A Knotless Labro-Bicipital Repair Technique for SLAP Lesions Özgür Koyuncu, M.D., Ilker Eren, M.D., Aksel Seyahi, M.D., Serkan Uludag, M.D., Mehmet Demirhan, M.D.  Arthroscopy Techniques  Volume 4, Issue 5, Pages e493-e497 (October 2015) DOI: 10.1016/j.eats.2015.05.015 Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 1 (A) Fraying around the biceps anchor and synovitis around the tendon attachment are typical findings of a SLAP lesion. (B) Examination of Snyder type II SLAP lesion. It is important to verify that the tear extends beyond the articular border (blue arrow) medially to expose the footprint (orange arrow). Arthroscopy Techniques 2015 4, e493-e497DOI: (10.1016/j.eats.2015.05.015) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 2 Steps of technique: (a) posterior passage, (b) anterior retrieval, (c) penetration through anchor, and (d) fixation. Arthroscopy Techniques 2015 4, e493-e497DOI: (10.1016/j.eats.2015.05.015) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 3 (A) First step of suture passage. A nitinol SutureLasso is piercing the posterior biceps anchor (arrow). (B) Suture is delivered through the biceps anchor and ready for the next step. Arthroscopy Techniques 2015 4, e493-e497DOI: (10.1016/j.eats.2015.05.015) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 4 Second step. (A) An empty BirdBeak device pierces the anterior biceps anchor (B) to carry the inferior free end of the suture through. It is possible to use another suture passer for this step; however, we recommend the demonstrated technique. Arthroscopy Techniques 2015 4, e493-e497DOI: (10.1016/j.eats.2015.05.015) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 5 (A) Both limbs are carried to the anterosuperior cannula and placed in the BirdBeak device. An appropriate passage point is important for correct fixation. (B) The passed limbs are retrieved from the midglenoid portal. Arthroscopy Techniques 2015 4, e493-e497DOI: (10.1016/j.eats.2015.05.015) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 6 Series of guides prepared to achieve safe passage through rotator cuff. (a) Long spinal needle to check entry point. (b) Flexible straight nitinol guide. (c, d, f) Dilators used consecutively. (e, g) Bone guide and drill bit of anchor. Arthroscopy Techniques 2015 4, e493-e497DOI: (10.1016/j.eats.2015.05.015) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 7 A 3.5-mm biocomposite knotless suture (BioComposite PushLock) is used for fixation. The anchor entry point is just below the biceps anchorage and medial to the cartilage border. An oblique orientation is preferred to increase mechanical stability (dead-man angle). The anchor is delivered and fixed to the prepared pilot hole while gentle tension is kept on the suture limbs. Arthroscopy Techniques 2015 4, e493-e497DOI: (10.1016/j.eats.2015.05.015) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions

Fig 8 Completed SLAP repair. No suture parts or knots are in contact with the other intra-articular structures. Arthroscopy Techniques 2015 4, e493-e497DOI: (10.1016/j.eats.2015.05.015) Copyright © 2015 Arthroscopy Association of North America Terms and Conditions