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Técnica sem nós para tenodese TensionTight™

O botão TensionTight™ é usado para realizar uma tenodese do bíceps onlay sem nós com uma abordagem artroscópica suprapeitoral ou subpeitoral aberta. Uma mandíbula de travamento no botão permite uma tenodese do bíceps sem nós. Proteger o reparo do tendão do bíceps com um ponto Loop 'N' Tack™ permite uma tenodese suprapeitoral totalmente artroscópica.

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A step-by-step demonstration of how a product would (or could) be used in a surgical technique.

Eine schrittweise Demonstration, wie ein Produkt in einer Operationsanleitung verwendet werden würde (oder könnte).

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Demonstração passo a passo de como um produto seria utilizado em uma técnica cirúrgica.

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Demostración paso a paso de cómo se utilizaría un producto en una técnica quirúrgica.

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Surgical Technique Guides

Suprapectoral Biceps Tenodesis With the TensionTight™ Locking Button

Arthroplasty Shoulder

Elbow

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Ein umfassender Überblick über das Portfolio eines Produktteams.

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Visão geral e abrangente do portfólio de produtos de cada segmento.

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Descripción general y completa sobre la cartera de productos de cada segmento. 

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Shoulder and Elbow - Next Generation in Repair and Reconstruction 2024

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.

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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

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

Surgical Technique Videos

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.

A general overview including the relevant steps of an Arthrex surgical technique. These animations always include a voice-over explaining the process.

Eine allgemeine Übersicht, einschließlich der relevanten Schritte einer Arthrex Operationsanleitung. Diese Animationen enthalten immer Voice-Overs, die den Prozess erklären.

Operationstechnik-Animationen

Visão geral incluindo as etapas relevantes de uma técnica cirúrgica Arthrex. Essas animações sempre incluem uma narração explicando o processo.

Animações de técnicas cirúrgicas

Descripción general que incluye los pasos relevantes de una técnica quirúrgica de Arthrex. Estas animaciones siempre incluyen una voz en off que explica el proceso.

Animaciones de técnicas quirúrgicas

Surgical Technique Animations

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.

Técnica sem nós para tenodese TensionTight™

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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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Animações de técnicas cirúrgicas (1)

Subpectoral Biceps Tenodesis Using the TensionTight™ Button

Atualizações científicas (3)

Biceps Tenodesis: When and Where Scientific Update

Biceps Tenotomy Versus Tenodesis Scientific Update

Biceps Tenodesis: Options for Fixation Scientific Update

Catálogos (1)

Shoulder and Elbow - Next Generation in Repair and Reconstruction 2024

Guias de técnicas cirúrgicas (1)

Suprapectoral Biceps Tenodesis With the TensionTight™ Locking Button

Vídeos de técnicas cirúrgicas (1)

Subpectoral Biceps Tenodesis With the TensionTight™ Locking Button

Related Products (2)

AR-2350

AR-4068LNT