# One-Step Release Technique for Tendon Extraction During Biceps Tenodesis

## TL;DR

A new one-step technique for tendon release during biceps tenodesis is described, combining cutting and gripping in a single step for arthroscopic and open shoulder surgeries.

## Contribution

The novel one-step technique simplifies biceps tenodesis by integrating tendon cutting and grasping into a single maneuver.

## Key findings

- The one-step technique is applicable in arthroscopic and open shoulder procedures.
- The BITER instrument enables efficient tendon release and exteriorization in a single step.

## Abstract

All biceps tenodesis techniques involving extra-articular tendon preparation consist of 2 distinct steps for tenotomy and tendon grasping. These 2 maneuvers are performed by different instruments. A single-step tendon release technique is described for both arthroscopic and open shoulder surgery. This technique finds application in arthroscopic proximal suprapectoral tenodesis, open treatment of proximal humerus fractures, and suprapectoral mini-open tenodesis. Herein, we describe an arthroscopic biceps tenodesis technique that combines the actions of cutting and gripping the tendon in a single step.

Video 1Video of an arthroscopic 1-step release technique for tendon extraction during biceps tenodesis. Right shoulder. Beach-chair position. Diagnostic arthroscopy and creation of an anterolateral portal with an outside-in technique. Introduction of the BITER by the anterolateral portal. Tenotomy using the BITER and exteriorization of the tendon stump. Resection of the proximal part of the tendon and reinforcement of the stump with a No. 2 FiberWire suture using the baseball stitch technique. Debridement of the reinsertion zone at the sulcus entry with a motorized shaver. Long head of the biceps tenodesis using a self-punching knotless anchor loaded with the 2 tails of No. 2 FiberWire sutures. Tensioning of the suture threads, release of the tether suture from the inserter handle, and cutting of the suture threads. A highly stable long head of the biceps tenodesis is achieved.

Video of an arthroscopic 1-step release technique for tendon extraction during biceps tenodesis. Right shoulder. Beach-chair position. Diagnostic arthroscopy and creation of an anterolateral portal with an outside-in technique. Introduction of the BITER by the anterolateral portal. Tenotomy using the BITER and exteriorization of the tendon stump. Resection of the proximal part of the tendon and reinforcement of the stump with a No. 2 FiberWire suture using the baseball stitch technique. Debridement of the reinsertion zone at the sulcus entry with a motorized shaver. Long head of the biceps tenodesis using a self-punching knotless anchor loaded with the 2 tails of No. 2 FiberWire sutures. Tensioning of the suture threads, release of the tether suture from the inserter handle, and cutting of the suture threads. A highly stable long head of the biceps tenodesis is achieved.