Arthroscopic Subdeltoid Approach to the Biceps Transfer

Abstract

Arthroscopy is an accepted tool in the treatment of many types of shoulder pathology. The arthroscopic subdeltoid approach consists of the posterior–portal-based arthroscope being advanced into the subdeltoid space via the subacromial space, then exposure of the space with shaving or radiofrequency ablation. The other portals are then made with a spinal needle localization piercing the anterior deltoid. This subdeltoid approach is well-suited to problems such as pectoralis major and subscapularis muscle tear, as well as massive rotator cuff tear repairs, problems that were previously difficult to address from the standard arthroscopic portals. This approach also allows transfer of the biceps tendon to the conjoint tendon. When patients continue to be symptomatic despite conservative interventions, surgical options need to be explored. Currently, there is no gold standard for the surgical treatment of biceps tendon pathology. Some authors favor tenodesis whereas others advocate tenotomy or transfer. Many of the treatments, including tenodesis and tenotomy, have had excellent rates of success, but complications, such as deformity, persist. We describe a new arthroscopic technique for biceps tenodesis via transfer of the long head of the biceps tendon to the conjoint tendon using the subdeltoid space. With this technique, the tendons are under direct visualization for proper tensioning, and the transferred tendon is approximately in the same orientation as in its native location. In the appropriately indicated patient, this technique may yield relief from biceps specific symptoms.