Transcript
InfraPectoral Biceps Tenodesis
Mike Walton@mrmikewalton mikewalton@shoulderdoc.co.uk
Santander 2015
Tenotomy or Tenodesis?
• No evidence in literature to support tenodesis
• Essentially cosmetic procedure
An Evidenced Based Decision
• Functional Loss - Power (De Carli, 2012)
Significant difference between operated and non-operated sides but no difference between tenotomy and tenodesis groups
An Evidenced Based Decision
• Functional Loss - Biceps Muscle Cramps
• Lim, 2011 - 10% with tenotomy
• Duff, 2012 - 19% with tenotomy
• Slenker, 2012 - 19% with tenotomy, 24% with tenodesis
SubPectoral TenodesisOrthopedics. 2015 Jan 1;38(1):37-41. doi:10.3928/01477447-20150105-04. Open subpectoral biceps tenodesis: reliable treatment for all biceps tendon pathology. Kane P, Hsaio P, Tucker B, Freedman KB
SubPectoral Tenodesis• How should I do it??
• Interference Screw - not keen in diaphysis
SubPectoral Tenodesis• How should I do it??
• Interference Screw - not keen in diaphysis
SubPectoral Tenodesis• How should I do it??
• Bicortical Fixation with Endobutton?
J Shoulder Elbow Surg. 2015 Jan;24(1):138-42. doi: 10.1016/j.jse.2014.06.038. Epub 2014 Sep 3. Safety of open suprapectoral and subpectoral biceps tenodesis: an anatomic assessment of risk for neurologic injury. Sethi PM1, Vadasdi K2, Greene RT2, Vitale MA2, Duong M2, Miller SR2
SubPectoral Tenodesis• How should I do it??
• Anchors?
• No interossesous tendon fixation• Weaker construct• Not strong enough for sports population
SubPectoral Tenodesis• Optimal technique
• Strong to allow early mobilisation
• Direct Vision
• Interosseous tendon
• No diaphyseal stress riser
• QUICK AND EASY
• Beach chair Position
• Biceps tenotomy
• Small incision at lower boarder of pec major
• LHB easily palpable
• Small incision at lower boarder of pec major
• LHB easily palpable
Get Tension Right
• FibreLoop whip stitch
• Approx 5 passes
• Approx 2cm
• 5-7mm Reamer hole
• 2.5mm prox drill hole
6/7mm Reamer
2.5mm Drill
• 5-7mm Reamer hole
• 2.5mm prox drill hole
• Suture passer from proximal to distal and deliver FibreLoop
• Tie over EndoButton
Rehabilitation
• As little change as possible
• Elbow ROM as comfort allows
• No strengthening 6 weeks
• No weight training 3 months
Rehabilitation
• As little change as possible
• Elbow ROM as comfort allows
• No strengthening 6 weeks
• No weight training 3 months
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