The new LassoLoop360° technique for biomechanically superior tissue grip

Fast Arthroscopic Biceps Tenodesis Without Penetrating Grasper

Long head of the biceps pathology is a common cause of shoulder pain and dysfunction. Surgical treatment can be either a tenotomy or a tenodesis. Long-term results may be similar in both surgical techniques; however, the latest systematic reviews indicate that tenodesis offers superior clinical and functional results in young patients and athletes. Considering the favorable results with the biceps tenodesis, we present this arthroscopic tenodesis in which the long head of the biceps is fixed in the bicipital groove with an all-suture anchor passed directly through the tendon, providing a stable and fast fixation without using penetrating grasper.

The high resistance loop (H-loop) technique used for all-inside arthroscopic knotless suprapectoral biceps tenodesis: A case series

Introduction

Suprapectoral tenodesis is a common technique for the treatment of long head biceps tendon lesions. However, so far, there is no gold standard treatment in all-inside arthroscopy. The purpose of the present study was to introduce and evaluate the functional outcomes of an innovative, all-inside arthroscopic high resistance loop (H-loop, high resistance to tissue cutout and 360° grasping of the tendon) technique for long head of biceps (LHB) tenodesis.

Method

From September 2020 to March 2022, a series of cases of 32 consecutive patients (28 rotator cuff tear with LHBT pathology and 4 superior labrum anterior-posterior (SLAP) tears which including 2 type II and 2 type IV) who received LHB tenodesis using all-inside arthroscopic high resistance loop technique were included in this study. The American Shoulder and Elbow Surgeon Score (ASES), Visual Analog Scale (VAS), Simple Shoulder Test Score (SST), Constant–Murley scores, and University of California at Los Angeles Scoring System (UCLA) were used to evaluate the clinical outcomes of patients in preoperative and final follow-up. Meanwhile, postoperative complications were also observed.

Result

32 patients (14 women and 18 men, average age was 55.7 years) underwent all-inside arthroscopic knotless suprapectoral biceps tenodesis using the H-Loop stitch technique. The mean time of follow-up was 16.2 ± 2.6 months. The ASES, VAS, Constant–Murley, SST, and UCLA scores improved from 51.5 ± 15.8, 5.5 ± 1.6, 57.8 ± 14.7, 5.0 ± 2.8, and 16.1 ± 3.8 preoperatively, to 89.1 ± 7.5, 1.0 ± 0.8, 87.3 ± 5.5, 10.4 ± 1.5, and 31.3 ± 2.6 in the last follow-up, respectively (p < 0.001). During the follow-up, no patients in this study experienced postoperative complications such as infection of the wound, injury of nerves, and hardware failure; no patients required revision after their operation. In addition, none of the patients had cramping or a “Popeye” deformity during follow-up.

Conclusion

This article presents an innovative, all-arthroscopic H-loop technique for LHB tenodesis. This technique for LHB tenodesis showed favorable functional and cosmetic outcomes, as well as high satisfaction rates. Due to its simplicity of operation and satisfactory preliminary clinical outcomes, H-loop technique is perhaps another option to choose in all-inside arthroscopic LHB tenodesis.

A novel arthroscopy training program based on a 3D printed simulator

Background

Arthroscopy is the most important and exciting contribution to sports medicine of the last 100 years. One of its main limitations, however, is the steep learning curve it requires, which is not easy to beat given the scarcity and the high price of arthroscopy simulators.

Hypothesis/purpose

To describe and evaluate the effectiveness of an open-access arthroscopy training program based on a 3D-printed simulator.

Methods

A model was designed, which was to be printed on a fused filament fabrication (FFF) 3D printer for home use with polylactic acid (PLA) filaments. Fourteen exercises were prepared, each with its timeframe and conceptual goals, arranged from least difficult to most challenging. Exercises were designed to assist subjects in developing the skills of an experienced arthroscopic surgeon through use of the simulator. Twenty subjects from nine hospitals completed the arthroscopy training program. Performance in each exercise was evaluated according to the Arthroscopic Surgical Skill Evaluation Tool (ASSET), taking into account the number of times a student had to repeat each exercise to complete it successfully.

Results

The mean ASSET score for each exercise was 22 points (IQR 19-25) and the mean number of times students had to repeat each exercise was 16 (95% CI 15.27-17.97). Eighty-five percent of subjects completed the program. The device was printed without difficulty by an independent investigator without prior knowledge of 3D printing. The price of the device was under US$ 12.

Conclusion

Subjects exhibited an improvement in their basic arthroscopic skills on the simulator. The number of times each of them had to repeat each exercise was similar, which is indicative of a smooth progression of difficulty along the program. The device proved easy to print, accessible, economical, and effective. This is the first structured program based on an open-access arthroscopic simulator to obtain satisfactory results.

Can a Two Simple Stitches Method Provide Secure Fixation Strength in Biceps Tenodesis?: Biomechanical Evaluation of Various Suture Techniques

Background

The purpose of this study was to compare the initial fixation strength between four different suture methods for the long head of the biceps.

Methods

Forty-eight fresh frozen porcine flexor hallucis longus tendons (mean width at suture site, 8.5 ± 0.9 mm) and phalanx bones were randomly assigned to one of the four arthroscopic biceps tenodesis techniques: simple stitch (SS), mattress suture (MS), lasso-loop (LL), and two simple stitches (2SS). A biceps tenodesis was performed according to the four techniques using all-suture type suture anchors (1.9-mm SUTUREFIX anchor with No. 1 ULTRABRAID sutures). Biomechanical evaluations were performed to test load to failure (N), stiffness (N/mm), stress (N/m²), and mode of failure.

Results

As for the SS, MS, LL, and 2SS, the mean load to failure was 50.9 ± 14.61 N, 82.3 ± 24.8 N, 116.2 ± 26.7 N, and 130.8 ± 22.5 N (p < 0.001), respectively; mean stiffness was 6.1 ± 1.3 N/mm, 6.7 ± 2.6 N/mm, 7.8 ± 1.4 N/mm, and 8.1 ± 4.2 N/mm, respectively (p = 0.258); and mean stress was 0.7 ± 0.3 N/m², 1.4 ± 0.8 N/m², 2.9 ± 0.7 N/m², and 2.7 ± 0.8 N/m², respectively (p < 0.001). All the failures happened by the suture cutting through the tendon along its longitudinal fibers.

Conclusions

Neither the SS nor the MS method was enough to securely fix the biceps tendon with a significantly lower mechanical strength; however, the 2SS method showed similar initial fixation strength as the LL technique.

The 360 Double Lasso Loop for Biceps Tenodesis: Tips and Tricks

The management of the intra-articular portion of the long head of the biceps tendon (LHB) is a recurring topic in every discussion about shoulder pain. In massive rotator cuff tears or in tears of the superior third of the subscapularis tendon, our approach is to systematically perform a tenodesis of the LHB. In this Technical Note, we present our arthroscopic technique for LHB tenodesis at the articular margin of the humeral head using a single anchor and a 360 double lasso loop. This technique guaranties a strong and efficient fixation of the biceps tendon and is reproducible when following the steps and tips and tricks outlined herein.