Richards Jarod A, Haralson Warren G, Woodard David R, Nuelle Clayton W, DeFroda Steven F
Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, U.S.A.
Arthrosc Tech. 2024 Aug 27;14(2):103202. doi: 10.1016/j.eats.2024.103202. eCollection 2025 Feb.
Anterior shoulder pain is a common complaint often caused by pathology of the long head of the biceps such as biceps tendinitis, partial biceps tears, biceps instability, and SLAP lesions. Surgical treatment of biceps pathology includes tenotomy versus tenodesis, with tenodesis being favored in young, active patients owing to less cramping pain and superior outcomes in terms of shoulder function and cosmesis. Various surgical techniques for tenodesis of the long head of the biceps exist, with varying indications. Subpectoral biceps tenodesis is primarily indicated for zone 2 to 3 tendon pathology and revision biceps tenodesis. Secondary indications include overhead athletes, chronic biceps tendinopathy, and rotator cuff repair. Proximal arthroscopic biceps tenodesis performed "high in the groove" has been shown to preserve biceps length and reduce Popeye deformity compared with tenotomy. Knotless techniques are becoming popular; they provide low-profile fixation that limits knot abrasion and is not reliant on knot security for fixation. We present a variation of suprapectoral biceps tenodesis using knotless fixation in an onlay technique.
肩部前方疼痛是一种常见的主诉，通常由肱二头肌长头的病变引起，如肱二头肌肌腱炎、肱二头肌部分撕裂、肱二头肌不稳定和SLAP损伤。肱二头肌病变的手术治疗包括肌腱切断术和肌腱固定术，由于痉挛性疼痛较少，且在肩部功能和美观方面效果更佳，肌腱固定术在年轻、活跃的患者中更受青睐。存在多种肱二头肌长头肌腱固定术的手术技术，其适应证各不相同。胸小肌下肱二头肌肌腱固定术主要适用于2区至3区肌腱病变和肱二头肌肌腱固定术翻修。次要适应证包括过头运动员、慢性肱二头肌肌腱病和肩袖修复。与肌腱切断术相比，在“沟内高位”进行的近端关节镜下肱二头肌肌腱固定术已被证明可保留肱二头肌长度并减少“大力水手”畸形。无结技术正变得越来越流行；它们提供了低轮廓固定，限制了结的磨损，并且固定不依赖于结的安全性。我们介绍一种采用无结固定的胸小肌上肱二头肌肌腱固定术的改良术式，采用覆盖技术。
