Amouyel Thomas, Le Moulec Yves-Pierre, Tarissi Nicolas, Saffarini Mo, Courage Olivier
Department of Orthopaedic Surgery, Hopital Privé de l'Estuaire (HASS), Le Havre, France.
Alliance Scientifique, Lyon, France.
Arthrosc Tech. 2017 Oct 23;6(5):e1953-e1957. doi: 10.1016/j.eats.2017.07.025. eCollection 2017 Oct.
Arthroscopic repair of the long head of the biceps (LHB) is performed to treat various biceps pathologies yet the choice between tenotomy or tenodesis remains controversial. Although tenotomy is simpler and quicker, tenodesis results in fewer complications, and there are several techniques available using various fixation devices and sites. This Technical Note describes an all-arthroscopic, suprapectoral tenodesis technique using a bioresorbable interference screw, without motorized devices to create the humeral tunnel in the bicipital groove. The LHB tendon is detached from its glenoid insertion using an arthroscopic cutting instrument or electrocautery. Two portals are created 50 mm distal to the acromioclavicular joint and at 15 mm on either side of the bicipital groove. The arthroscope is introduced through the distal lateral portal till it makes contact with the humerus. The LHB is fastened within its groove using a grasper, reinforced, and then fixed in the humeral tunnel using an interference screw. The present technique is safe, simple, and reproducible. It requires 2 portals in addition to the standard posterior portal and the intra-articular working portal. It minimizes iatrogenic intra-articular damage and thereby limits possible complications. It also limits the intra-articular operative time compared with SLAP repairs.
关节镜下肱二头肌长头（LHB）修复术用于治疗各种肱二头肌病变，但在腱切断术和腱固定术之间的选择仍存在争议。尽管腱切断术更简单、更快，但腱固定术导致的并发症更少，并且有几种使用各种固定装置和部位的技术。本技术说明描述了一种全关节镜下的胸上腱固定术，使用生物可吸收加压螺钉，无需电动装置在肱二头肌沟内创建肱骨隧道。使用关节镜切割器械或电灼将LHB肌腱从其关节盂附着处分离。在肩锁关节远端50毫米处以及肱二头肌沟两侧15毫米处创建两个切口。通过远端外侧切口插入关节镜，直到其与肱骨接触。使用抓钳将LHB固定在其沟内，加强固定，然后使用加压螺钉固定在肱骨隧道内。本技术安全、简单且可重复。除了标准的后切口和关节内工作切口外，还需要两个切口。它将医源性关节内损伤降至最低，从而限制可能的并发症。与SLAP修复相比，它还缩短了关节内手术时间。
