Table 3.

Step-by-Step Guide to Performing the Proposed Technique

Step 1: Position the patient comfortably seated on an examination table, with the back of the bed to set approximately 70° to 80° and the ipsilateral shoulder positioned so that the posterior, lateral, and anterior aspects of the shoulder are unobstructed (Fig 1).

Step 2: The ipsilateral arm should be supported on a padded mayo stand in slight forward flexion and abduction to allow for optimum entry in the glenohumeral joint. Mark out relevant surface anatomy and anticipated portals, including anterior, posterior, and lateral portals (Fig 2).

Step 3: Prior to the procedure, the planned arthroscopy portal sites are injected with 5 mL of a 1:1 ratio of 0.5 ropivacaine and 1% lidocaine with epinephrine. After 5 to 10 minutes, another 20 mL of a 1:1 ratio of lidocaine with epinephrine and ropivacaine is then used to infiltrate the joint one more time and establish that the portals can adequately gain access to the joint.

Step 4: A standard posterior arthroscopy portal is made using a No. 11 blade. A small 2-mm stab incision is made.

Step 5: Under direct visualization, the anterosuperior portal is established by passing a spinal needle just inferior to the biceps tendon in the rotator interval. A diagnostic arthroscopy is then performed using an 18-gauge spinal needle as both a probe and an outflow. Once confirmed that our anterosuperior portal site (working portal) is adequate, a small 3- to 4-mm stab incision is made.

Step 6: Using a 2.75-mm BirdBeak Suture Passer (Arthrex), a 1.3-mm SutureTape is passed through the biceps tendon approximately 1 to 1.5 cm (Fig 3) from the bicep-labral anchor and then again approximately 5 mm to 1 cm from the long head of biceps origin (Fig 4).

Step 7: A nanobiter is then used to tenotomize the biceps tendon at its labral junction.

Step 8: A 2.0-mm shaver can then be used to shave down any remnant of the remaining bicep at its previous origin.

Step 9: Finally, the 2 limbs of the SutureTape are tied to the overlying shoulder capsule, at the level of the rotator interval, with an arthroscopic knot pusher—ensuring adequate cinching of the knot (Fig 5).

Step 10: Apply wound closure and soft dressing as indicated.