Infrapectoral biceps tenodesis by Mike Walton @mrmikewalton

1. InfraPectoral Biceps
Tenodesis
Mike Walton
@mrmikewalton mikewalton@shoulderdoc.co.uk
Santander 2015

4. Tenotomy or Tenodesis?
• No evidence in literature to support
tenodesis
• Essentially cosmetic procedure

5. An Evidenced Based Decision
• Functional Loss - Power (De Carli, 2012)
Significant difference between operated and
non-operated sides but no difference between
tenotomy and tenodesis groups

6. An Evidenced Based Decision
• Functional Loss - Biceps Muscle Cramps
• Lim, 2011 - 10% with tenotomy
• Duff, 2012 - 19% with tenotomy
• Slenker, 2012 - 19% with tenotomy, 24%
with tenodesis

7. SubPectoral Tenodesis
Orthopedics. 2015 Jan 1;38(1):37-41. doi:10.3928/01477447-20150105-04.
Open subpectoral biceps tenodesis: reliable treatment for all biceps
tendon pathology.
Kane P, Hsaio P, Tucker B, Freedman KB

8. SubPectoral Tenodesis
• How should I do it??
• Interference Screw - not keen in diaphysis

9. SubPectoral Tenodesis
• How should I do it??
• Interference Screw - not keen in diaphysis

10. SubPectoral Tenodesis
• How should I do it??
• Bicortical Fixation with Endobutton?
J Shoulder Elbow Surg. 2015 Jan;24(1):138-42. doi: 10.1016/j.jse.
2014.06.038. Epub 2014 Sep 3.
Safety of open suprapectoral and subpectoral biceps tenodesis:
an anatomic assessment of risk for neurologic injury.
Sethi PM1, Vadasdi K2, Greene RT2, Vitale MA2, Duong M2, Miller
SR2

11. SubPectoral Tenodesis
• How should I do it??
• Anchors?
• No interossesous tendon fixation
• Weaker construct
• Not strong enough for sports population

12. SubPectoral Tenodesis
• Optimal technique
• Strong to allow early mobilisation
• DirectVision
• Interosseous tendon
• No diaphyseal stress riser
• QUICK AND EASY

14. • Beach chair Position
• Biceps tenotomy
• Small incision at lower
boarder of pec major
• LHB easily palpable

15. • Small incision at lower
boarder of pec major
• LHB easily palpable

16. Get Tension Right

18. • FibreLoop whip
stitch
• Approx 5 passes
• Approx 2cm

19. • 5-7mm Reamer hole
• 2.5mm prox drill hole

20. 6/7mm Reamer
2.5mm Drill
• 5-7mm Reamer hole
• 2.5mm prox drill hole

21. • Suture passer from
proximal to distal
and deliver
FibreLoop

22. • Tie over
EndoButton

24. Rehabilitation
• As little change as possible
• Elbow ROM as comfort allows
• No strengthening 6 weeks
• No weight training 3 months

25. Rehabilitation
• As little change as possible
• Elbow ROM as comfort allows
• No strengthening 6 weeks
• No weight training 3 months