Arthroscopic Suture Anchor Tenodesis: Loop-Suture Technique Min Soo Shon, M.D., Kyoung Hwan Koh, M.D., Tae Kang Lim, M.D., Seung Won Lee, M.D., Young Eun Park, M.D., Jae Chul Yoo, M.D.  Arthroscopy Techniques  Volume 2, Issue 2, Pages e105-e110 (May 2013) DOI: 10.1016/j.eats.2012.12.003 Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 1 Arthroscopic images of right shoulder showing biceps tendon from posterior viewing portal with patient in lateral decubitus position. (A) Arthroscopic scissors or a radiofrequency device was used to partially sever the tendon at its junction with the superior labrum to maintain length-tension of the LHBT. (B) In addition, this step served to mark the site of the cut, allowing the easy and complete cutting of the partially severed tendon when approaching the intra-articular space from the subacromial space through the torn site of the rotator cuff after suture anchor fixation of the tendon. (BT, biceps tendon; RI, rotator interval.) Arthroscopy Techniques 2013 2, e105-e110DOI: (10.1016/j.eats.2012.12.003) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 2 Arthroscopic images of right shoulder showing bicipital groove and biceps tendon in subacromial space from posterolateral viewing portal. (A) The lateral portion of the biceps sheath, including the upper portion of the transverse humeral ligament, was transected and released with a radiofrequency device. (B) The biceps tendon was pulled out of the bicipital groove and kept hanging up by use of the probe introduced from the lateral portal. The manipulation with the probe helps to achieve good visualization and facilitates the subsequent anchor insertion and loop-suture technique for the tenodesis. (bg, bicipital groove; BT, biceps tendon; GT, greater tuberosity.) Arthroscopy Techniques 2013 2, e105-e110DOI: (10.1016/j.eats.2012.12.003) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 3 Arthroscopic images of right shoulder from posterolateral viewing portal. Tapping (A) and insertion (B) of suture anchor into proximal portion within bicipital groove through existing anterior portal. The most common placement site for anchor insertion is the bicipital groove, roughly 1 to 2 cm distal to the starting point of the groove. Arthroscopy Techniques 2013 2, e105-e110DOI: (10.1016/j.eats.2012.12.003) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 4 Arthroscopic images of right shoulder showing loop-suture technique for tenodesis from posterolateral viewing portal. (A) The loop strand is wrapped circumferentially with the biceps tendon by making a lasso-type loop. (B) The sutured-strand technique was performed with a simple suture that was tied, achieving fixation of the biceps tendon in situ within the bicipital groove. This technique was designed to improve biceps grip and simultaneously minimize the longitudinal splitting of the tendon. (Ls, loop strand; Ss, sutured strand.) Arthroscopy Techniques 2013 2, e105-e110DOI: (10.1016/j.eats.2012.12.003) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 5 Arthroscopic images from posterolateral viewing portal in subacromial space. (A) After cutting of the proximal portion of the biceps tendon at the previously marked site at the glenoid insertion, the remnant biceps tendon is pushed out of the glenohumeral joint to the subacromial space by a probe. (B) Afterward, the grasper is introduced to grab the remnant tendon, and the tendon at the proximal site to the tenodesis site is severed by the scissors. (BT, biceps tendon.) Arthroscopy Techniques 2013 2, e105-e110DOI: (10.1016/j.eats.2012.12.003) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions

Fig 6 Arthroscopic image from posterolateral viewing portal in subacromial space. Secure fixation after suture anchor tenodesis with the loop-suture technique is confirmed. (BTs, stump of severed biceps tendon.) Arthroscopy Techniques 2013 2, e105-e110DOI: (10.1016/j.eats.2012.12.003) Copyright © 2013 Arthroscopy Association of North America Terms and Conditions