Long Biceps Subpectoral Tenodesis With Suspensory Button and Bicortical Fixation

Abstract

Tenodesis of the long head of the biceps (LHB) tendon has long been recognized as a valid alternative to address pathologic conditions of this tendon. However, the location and type of fixation is still a matter of discussion, because common complications associated with this procedure include failure of the repair, persistent pain, reaction to the fixation device, cosmetic deformity, and fracture. The authors describe a method of subpectoral LHB tenodesis that aims to preserve bone stock and allows a strong, easy, and reproducible type of fixation with a minimal approach. LHB tenotomy is performed arthroscopically in a standard fashion, and the tenodesis is completed with bicortical fixation in the humerus using a knotless suspensory button with an appropriate pusher originally developed for another purpose. Magnetic resonance imaging showed a safe distance between the implant and important vasculonervous structures. In the cases where subpectoral fixation is chosen, this method seems to offer additional safety as a result of the minimal amount of bone removed and the very small size of the implant.

The X-Pulley Technique for Subpectoral Long Head of the Biceps Tenodesis Using All-Suture Anchors

“…The risk of this tendon damage appears to be lower with cortical buttons; nevertheless, the cortical holes are still reasonably large and will involve both cortices with bicortical techniques. Therefore, the risk of fracture may persist with the buttons 8 . Furthermore, biomechanically, the construct with the button may not be the strongest.…”

“…Therefore, the risk of fracture may persist with the buttons. 8 Furthermore, biomechanically, the construct with the button may not be the strongest. In addition, there are concerns of neurovascular damage with bicortical techniques.…”

Diagnosis and Treatment of Injuries to the Biceps and Superior Labral Complex in Overhead Athletes

“…Alternatively, many surgeons favor an open subpectoral technique for biceps tenodesis using an interference screw [61], suture anchor [62], unicortical button [63], or bicortical button for fixation [64]. A recent study by Green et al demonstrated good results in a technique that involves docking the tendon into a socket in the humerus without the use of an interference screw [65].…”