Arthroscopic Biceps Tenodesis: The Castagni Technique (SS-17)

Abstract

The biceps has recently been emphasized as an important pain generator in the shoulder. Arthroscopic treatment of partial biceps tears seems desirable, however current tenodesis techniques involving interference screw techniques are complex and can risk the axillary nerve. Tenotomy is appropriate for many patients, but does result in significant cosmetic deformity in as many as 10% of patients. Castagni et. al. presented a technique of arthroscopic suturing of the tenotomized biceps to the rotator cuff and transverse ligament. This allows relatively simple reattachment of the tendon without hardware or transosseous drilling. Thirty-eight patients were treated over a 4year period. Mean age was 58.6 years, with 28 male and 10 female. Thirty-four patients had associated rotator cuff pathology; all patients had an associated acromioplasty. The biceps was arthroscopically tagged, and then tenotomized with electrocautery. It was then sutured to the rotator cuff tendon using permanent #2 sutures. In 32 patients, the suture used was off an arthroscopically placed suture anchor and then incorporated into the repair of the rotator cuff. UCLA scores averaged 31.4 (S.D.= 5.5) and the SST scores improved from a mean of 6.5 to 10.9 categories (P < .02). No patient developed any cosmetic deformity post tenodesis. Arthroscopic suture tenodesis appears to be a reliable technique to manage the partial biceps rupture. The ease and low morbidity of this technique compares favorably with arthroscopic tenotomy, without the risk of unpleasant cosmetic deformity and may allow tenodesis in those patients where open or complex arthroscopic surgery seems undesirable.