Biceps Tenodesis




- intra-articular

- suprapectoral



- suprapectoral

- subpectoral


A.  Arthroscopic Intra-articular


Biceps Tenodesis Intra articular



- suture biceps to superior capsule using figure 8 no 2 non absorbable



- anterior portal + portal of Wilmington

- debride capsule and biceps with shaver so will heal

- use curved suture passer with no 1 PDS

- suture shuttle no 2 fibre wire

- divide 90% biceps insertion so will rupture in time

- allows healing of biceps to capsule


Biceps Tenodesis First PassBiceps Tenodesis PDSBiceps Tenodesis First Suture


Biceps Tenodesis Second PassBiceps Tenodesis CompletedBiceps Tendon Insertion Cut


Attempt Figure 8 Suture Configuration


Biceps Tenodesis Step 1Biceps Tenodesis Step 2


B.  Arthroscopic Suprapectoral Technique


1.  Secure Biceps Tendon - allows tensioning and prevents losing tendon


A.  Birds Beak Passer with 2 ethibond loop

- pass loop through intact tendon at entry through RC interval

- retrieve loop out through portal and lock

- this gives strong hold on tendon


B.  Pass 18 G spinal needle through biceps tendon

- thread 1 PDS or nylon

- retrieve both suture ends via portal in rotator interval

- secure with half hitches

- pass 1 loop of PDS about entire tendon and tie again


Arthroscopy Tagging Biceps TendonArthroscopy Secured Biceps Tendon


2.  Resect tendon with electrocautery at insertion


Arthroscopy Biceps Tenotomy


3.  Make portal over biceps interval into subacromial space

- release biceps tendon with electrocautery or arthroscopic scissors


4.  Secure tendon

- make drill hole

- insert tendon

- secure with biotenodesis screw

- multiple techniques with specifically designed equipment


C.  Open Technique for Intact Biceps


1.  Divide biceps arthroscopically

- may wish to place stay suture first to avoid retraction

- biceps normally has vinculae preventing complete retraction into arm


2.  Suprapectoral

- deltoid split

- between anterior and middle parts

- find biceps in groove

- pull out of wound and whip stitch with heavy suture

- drill appropriate size tunnel for fixation screw

- multiple biceps tenodesis devices

- push the tendon into the hole, then fixate with screw


3.  Subpectoral

- medial incision in arm

- below inferior edge of pectoralis major

- find biceps tendon

- whip stitch

- pass through drill holes / secure with screw / secure with anchor


Biceps Subpectoral TenodesisSubpectoral Biceps Tenodesis


D.  Open Technique for Ruptured LHB / Popeye in young patient


1.  Locate biceps




A.  Suprapectoral

- best to make deltopectoral approach

- biceps may be futher retracted


B.  Subpectoral approach


2.  Fixation