Arthroscopic Proximal Biceps Tenodesis using the Smith Nephew TWINFIX TI QUICKT Fixation - PDF document

Arthroscopic ProximalBiceps Tenodesis usingthe Smith & NephewFixation System. Shoulder Series Technique Guide Reviewed by: Joe de Beer, MDirector of the Cape Shoulder Institute, Western Cape, SouthAfricaonorary consultant to the South African Sports ScienceOrthapaedic Institute, Newlands Cape Town, South Africaonorary consultant to the University of Stellenbosch, Schoolof Medicine, Tygerberg, South AfricaBruno Toussaint, MDlinique GŽnŽrale, Annecy, France Arthroscopic Proximal Biceps Tenodesis using theSmith & NephewTWINFIXª TIQUICK-Tª FixationSystem. Introduction Degeneration of the long head of the biceps can occur in conjunctionwith rotator cuff tears or on its own. There is often a failure of thesling mechanism holding the biceps in the groove and this may resultin secondary damage to the insertion of the subscapularis tendon.In cases of disease of the long head of the biceps, either a tenotomytenodesis of the tendon is indicated. Usually in elderly patients, asimple tenotomy is done arthroscopically, whereas in younger, moreactive patients a tenodesis is preferred.Principles of tenodesis: to allow for healing of the tendon to thebicipital groove, the bone surface at the base of the bicipital groove isdecorticated. The biceps is then transected at its origin at thesuperior pole of the glenoid. It is then fixed by various means: eitherinto a pre-made hole in the humeral head using bone anchors withsutures; using a tenodesis screw; or, using the QUICK-T device. also avoids the need forpainful sliding of the tendon in its groove and preserves elbow flexionand supination power. Furthermore, it avoids the bulging of the bicepsrm, which some patients may find cosmeticallyunacceptable.cated, we favour the QUICK-T device for olderhese could be used) but for stronger, youngereased pull-outstrength. Technique Perform a standard shoulderarthroscopy and address anyassociated pathology.1.Inspect the glenohumeral jointfirst and confirm thepathology.2.If the rotator cuff is torn,access is relatively easy in thesubacromial space. If therotator cuff is intact, open therotator interval (Figure 1)enough to allow access to thebicipital tendon from thesuperior view in thesubacromial space (Figure 2).3.Repair any associatedpathology, e.g., subscapularisrepair. Perform anacromioplasty, if necessary.Prior to repairing a torn rotatortendon. With the arthroscopein the lateral subacromialportal, establish an antero-teral accessory portal. Figure 2. Rotator interval open, revealing the biceps tendon. re 1. Opening of the rotator interval to expose the biceps tendon from its origin to the B.T.groove. VULCANªRFProbe Transverse ligament Biceps tendon in groove Rotator cuff Rotator cuff interval M. Subscapularis pularis M. Subscapularis Coracoid proc. Superior Labrum Cartilage surface(Humeral head) .Lift the biceps out of its grooveand decorticate the groove(Figure 3). 6.Place a cannula through theanterolateral portal for QUICK-T device passage.Under direct vision, screw the5.0 mm QUICK-T devicethrough the tendon and intothe bicipital groove (Figure 4). Figure 3. Preparation of intertubercular groove. Fixation of the biceps tendon. Roughening of bicepsnotch burr Insertion of QUICK-Tª deviceoove ional: Use a TWINFIXªanchor to increase fixation security. .Using the Smith &NephewQUICK-Tª Knot Pusher SutureCutter, slide the knot and T-bar down, ensuring that itcontacts the biceps tendon atright angles to the length ofthe tendon and that thebiceps tendon is secured tothe bicipital groove (Figure 5).Cut the sutures leaving a Orienting theeyelet of the QUICK-T deviceat right angles to the length ofthe tendon facilitatesplacement of the T-bar. The T-bar can be simply guided ontothe tendon with angrasper. Optional: Insert a secondce to ensurebetter fixation. Alternatively, aTWINFIX anchor can also beinserted for extra fixation. Usetwo sutures to make twoÒlocking loopsÓ in the tendon Figure 5. T-bar deployed at right angle to tendon. Deploy T-bar at rightangle to tendon TWINFIXªanchor placedproximal to QUICK-Tª device .Transect the biceps at itsorigin with a punch orradiofrequency device. If thesection of the biceps tendonproximal to the tenodesis siteappears too long, the loosepart of the tendon may be cutabout 1 cm away from theQUICK-T device and removed(Figure 7). Correcttendon length is ensured bydoing the tenotomy only afterfixation. Post operative care. Place the patient in a sling andlimit elbow extension, as well asactive flexion and supination of Figure 7. Final result using additional anchor fixation. TWINFIXª anchor withsuture fixation QUICK-Tª device Remove section of biceps tendonvision at origin and ±1 cmproximal to T-bar