Revision Open Subpectoral Biceps Tenodesis With Allograft Tendon Reconstruction for Symptomatic Failed Biceps Tenodesis

Joseph W. Galvin; B. Gage Griswold; Peter M. Van Steyn; Michael J. Steflik; Stephen A. Parada

doi:10.1016/j.eats.2021.12.029

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Revision Open Subpectoral Biceps Tenodesis With Allograft Tendon Reconstruction for Symptomatic Failed Biceps Tenodesis

Journal article

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Peer reviewed

Revision Open Subpectoral Biceps Tenodesis With Allograft Tendon Reconstruction for Symptomatic Failed Biceps Tenodesis

Joseph W. Galvin, B. Gage Griswold, Peter M. Van Steyn, Michael J. Steflik and Stephen A. Parada

Arthroscopy techniques (Amsterdam), Vol.11(5), pp.e711-e715

05/01/2022

DOI: 10.1016/j.eats.2021.12.029

PMCID: PMC9134021

PMID: 35646562

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Abstract

Biceps tenodesis and tenotomy are both effective surgical procedures for management of shoulder pain and dysfunction secondary to SLAP tears, biceps tendinitis, rotator interval pulley lesions, and failed SLAP repairs. These procedures are generally safe with low complication rates. However, failure of a proximal biceps tenodesis or tenotomy can rarely lead to symptomatic Popeye deformity with pain and cramping with repetitive forearm supination and elbow flexion. Surgical revision is indicated in young active patients to restore the length tension relationship of the biceps brachii to improve supination and flexion strength, as well as to provide symptomatic relief and improved endurance. Failed biceps tenodesis can be a challenging surgical scenario, as oftentimes there is limited available proximal biceps tendon tissue, especially in the setting of prior subpectoral biceps tenodesis. We report a technique of revision open subpectoral biceps tenodesis with allograft tendon augmentation for the management of symptomatic Popeye deformity in young active patients with little to no remaining proximal biceps tendon. Video 1 Description of the revision subpectoral biceps tenodesis with tibialis anterior allograft tendon technique in the beach chair position. The prior open subpectoral biceps tenodesis incision is extended approximately 15 cm distally, and the biceps muscle belly is found retracted to the distal aspect of the arm. The conjoined tendon, the short head of the biceps, and the coracobrachialis are identified. The musculocutaneous nerve must be identified exiting the lateral aspect of the conjoined tendon, running in the interval between the biceps muscle belly and the brachialis. The tibialis anterior allograft is first weaved horizontally through the musculotendinous junction from medial to lateral. It is then weaved distally to the initial weave, from anterior to posterior. The tendon is then trimmed to length, and the junction site is sutured with multiple no. 2 nonabsorbable sutures and tenodesed in a subpectoral location. A demonstration of patient cosmesis and function after the procedure is also shown.

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Details

Title: Subtitle: Revision Open Subpectoral Biceps Tenodesis With Allograft Tendon Reconstruction for Symptomatic Failed Biceps Tenodesis
Creators: Joseph W. Galvin - Madigan Army Medical Center
B. Gage Griswold - Augusta University
Peter M. Van Steyn - Madigan Army Medical Center
Michael J. Steflik - Augusta University
Stephen A. Parada - Augusta University
Resource Type: Journal article
Publication Details: Arthroscopy techniques (Amsterdam), Vol.11(5), pp.e711-e715
Publisher: Elsevier
DOI: 10.1016/j.eats.2021.12.029
PMID: 35646562
PMCID: PMC9134021
ISSN: 2212-6287
eISSN: 2212-6287
Language: English
Date published: 05/01/2022
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9984618525102771

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