Arthroscopic biceps tenodesis using the knotless lasso technique.

Long head biceps tendinopathy can be a significant pain generator, often presenting with pain localised to the anterior shoulder. Biceps tenodesis, both open and arthroscopic, is a well-established treatment for long head biceps pathology. In this presentation, we describe a novel arthroscopic onlay technique for long head biceps tenodesis using a lasso configuration with two knotless suture anchors that provide an efficient, low-profile construct to limit scarring and adhesions while providing circumferential fixation. We use this technique for the following surgical indications: severe tendinosis refractory to non-operative management, unable superior labral anterior to posterior (SLAP) tears, biceps instability and partial or complete tearing. The procedure is performed using standard shoulder arthroscopy portals with the addition of an anterolateral biceps working portal approximately 2 cm inferior and 2 cm lateral to the anterior rotator interval portal. Novel advantages of this technique include a low-profile knotless construct, efficient suture passage and circumferential two-point fixation while maintaining anatomic biceps tensioning. Technical pearls including visualisation, release of the biceps tendon from the groove and location of two point tenodesis fixation are all critical to a good outcome.