Look, I can really have fun and set this anchor. This is this is rock solid. Super strong. I have now four limbs coming out over here. And let's spread out those four limbs. And what I'm going to do now is simply start to shuttle my stitches back into those four limbs. Here are the two loops. I'm going to load these loops with one limb of the suture. They're actually loaded in opposite directions and by loading loading them in opposite directions, you can get that tension slide effect of really pulling and ratcheting this down. We'll do one at a time. I'll load this through. I'll pinch it over itself for about an inch. And then as I engage it, it comes in. Once it actually engages in one two, it's a series of small, gentle tugs. Now, I've got to do the same with my other side of Blue Loop, which is right here. I'm going to see that it slides once again just to double check. I'm going to grab my other limb from my biceps, pull it through, bend it over and in the same way bring it down. And now as I engage 121. Two, three. And now I've got my tension slide ready to go. Sometimes. I'll want to use a tonsil or a pickup just to get. The tendon facing the right direction, so I engage a little bit. It's coming in. I engage a little more. So now I'm going to start to engage the biceps. You can see it's starting to duck into that hole. I'm going to grab the other limb, start to duck it into the hole. And now we have it really lined up. So what you can see now is I've really sort of shimmied it down all the way into place. I know I'm happy with how deep it is because one, I can see the end of my whip stitches. I've got three or at least two out of my whip stitches buried through. You're going to recall back to why I put in an earlier shuttling stitch, and that early shuttling stitch is going to help me. Now pass back through. The biceps and really lock it into place so I don't have to worry about sticking a needle in, because some of these can be really big guys. So I'll pull it over. I'll keep steady tension on on one limb and then just bring this through and that's it. And now this biceps is locked into place. I'll tie it over itself. If I'm worried, even in a deep arm, I can use a knot pusher. But I'm not trying to get down into the aperture. And here you can see the biceps is fixed into place very nicely. In terms of the length, I've really got the muscular end sitting right up over here. So the muscular end is going to sit underneath the pectoralis. So I've got the contour maintained at this point. Now I have the option to use a peak interference screw. And I'm going to slide it in right there. Hold the paddle. And the peak gets a really strong bite. And some may argue fills the canal and restores the the strength of the canal so that you can reduce your risk of fracture.

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