Proximal biceps tenodesis with biceps button
Methods and drill guide systems that provide internalization of the biceps tendon with use of fixation devices such as the Arthrex BicepsButton™ or Pectoralis Button tensioned outside a smaller converged drill hole. The technique converges two angled drill holes and use the button to fixate a reinforced (whipstitched) biceps tendon into a single bone versus stabilizing two bones. The biceps tendon is being pulled into the larger of the drilled holes and fixed by the button outside of the smaller drilled hole.
1. A method of proximal biceps tenodesis, the method comprising the steps of:
exposing a native biceps without externalizing the native biceps;
forming a first bone socket in a proximal humerus, at an inferior border of a bicepital groove;
inserting a first cannulated tube of a drill guide system into the first bone socket, the drill guide system including a triangular guide having a plate, the first cannulated tube, and a second cannulated tube, the first and second cannulated tubes being non-parallel to each other and to the plate, the drill guide system further including a solid rod, a cannulated sleeve, and a drill;
while the first cannulated tube remains in place, forming a second bone socket at a location superior to the first bone socket with the second cannulated tube, the cannulated sleeve, and the drill, the second bone socket intersecting the first bone socket and forming a resulting bone tunnel having a V shape;
passing a first flexible strand through the first socket and the second socket of the resulting bone tunnel having the V shape;
passing a second flexible strand around or through the native biceps adjacent the first bone socket to form at least one locking stitch and two free ends;
employing the first flexible strand, passing the two free ends of the second flexible strand through the first and second bone sockets, and out of the second bone socket;
pulling on the two free ends to insert the native biceps into the first socket of the resulting bone tunnel with the V shape; and
passing the two free ends through apertures of a button and tying the two free ends over the button and on a humeral cortex with the button positioned over the second bone socket, to secure the native biceps into the resulting bone tunnel having the V shape.
2. The method of claim 1 , wherein the first and second cannulated tubes are integral to the plate and form an angle of 60 degrees relative to the plate and to each other.