Biceps Tendon Repair
Reattaching the biceps tendon to the arm bone in a tenodesis procedure can be done by several techniques including bone tunnels, interference screws, and suture anchors. These techniques are all performed through an open approach, meaning an additional incision on the upper arm to reattach the tendon.
The bone tunnel technique is done by drilling two holes in the bone, placing sutures through the tendon and bone to tie the tendon into place. Interference screws were later used to compress the tendon within the drill hole in the bone for increased fixation strength. However, as orthopedics advanced, sutures anchors were developed. Suture anchors were initially small metal screws with sutures attached to them that were then buried into the bone and the sutures were used to affix the tendon to the bone.
Suture anchors have allowed smaller incisions to be used to perform this technique. More recent versions of suture anchors act like barbs, where they allow insertion into the bone, but hooks prevent it from being pulled out. Newer suture anchors use all- suture systems, which allows for smaller implants and minimizing bone loss.
Biceps Tendon Repair
Surgical treatment of biceps tendonitis is often performed through the technique of arthroscopy. This is the surgical technique of making small incisions around the shoulder, using a small camera to look inside the joint, and using special instruments to perform interventions within the shoulder joint.
Historically, surgical treatment of biceps tendonitis has been with tenotomy, which means cutting the diseased tendon without further treatment. This has provided good symptomatic relief, however can result in aesthetically unpleasing deformity of the biceps muscle and has associated cramping with biceps muscle use. To mitigate these effects, what is performed more commonly today is called a biceps tenodesis procedure.
Tenodesis means to move a tendon from one location and affix it in a new location. This allows for normal tensioning of the muscle preventing deformity and associated cramping. There is not difference in strength postoperatively with either procedure.
Biceps tendonitis is a common cause of shoulder pain in the front of the shoulder. It is most common in patients who perform overhead activities, whether for sport or for work. Front of the shoulder is often very tender to palpation and can be worse with lifting objects with that arm. The underlying process that is occurring is inflammation and degeneration of the biceps tendon as it passes through the shoulder.
At times the degeneration can significant enough that the tendon ruptures, resulting in a deformity of the biceps muscle. Treatment can include anti-inflammatory medications and physical therapy; however, this does not always work. When conservative treatment has failed, then surgery is indicated.
Arthrex FiberTak™ is an all suture-based suture anchor that can be used to reattach the proximal biceps through a minimally invasive approach. All suture-based anchors provide rigid fixation with minimal bone loss that can come with other fixation. It can come with a single or double set of sutures attached to it.
The anchor is placed through a small hole drilled into the bone. As tension is pulled on the sutures, it expands a thickened area of the suture securing it in place and preventing it from coming back through the hole. The system is also designed to allow for easy tensioning of the tendon down to the bone by allowing some movement in the sutures prior to final tightening. This system is available for fixation of other soft tissues in the shoulder to include the labrum and in rotator cuff repairs.