Tenoscopic Suprapectoral Biceps Tenodesis Dirk Maier, M.D., Kaywan Izadpanah, M.D., Martin Jaeger, M.D., Peter Ogon, M.D., Norbert P. Südkamp, M.D.  Arthroscopy Techniques  Volume 5, Issue 1, Pages e55-e62 (February 2016) DOI: 10.1016/j.eats.2015.10.002 Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 1 Patient positioning and portal placement. A right shoulder is shown with the patient in the beach-chair position. (A) The posterior portal (PP), tenoscopy portal (TP), anterior portal (AP), high suprapectoral tenodesis portal (HTP), and low suprapectoral tenodesis portal (LTP) are marked (viewed from lateral). (B) The arthroscope is placed in the PP for glenohumeral arthroscopy, and an 8.25-mm working cannula is inserted into the AP (viewed from anterolateral). (C) Correct TP localization is verified with a K-wire before definite portal placement (viewed from posterolateral). (D) In this case, a standard 4.0-mm, 30° arthroscope is used for biceps tenoscopy (viewed from posterolateral). An additional standard arthroscopic sheath remains intra-articularly for later long head of the biceps tendon tenotomy. Arthroscopy Techniques 2016 5, e55-e62DOI: (10.1016/j.eats.2015.10.002) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 2 Glenohumeral arthroscopy (beach-chair position, left shoulder). (A) Hook probe evaluation shows a combined anterior and posterior SLAP lesion (G) for which anatomic reconstruction is not appropriate. (B) Rotator interval anatomy: humeral head (HH), subscapularis tendon (SSC), superior glenohumeral ligament (SGHL), and long head of biceps tendon (LHBT). The mesotenon (arrowhead) follows the LHBT into the biceps tendon sheath. If present, the mesotenon typically travels medial to the LHBT. (C) The tenoscopy portal is localized in line with and directly anterior to the LHBT shortly before its entrance into the bicipital groove. Correct localization is verified with a K-wire before definite portal placement. The mesotenon (arrowhead) follows the LHBT into the biceps tendon sheath. (D) A blunt 4.0-mm rod is inserted into the biceps tendon sheath and serves as a guide for insertion of the shaft of the arthroscope. (RI, rotator interval.) Arthroscopy Techniques 2016 5, e55-e62DOI: (10.1016/j.eats.2015.10.002) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 3 Tenoscopic suprapectoral biceps tenodesis (beach-chair position, left shoulder). (A) Biceps tenoscopy shows the long head of the biceps tendon (LHBT) within the biceps tendon sheath. The LHBT is accompanied by a vascularized mesotenon (arrowhead). (B) Electrosurgical release of anterior biceps tendon sheath and transverse humeral ligament. The LHBT (asterisk) is centered within the bicipital groove. (C) Temporary LHBT medialization eases exposition of the bicipital groove (BG). (D) A guidewire for cannulated drilling is placed centrally within the lower (distal) BG (arrowhead). (E) The LHBT (being held aside with a probe for demonstration purposes) is running straight across the drill hole and is ready for tenodesis. The LHBT is fixed proximal to the tenodesis site and tenotomized intra-articularly before tenodesis. (F) Completed tenodesis with forked-eyelet 7.0-mm SwiveLock Tenodesis screw (Arthrex). Arthroscopy Techniques 2016 5, e55-e62DOI: (10.1016/j.eats.2015.10.002) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions

Fig 4 Resected proximal portion of long head of biceps tendon (left, proximal; right, distal). The total length of the specimen is 6.0 cm. The mean length of the articular portion is about 2.5 cm, so tenodesis was performed approximately 3.5 cm distally from the articular margin. Arthroscopy Techniques 2016 5, e55-e62DOI: (10.1016/j.eats.2015.10.002) Copyright © 2016 Arthroscopy Association of North America Terms and Conditions