AN ALL ARTHROSCOPIC SUPRAPECTORAL DOUBLE ROW TECHNIQUE OF LONG HEAD OF BICEPS TENODESIS USING ALL SUTURE ANCHORS AND MAINTAINING INHERENT LENGTH AND TENSION OF THE TENDON - A COMPREHENSIVE STEP BY STEP TECHNICAL NOTE WITH ILLUSTRATIONS

Long Head of Biceps tendon (LHBT) tenodesis is a widely accepted modality that produces satisfactory outcomes, low revision rates and low complication rates in the treatment of pathologies affecting the LHBT[1,2]. The latter is recognized as a common source of shoulder pain and disability [1], often found in association with other lesions in the shoulder. Arthroscopic LHBT tenodesis is therefore an appealing minimally invasive procedure that can be combined with other arthroscopic interventions during the same sitting to address coexisting shoulder pathologies[3]. Various techniques have been described and in the absence of an undisputed superior technique, we present, in this article, a novel method of performing an all arthroscopic suprapectoral LHBT tenodesis with a double row repair maintaining its inherent length-tension relationship. In this particular technique, two all-suture anchors are used to secure the tendon cinch sutures for better apposition of the tendon over the bone bed. Performing the tenodesis prior to the tenotomy enables us to maintain the native length of the LHBT, preserving the length-tension relationship. Furthermore, securing the proximal intra-articular segment of the LHBT initially during diagnostic arthroscopy facilitates its retrieval after dividing the LHBT following the tenodesis.