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The low-anterolateral portal for arthroscopic biceps tenodesis: description of technique and cadaveric study

  • Shoulder
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Arthroscopic biceps tenodesis surgery is an important procedure for the correction of biceps tendonitis or in conjunction with rotator cuff repair with biceps symptoms. Recent trends have developed in placing the biceps tendon lower in the bicipital groove for a tenodesis. However, a more distal biceps tenodesis location is technically challenging when carried out arthroscopically with standard posterior and lateral portals. We aimed to establish the safety of a low-anterolateral portal location for direct access to the lowest aspect of the bicipital groove.

Methods

An anatomical study design was used to examine portal to neurovascular structural measurements in 23 cadaveric shoulders. These shoulders had undergone low-anterolateral portal placement over the inferior most aspect of the bicipital groove as determined by palpation and direct arthroscopic visualization. No arthroscopic irrigation was performed. Following this, the shoulders underwent open dissection with the cannula in place to evaluate for any potential damage to any portion of the axillary nerve.

Results

All of the resultant portals in this study provided direct access to the inferior most aspect of the bicipital groove, and the dissection revealed that the portal was touching a small distal axillary nerve branch on the undersurface of the anterior deltoid in nearly half of the shoulders.

Conclusions

The placement of a low-anterolateral portal for arthroscopic biceps tenodesis at the distal bicipital groove does not produce significant neurovascular damage; the portal trajectory comes close to distal anterior branches of the axillary nerve. Given these findings, this portal should be placed bluntly to best protect these underlying neurovascular structures.

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References

  1. Ahmad CS, ElAttrache NS (2003) Arthroscopic biceps tenodesis. Orthop Clin North Am 34(4):499–506

    Article  PubMed  Google Scholar 

  2. Bhatia DN, de Beer JF, Dutoit DF (2008) An anatomic study of inferior glenohumeral recess portals: comparative anatomy at risk. Arthroscopy 24(5):506–513

    Article  PubMed  Google Scholar 

  3. Boileau P, Krishnan SG, Coste JS, Walch G (2002) Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation. Arthroscopy 18(9):1002–1012

    Article  PubMed  Google Scholar 

  4. Burkhart SS, Nassar J, Schenck RC Jr, Wirth MA (1996) Clinical and anatomic considerations of a new anterior inferior subaxillary nerve arthroscopy portal. Arthroscopy 12(5):634–637

    Article  CAS  PubMed  Google Scholar 

  5. Difelice GS, Williams RJ 3rd, Cohen MS, Warren RF (2001) The accessory posterior portal for shoulder arthroscopy: description of technique and cadaveric study. Arthroscopy 17(8):888–891

    CAS  PubMed  Google Scholar 

  6. Flatow EL, Bigliani LU (1992) Tips of the trade. Locating and protecting the axillary nerve in shoulder surgery: the tug test. Orthop Rev 21(4):503–505

    CAS  PubMed  Google Scholar 

  7. Gartsman GM, Hammerman SM (2000) Arthroscopic biceps tenodesis: operative technique. Arthroscopy 16(5):550–552

    Article  CAS  PubMed  Google Scholar 

  8. George MS (2008) Arthroscopic biceps tenodesis incorporated into rotator cuff repair using suture anchors. Orthopedics 31(6):552–555

    Article  PubMed  Google Scholar 

  9. Klepps S, Hazrati Y, Flatow E (2002) Arthroscopic biceps tenodesis. Arthroscopy 18(9):1040–1045

    Article  PubMed  Google Scholar 

  10. Lo IK, Burkhart SS (2004) Arthroscopic biceps tenodesis using a bioabsorbable interference screw. Arthroscopy 20(1):85–95

    Article  PubMed  Google Scholar 

  11. Lo IK, Lind CC, Burkhart SS (2004) Glenohumeral arthroscopy portals established using an outside-in technique: neurovascular anatomy at risk. Arthroscopy 20(6):596–602

    Article  PubMed  Google Scholar 

  12. Lutton DM, Gruson KI, Harrison AK, Gladstone JN, Flatow EL (2011) Where to tenodese the biceps: proximal or distal? Clin Orthop Relat Res 469(4):1050–1055

    Article  PubMed  Google Scholar 

  13. Matthews LS, Zarins B, Michael RH, Helfet DL (1985) Anterior portal selection for shoulder arthroscopy. Arthroscopy 1(1):33–39

    Article  CAS  PubMed  Google Scholar 

  14. Mazzocca AD, Rios CG, Romeo AA, Arciero RA (2005) Subpectoral biceps tenodesis with interference screw fixation. Arthroscopy 21(7):896

    Article  PubMed  Google Scholar 

  15. Mazzocca AD, Cote MP, Arciero CL, Romeo AA, Arciero RA (2008) Clinical outcomes after subpectoral biceps tenodesis with an interference screw. Am J Sports Med 36(10):1922–1929

    Article  PubMed  Google Scholar 

  16. Meyer M, Graveleau N, Hardy P, Landreau P (2007) Anatomic risks of shoulder arthroscopy portals: anatomic cadaveric study of 12 portals. Arthroscopy 23(5):529–536

    Article  PubMed  Google Scholar 

  17. Nho SJ, Reiff SN, Verma NN, Slabaugh MA, Mazzocca AD, Romeo AA (2010) Complications associated with subpectoral biceps tenodesis: low rates of incidence following surgery. J Should Elbow Surg 19(5):764–768

    Article  Google Scholar 

  18. Nord KD, Mauck BM (2003) The new subclavian portal and modified Neviaser portal for arthroscopic rotator cuff repair. Arthroscopy 19(9):1030–1034

    Article  PubMed  Google Scholar 

  19. Pearsall AW 4th, Holovacs TF, Speer KP (1999) The low anterior five-o’clock portal during arthroscopic shoulder surgery performed in the beach-chair position. Am J Sports Med 27(5):571–574

    PubMed  Google Scholar 

  20. Provencher MT, LeClere LE, Romeo AA (2008) Subpectoral biceps tenodesis. Sports Med Arthrosc 16(3):170–176

    Article  PubMed  Google Scholar 

  21. Richards DP, Burkhart SS (2004) Arthroscopic-assisted biceps tenodesis for ruptures of the long head of biceps brachii: the cobra procedure. Arthroscopy 20(suppl 2):201–207

    Article  PubMed  Google Scholar 

  22. Romeo AA, Mazzocca AD, Tauro JC (2004) Arthroscopic biceps tenodesis. Arthroscopy 20(2):206–213

    Article  PubMed  Google Scholar 

  23. Sanders B, Lavery KP, Pennington S, Warner JJ (2012) Clinical success of biceps tenodesis with and without release of the transverse humeral ligament. J Should Elbow Surg 21(1):66–71

    Article  Google Scholar 

  24. Sekiya JK, Elkousy HA, Rodosky MW (2003) Arthroscopic biceps tenodesis using the percutaneous intra-articular transtendon technique. Arthroscopy 19(10):1137–1141

    Article  PubMed  Google Scholar 

  25. Wolf EM (1989) Anterior portals in shoulder arthroscopy. Arthroscopy 5(3):201–208

    Article  CAS  PubMed  Google Scholar 

  26. Woolf SK, Guttmann D, Karch MM, Graham RD 2nd, Reid JB 3rd, Lubowitz JH (2007) The superior-medial shoulder arthroscopy portal is safe. Arthroscopy 23(3):247–250

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank the contributions made by Dr. Denis Clohisy and the Department of Orthopaedic Surgery at the University of Minnesota for the provision of funds and for the acquisition of materials and cadavera for this study. The authors would also like to thank Dr. Michal P. Zlowodzki for his contributions in the assistance of data collection for this study.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave S #R200, Minneapolis, MN, 55454, USA

    Michael L. Knudsen, Jason C. Hibbard & Jonathan P. Braman

  2. Department of Physical Medicine and Rehabilitation, University of Minnesota, MMC 388, Office: ChRC 366B, 420 Delaware St. SE, Minneapolis, MN, 55455, USA

    David J. Nuckley

Authors
  1. Michael L. Knudsen
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  2. Jason C. Hibbard
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  3. David J. Nuckley
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  4. Jonathan P. Braman
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Correspondence to Jonathan P. Braman.

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Knudsen, M.L., Hibbard, J.C., Nuckley, D.J. et al. The low-anterolateral portal for arthroscopic biceps tenodesis: description of technique and cadaveric study. Knee Surg Sports Traumatol Arthrosc 22, 462–466 (2014). https://doi.org/10.1007/s00167-013-2444-9

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  • DOI: https://doi.org/10.1007/s00167-013-2444-9

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