Arthroscopic suprapectoral biceps tenodesis with dual expansion PEEK anchor and bone socket fixation

Pathology of the long head of the biceps (LHB) is a common cause of shoulder pain.1–3 Aside from direct damage to the biceps tendon, other causes of biceps pain include tears of the superior labrum (SLAP lesions) and lesions of the biceps pulley and upper subscapularis, which can result in bicipital instability. Initial management of LHB pathologies usually includes rest, non-steroidal anti-inflammatory drugs, physical therapy, and corticosteroid injection. If conservative measures fail, the main surgical options employed are tenotomy and tenodesis. Tenotomy has long been regarded as a simple solution to pain associated with tendinopathy. However, patients who undergo tenotomy may subsequently experience retraction of the biceps tendon and cramping of the brachial biceps muscle.4 Tenodesis has been shown to have similar relief of pain as tenotomy, and better functional performance in some studies.5,6 The most definitive advantage of tenodesis over tenotomy is a much lower incidence of inferior migration of the biceps, the “Popeye” deformity.2 Furthermore, tenodesis may improve long-term function because it better restores normal anatomy.7 Our indications for tenodesis include chronic tendonitis, partial or complete tears of the LHB, SLAP lesions in older patients, or failed SLAP repairs and tendon subluxation out of the bicipital groove in active patients who have failed conservative management. Interference screws commonly used for tenodesis have been shown to have higher ultimate load to failure and improved stiffness compared to suture anchors, although, these devices may have a higher revision rate due to rupture of the tendon at site of tenodesis.8,9 It is believed that the failures of these devices are due, in part, to trauma to the tendon during fixation. It is postulated that screw threads can cause rotation of the graft, decreased restored tension, and a reduced load to failure. Recent ex vivo models have demonstrated that use of sheathed screws can decrease malrotation of screws and trauma to tendon during tenodesis.8 In addition to tendon rupture, subpectoral tenodesis with an interference screw can be associated with humerus fracture at the site of placement.10 Interference screw placement has been shown to decrease humeral strength by up to 25% in some models.11 To our knowledge there is no known association of humerus fracture associated with suprapectoral methods. Compared to biceps tenodesis at the superior margin of the bicipital groove, there is less chance of impingement on the acromial roof, persistent instability, or leaving residual diseased tendon with a tenodesis at the inferior margin. For all of these reasons, we prefer arthroscopic suprapectoral biceps tenodesis using a non-threaded implant, as described in this chapter. CONTENTS