Biceps Tenodesis for Distal Biceps Tendon Repair

1. Surgical Approach

2. Incision

3. Superficial Dissection to Antebrachial Fascia

1. Identification and Preservation of Lateral Antebrachial Nerve

4. Identification and Mobilization of Distal Biceps Tendon Stump

5. Preparation of Tendon Stump

1. Whip Stitches Through Tendon
2. Debride Distal End of Tendon Stump
3. Confirm Tendon Sizing
4. Mark Distal Centimeter of Tendon Stump
5. Place Shuttle Stitch
6. Place Limbs of Whip Stitch Through Distal Biceps Tendon Button
7. Place Button on Insertion Device

6. Preparation of Proximal Radius Insertion Site

1. Deep Dissection to Proximal Radius
2. Sharp Excision of Tendon Remnant from Footprint
3. Decortication of Radial Tuberosity Footprint

7. Tenodesis Tendon Repair

1. Unicortical Placement of Guidewire in Radial Tuberosity
2. Confirm Guidewire Placement via Fluoroscopy
3. Advance Guidewire Through Second Cortex
4. Place 7.5-mm Acorn Reamer over Guidewire and Across First Cortex
5. Irrigation to Remove Bone Shavings
6. Place Biceps Button Through Both Cortices
7. Deliver Tendon Through Bone Tunnel
8. Deliver Second Limb of FiberWire Through Tendon via Previously Prepared Shuttle Stitch
9. Tie Two Ends Together to Lock Distal Biceps Tendon in Bone Tunnel
10. Examine First Point of Fixation
11. 7-mm Tenodesis Screw Placement for Second Point of Fixation
12. Tie Two Limbs of FiberWire Together for Third Point of Fixation

8. Remarks on Closure and Splint