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Surgical treatment of symptomatic pathology of the long head of the biceps tendon generally consists of either biceps tenotomy or tenodesis. Biceps tenodesis is generally recommended for younger patients and has been well described using open techniques. With advancements in arthroscopic ability and equipment, new arthroscopic techniques have recently been reported. These techniques can be especially useful when used in conjunction with other arthroscopic procedures such as distal clavicle resection, rotator cuff repair, and subacromial decompression. We present a modification of the techniques suggested by other researchers. In this technique, a bone anchor is used as a pulley at the bottom of the tunnel to pull the tendon into position. This is followed by interference screw fixation. To our knowledge, this technique has not been previously described.

Purpose: The purpose of this study was to evaluate the outcome of arthroscopic distal clavicle resection by the direct superior approach for treatment of isolated osteolysis of the distal clavicle., Type of Study: Case series., Materials and Methods: Forty-one shoulders in 37 patients underwent arthroscopic resection of the distal clavicle. Thirty-three patients were male and 4 female, with an average age of 39 years. All patients complained of pain localized to the acromioclavicular joint region. Symptoms began after a traumatic event in 18 shoulders and were associated with repetitive stressful activity in 23 shoulders., Results: At an average follow-up of 6.2 years, 22 shoulders had excellent results, 16 had good results, and 3 were failures. All 3 failures occurred in patients with a traumatic etiology., Conclusions: Arthroscopic resection for osteolysis of the distal clavicle has results comparable to open excision with low morbidity. Patients with a traumatic etiology had slightly worse results compared with patients with a microtraumatic etiology.

Twenty-five patients underwent arthroscopic debridement to treat early glenohumeral osteoarthritis. The group consisted of 19 men and 6 women with an average age of 46 years (range, 27 to 72 years.) The operative procedure consisted of lavage of the glenohumeral joint, debridement of labral tears and chondral lesions, loose body removal, and partial synovectomy and subacromial bursectomy. Follow-up averaged 34 months, with a range of 12 to 63 months. Overall, results were rated as excellent in 2 patients (8%), good in 19 patients (72%), and unsatisfactory in 5 (20%). Two patients had complete relief of pain, 18 patients had only occasional mild pain, and 5 had moderate to severe pain postoperatively. Of the 12 patients with marked preoperative stiffness, 10 (83%) had improvement in range of motion postoperatively. Arthroscopic debridement is a reasonable approach for treating early glenohumeral osteoarthritis that has failed to respond to nonoperative treatment, in which the humeral head and glenoid remain concentric, and where there is still a visible joint space on an axillary radiograph. The procedure is not recommended when there is severe joint incongruity or large osteophytes.

We retrospectively reviewed 117 consecutive patients who underwent arthroscopic acromioclavicular joint (ACJ) arthroplasties. Only patients who underwent ACJ arthroplasties from a bursal approach in conjunction with subacromial decompression were included. Patients with isolated ACJ arthrosis treated with resection of the distal clavicle from a superior approach, isolated impingement with only undersurface distal clavicle debridement, prior surgery, or other shoulder pathology were excluded. Twenty-four patients met these rigid criteria for inclusion in the study. After an arthroscopic subacromial decompression, the distal clavicle was visualized and resected through a standard bursal approach. In addition, an anterosuperior portal was used in 50% of the patients to confirm adequate clavicle resection. Postoperative follow-up averaged 32.5 months (range, 24 to 70 months). Preoperative and postoperative pain were rated subjectively on a 5-point scale (1, incapacitating pain; 5, no pain). Operative reports and postoperative radiographs were reviewed to determine technical factors that may have influenced outcome. Seventeen patients had excellent results (71%), 4 good (16.5%), and there were 3 failures (12.5%). Average preoperative pain rating was 1.8 and was improved to 4.3 postoperatively. The average amount of clavicle resection was only 5.4 mm. Given smooth, even, and complete bone removal, the amount of bone resected did not correlate with outcome. Arthroscopic distal clavicle resection performed in conjunction with subacromial decompression gave excellent results, comparable to isolated ACJ procedures. In this series, additional use of an anterosuperior portal for more direct shaver placement and complete ACJ viewing allowed consistent bone resection and excellent results in a high percentage of patients.

Arthroscopic shoulder surgery can be performed under regional or general anesthesia. The objective of this study was to demonstrate that regional anesthesia has several benefits over general anesthesia for this type of surgery, particularly in the ambulatory patient. Forty patients received general anesthesia and 63 an interscalene block. The regional block was found to be safe and effective, with a high degree of patient acceptance. It provided excellent intraoperative analgesia and muscle relaxation. Postoperatively, regional anesthesia resulted in fewer side effects, fewer hospital admissions, and a shorter hospital stay than did general anesthesia.

The technique of arthroscopic resection of the outer end of the clavicle through a superior approach is evaluated to determine whether adequate bone removal can be achieved. Furthermore, the results are compared with open resection. Twelve patients with osteolysis of the outer end of the clavicle refractory to conservative treatment underwent resection: six open and six arthroscopically through a superior approach. The distances from the acromial side of the AC joint to the lateral edge of the clavicle at its superior and inferior cortices were measured before and after surgery on anteroposterior radiographs. Bone removal was assessed by the difference between pre- and postoperative measurements. Satisfactory bone removal was possible arthroscopically and averaged 17 mm. This compared favorably with 18-mm average bone removal in the open group. Comparable pain relief and function were achieved in both groups. However, pain relief was achieved on average 3.4 months earlier in the arthroscopic group. Hospital stay was significantly shortened because the arthroscopic resections were outpatient procedures, whereas the open procedures had an average hospital stay of 3 days.

The results of arthroscopic treatment of chronic resistant calcific tendinitis of the shoulder in twenty-three patients were evaluated. Each patient had greater than 1 year of unsuccessful nonoperative management prior to arthroscopic surgery. The average age was 49 years (range 33-60) and average follow up was 26 months (range 12-47). Subacromial bursectomy was performed in all patients. Based on follow-up radiographs, thirteen patients had partial calcium removal while nine had complete removal of calcium. Results were graded as good in eleven patients (50%) with full motion and complete pain relief, satisfactory in nine (41%) patients with full motion and occasional episodes of pain, and unsatisfactory in two (9%) patients with persistent pain. Arthroscopic calcium removal and subacromial bursectomy are reasonable alternatives in the treatment of chronic calcific tendinitis resistant to conservative treatment.