All-Arthroscopic Anatomic Length-Tension Biceps Tenodesis With Unicortical Button

The long head of the biceps tendon is a frequent cause of persistent anterior shoulder pain. Biceps tenodesis is a popular choice for surgical management of this pathology, with myriad approach and fixation variations described. We describe an all-arthroscopic suprapectoral biceps tenodesis in the anatomic length-tension relation using a unicortical button. This technique offers an alternative method that provides proper tendon fixation at anatomic length with minimized additional surgical morbidity and postoperative complications.
Technique Video Video 1 The patient is placed in the lateral decubitus position. The camera is inserted through the posterior viewing portal with a shaver through the lateral subacromial working portal. The camera is advanced anteriorly, and an anterior subdeltoid bursectomy is performed to visualize the biceps tendon in its groove. The overlying sheath is removed from the lateral side, and a Scorpion suture passer, through an accessory low anterior biceps portal, is used to tag the tendon at the level of the tenodesis site. A 3.2-mm drill pin is then inserted through the accessory biceps portal and drilled at the level of the suture, and tenodesis is completed with a unicortical biceps button. The biceps tendon is then cut 1 cm proximal to the tenodesis site. The camera is returned to the intra-articular space, the tendon undergoes tenotomy from the glenoid, and the remnant is removed from the shoulder.