Name: Distal Biceps™ Repair using the BicepsButton™ and Tension Slide Technique
Uploaded: 2008-11-21T00:00:00Z
Channel: Arthrex

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VID1-0590-EN | A | Distal Biceps™ Repair using the BicepsButton™ and Tension Slide Technique

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.

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

Distal Biceps™ Repair using the BicepsButton™ and Tension Slide Technique

Hi, my name is Paul Sethi. I'm a sports medicine orthopedic surgeon from Greenwich, Connecticut. Today I'm going to demonstrate my repair of the distal biceps tendon using the tension slide technique. I favor this technique because it involves a small anterior incision to the distal biceps using the Arthrex BicepsButton, and it affords me the strongest fixation as well as the confidence to move my patients immediately. Postoperatively. I place the patient supine on the operating table. I mark the antecubital fossa. However, I make the incision four centimeters distal to the antecubital fossa. I prefer to use a transverse incision. And the first thing I do is identify the lateral antebrachial cutaneous nerve. I'll start by placing army navy retractors on either side of my finger, being careful to toe in and not put excessive stress on the lateral antebrachial cutaneous nerve. I often find a seroma, and the presence of the seroma lets me know that I am very near to the tendon. I place in Alice clamp on the edge of the tendon and deliver it through the wound. I debride the very end of the distal biceps so that it can fit into an eight millimeter socket. I use a use a FiberLoop stitch along the distal 2.5cm of the tendon, and I am careful to lock the last limbs of the suture on the distal biceps. I then place the biceps back into the antecubital fossa to keep the tendon moist, and turn my attention towards the radial tuberosity. I supinate and pronate the forearm so that I can be certain to feel the tuberosity rise underneath my index finger and maximal supination. Now that I've identified the radial tuberosity and am confident of the position, I use a spade tip, pin and drill a bicortical hole. I'll leave the spade pin in place, and then I'll drill an eight millimeters uni cortical hole, creating a socket for the tendon to sit in. I make certain not to violate the distal radial cortex. It's very important to use irrigation at this point and remove any bone fragments to prevent later heterotopic bone formation. Once I've finished making the bony aperture, I turn my attention back to the biceps tendon. I take one limb of each of the whipstitch and pass it through the BicepsButton. The limb comes in one side of the button and exits on the other side. The opposite limb does the same. It comes through one side and exits on the other side. I make certain that I haven't tangled these sutures. I then attach the biceps button to the button passer, and under direct visualization I place the button passer through the radial cortex. I pull back on the limbs to make certain that this is released. Once the button has been flipped, and I've tested it to see that it's seated well, I will make certain that none of the sutures are tangled. I will start to deliver the biceps into the bony aperture. It is easy to visualize the biceps seating into the socket and engaging on the distal cortex. Once the tension slide technique has been completed and the biceps is sitting flush against the posterior cortex, I hold one limb of the suture taut and I'll use a free needle to pass through the tendon. Once this is passed through, I will tie this knot down in a very deep forearm and knot pusher can be useful. After tying this knot, I routinely use a seven millimeter Bio-Tenodesis screw. Although this is not a requirement as the button itself is very strong fixation, I believe that this creates a more anatomic position. It is imperative to insert the tenodesis screw on the radial side of the tendon, so the tendon is pushed more ulnar. Once I've completed putting the screw in, I will tie a knot over the tenodesis screw and then visualize my tendon in supination and pronation. I copiously irrigate the wound. I close the skin using an absorbable subcuticular suture, and I place the patient in a soft dressing postoperatively the patient is placed in a soft dressing. I encourage the patients to actively supinate and pronate on postoperative day one, and I allow them to use their arm in flexion extension, lifting nothing more than a coffee cup. I found no post-operative complications and no post-operative ruptures in my clinical series. Patients return back to their activities of daily living extremely fast, have very little pain associated with this procedure, and are very pleased with their end their end result. I believe that the tension slide technique offers several advantages over existing clinical techniques. While there are many reports of good to excellent results with suture anchors with cortical buttons and interference screw alone, none of these reports include immediate active range of motion. The primary problem with the existing cortical button technique is that a preset length has to be determined between the edge of tendon and the edge of bone. It can also be difficult to flip this button. The tension slide technique docs the distal biceps tendon into the radius. There is no predetermination of length. There is no significant concern about flipping the button. Given the improvements in the techniques, this is tremendous advantage to the surgeon while they are operating. Furthermore, the strength of this repair using a button and a screw allows for early clinical range of motion. The increased surface area of this repair allows for a greater healing area. The more anatomic position that the biceps tendon is placed in by having an interference screw allows for a more normal, supination mechanic, and perhaps a full restoration of both flexion and supination strength. This technique is done through a four centimeter minimally invasive transverse incision. This is different than the traditional S-shaped incisions that go across the antecubital fossa. This technique additionally does not violate the interosseous membrane. Violating the interosseous membrane can be very painful. It can lead to heterotopic bone formation and can really slow down a patient's rehabilitation.

Distal Biceps™ Repair using the BicepsButton™ and Tension Slide Technique

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