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Arthroscopy Techniques
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    • Cover Image - Arthroscopy Techniques, Volume 12, Issue 2
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  • Technical Note
    Open Access

    Arthroscopic Suprapectoral Biceps Tenodesis With Tenodesis Screw

    Arthroscopy Techniques
    Vol. 7Issue 5e417–e422Published online: April 2, 2018
    • Brian Forsythe
    • William A. Zuke
    • Richard N. Puzzitiello
    • Anthony A. Romeo
    Cited in Scopus: 15
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    There are many methods for long head of the biceps tendon (LHBT) tenodesis, but a consensus on a superior method has yet to be met. In this article, we introduce a method for arthroscopic suprapectoral biceps tenodesis using a tenodesis screw in the bicipital tunnel. The intra-articular portion of the biceps tendon is transected. The subdeltoid space is then viewed via a lateral portal, and the tendon is mobilized from the bicipital tunnel. The tendon is retrieved through the anterior portal, and 5 whipstitch passes and a second distal stitch are placed.
    Arthroscopic Suprapectoral Biceps Tenodesis With Tenodesis Screw
  • Technical Note
    Open Access

    Technique for Type IV SLAP Lesion Repair

    Arthroscopy Techniques
    Vol. 7Issue 4e337–e342Published online: March 12, 2018
    • Burak Altintas
    • Rafael Pitta
    • Erik M. Fritz
    • Brendan Higgins
    • Peter J. Millett
    Cited in Scopus: 3
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    Type IV SLAP tears involve bucket-handle tears of the superior labrum with the tears extending into the biceps tendon. Surgical treatment options involve either primary repair or biceps tenodesis. Recent literature has shown good clinical outcomes after subpectoral biceps tenodesis for the treatment of type II and IV SLAP lesions. The purpose of this article is to present our technique for arthroscopic superior labrum repair with suture anchors and open subpectoral biceps tenodesis with an interference screw.
    Technique for Type IV SLAP Lesion Repair
  • Technical Note
    Open Access

    Arthroscopic Coracohumeral Ligament Release for Patients With Frozen Shoulder

    Arthroscopy Techniques
    Vol. 7Issue 1e1–e5Published online: December 4, 2017
    • Yoshihiro Hagiwara
    • Akira Ando
    • Kenji Kanazawa
    • Masashi Koide
    • Takuya Sekiguchi
    • Junichiro Hamada
    • and others
    Cited in Scopus: 22
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    Arthroscopic pancapsular release has been recommended for recalcitrant frozen shoulder, but regaining range of motion has not been sufficient compared with the unaffected side. There is no consensus about the reasons for these remaining restrictions in range of motion, but residual capsular or connective tissue must be considered a candidate. A thickened coracohumeral ligament at the rotator interval has been reported as one of the most specific manifestations of frozen shoulder. It covers wider portions of the subscapularis tendon, supraspinatus tendon, and infraspinatus tendon than previously reported.
    Arthroscopic Coracohumeral Ligament Release for Patients With Frozen Shoulder
  • Technical Note
    Open Access

    Arthroscopic Repair of Type II SLAP Tears Using Suture Anchor Technique

    Arthroscopy Techniques
    Vol. 6Issue 6e2137–e2142Published online: November 13, 2017
    • Mathew Hamula
    • Siddharth A. Mahure
    • Daniel J. Kaplan
    • Brent Mollon
    • Joseph D. Zuckerman
    • Young W. Kwon
    • and others
    Cited in Scopus: 0
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    Arthroscopic SLAP tear repair has become an increasingly used treatment for patients presenting with symptomatic SLAP tears after failed nonoperative management. Debridement, SLAP repair, and open or arthroscopic biceps tenodesis or tenotomy have been used for the treatment of SLAP tears. Various techniques for repair have been described, and furthermore, there is a high incidence of concomitant pathology of the shoulder. Repair remains an excellent option in isolated SLAP tears amenable to repair, with excellent outcomes in well-indicated patients.
    Arthroscopic Repair of Type II SLAP Tears Using Suture Anchor Technique
  • Technical Note
    Open Access

    Consolidated Proximal Biceps Tenodesis and Subscapularis Repair

    Arthroscopy Techniques
    Vol. 6Issue 5e1967–e1971Published online: October 23, 2017
    • Kyle E. Fleck
    • Larry D. Field
    Cited in Scopus: 3
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    Pathologic changes to the biceps tendon including subluxation are frequently encountered in patients with subscapularis tears. Operatively managing these combined lesions can be difficult depending on the status of the subscapularis tendon and the degree of biceps medialization. The presented technique is an effective and relatively simple method that simultaneously and efficiently provides for secure tenodesis of the biceps and fixation of subscapularis tendon detachment.
    Consolidated Proximal Biceps Tenodesis and Subscapularis Repair
  • Technical Note
    Open Access

    An All-Arthroscopic, Length-Tensioned Suprapectoral Biceps Tenodesis Technique

    Arthroscopy Techniques
    Vol. 6Issue 5e1599–e1605Published online: September 18, 2017
    • Allison J. Rao
    • Eamon Bernardoni
    • Nikhil Verma
    • Scott Trenhaile
    Cited in Scopus: 4
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    Biceps tenodesis remains a popular choice for treating anterior shoulder pain in the setting of primary biceps tendinitis or biceps pain due to concomitant glenohumeral joint pathology. A variety of surgical approaches and fixation construct options are available for biceps tenodesis. The advantages of an all-arthroscopic biceps tenodesis include anatomic maintenance of the length-tension relation with strength preservation and improved cosmetic results. This technique can be technically challenging but allows for a minimally invasive approach to anchor the biceps.
    An All-Arthroscopic, Length-Tensioned Suprapectoral Biceps Tenodesis Technique
  • Technical Note
    Open Access

    Mini-open Subpectoral Biceps Tenodesis Using a Suture Anchor

    Arthroscopy Techniques
    Vol. 6Issue 5e1625–e1631Published online: September 18, 2017
    • Christopher Arena
    • Aman Dhawan
    Cited in Scopus: 15
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    The long head of the biceps (LHB) tendon is a potential source of shoulder pain encountered by orthopaedic surgeons. A multitude of approaches to addressing LHB tendinopathy have been described. These include various surgical techniques such as tenodesis versus tenotomy, an arthroscopic versus an open approach, and differing methods of tenodesis fixation. Our preferred approach to addressing LHB tendinopathy is through a mini-open approach using a double-loaded 4.5-mm suture anchor. This Technical Note with accompanying video describes our technique for performing this procedure, as well as supporting clinical evidence and technical pearls.
    Mini-open Subpectoral Biceps Tenodesis Using a Suture Anchor
  • Technical Note
    Open Access

    Identifying and Exposing the Proximal Biceps in Its Groove: The “Slit” Technique

    Arthroscopy Techniques
    Vol. 6Issue 4e1285–e1290Published online: August 14, 2017
    • Mathew J. Mazoch
    • Wesley F. Frevert
    • Larry D. Field
    Cited in Scopus: 1
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    Proximal biceps tendon pathology is a common source of shoulder symptoms. Thus, visualization of the entire extent of the biceps tendon is often required for both diagnostic and therapeutic purposes. Accurately recognizing the presence and extent of biceps pathology intraoperatively is made more difficult, however, due to the extra-articular location of a significant portion of the biceps tendon as it courses within the bicipital groove. Unfortunately, identification of the biceps groove in the subacromial space is often challenging due to the lack of visual and tactile landmarks.
    Identifying and Exposing the Proximal Biceps in Its Groove: The “Slit” Technique
  • Technical Note
    Open Access

    Arthroscopic Repair of a Circumferential 360° Labral Tear

    Arthroscopy Techniques
    Vol. 6Issue 4e1131–e1136Published online: July 31, 2017
    • Allison J. Rao
    • Gregory L. Cvetanovich
    • William A. Zuke
    • Quentin Low
    • Brian Forsythe
    Cited in Scopus: 4
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    Injuries to the glenoid labrum can result in shoulder instability and pain. These lesions may occur anywhere around the glenoid labrum, and thus, the arthroscopist must be prepared to approach all aspects of the glenoid from multiple angles. The pan-labral or circumferential (360°) tear of the glenoid labrum presents a unique challenge to even the experienced arthroscopist. The extent of the lesion requires the use of accessory portals and percutaneous techniques to establish adequate visualization and to facilitate the proper trajectory for anchor placement.
    Arthroscopic Repair of a Circumferential 360° Labral Tear
  • Technical Note
    Open Access

    Biceps Tenodesis: Anatomic Tensioning

    Arthroscopy Techniques
    Vol. 6Issue 4e1125–e1129Published online: July 24, 2017
    • Matthew A. Tao
    • Jacob G. Calcei
    • Samuel A. Taylor
    Cited in Scopus: 7
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    Biceps tenodesis is a commonly employed surgical intervention for refractory symptoms related to the biceps-labral complex, those intra-articular and those within the extra-articular bicipital tunnel. While a litany of surgical techniques exists, the optimal method for ensuring an anatomic length-tension relationship during tenodesis remains elusive. Appropriate tensioning may limit undesirable outcomes such as cramping or cosmetic deformity. We describe herein our technique as a simple and efficient means to establish patient-specific, anatomic tensioning of the long head of the biceps during tenodesis.
    Biceps Tenodesis: Anatomic Tensioning
  • Technical Note
    Open Access

    Subpectoral Biceps Tenodesis Using an Expanding PEEK Device

    Arthroscopy Techniques
    Vol. 6Issue 4e1041–e1048Published online: July 17, 2017
    • Joseph C. Tauro
    • Matthew Moralle
    • Stephen Iacono
    Cited in Scopus: 0
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    In this Technical Note, we describe a method of mini-open long head biceps subpectoral tenodesis. The implant used is a threadless expanding PEEK (polyether ether ketone) interference device that fixes the biceps tendon in a drill hole in the humerus under the inferior border of the pectoralis major tendon. The diameter of the drill hole varies between 6 and 8 mm depending on the width of the tendon. The procedure can be performed through a 3-cm incision centered on the inferior border of the pectoralis tendon.
    Subpectoral Biceps Tenodesis Using an Expanding PEEK Device
  • Technical Note
    Open Access

    Long Biceps Subpectoral Tenodesis With Suspensory Button and Bicortical Fixation

    Arthroscopy Techniques
    Vol. 6Issue 4e1049–e1055Published online: July 17, 2017
    • Nuno Gomes
    • Manuel Ribeiro da Silva
    • Helder Pereira
    • Ricardo Aido
    • Ricardo Sampaio
    Cited in Scopus: 4
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    Tenodesis of the long head of the biceps (LHB) tendon has long been recognized as a valid alternative to address pathologic conditions of this tendon. However, the location and type of fixation is still a matter of discussion, because common complications associated with this procedure include failure of the repair, persistent pain, reaction to the fixation device, cosmetic deformity, and fracture. The authors describe a method of subpectoral LHB tenodesis that aims to preserve bone stock and allows a strong, easy, and reproducible type of fixation with a minimal approach.
    Long Biceps Subpectoral Tenodesis With Suspensory Button and Bicortical Fixation
  • Technical Note
    Open Access

    Arthroscopic Transtendinous Biceps Tenodesis With All-Suture Anchor

    Arthroscopy Techniques
    Vol. 6Issue 3e705–e709Published online: June 5, 2017
    • Chien-An Shih
    • Florence L. Chiang
    • Chih-Kai Hong
    • Cheng-Wei Lin
    • Ping-Hui Wang
    • I-Ming Jou
    • and others
    Cited in Scopus: 8
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    There are several methods for long head of the biceps (LHB) tenodesis, yet the optimal option is still debatable. Here we introduce a technique for arthroscopic suprapectoral biceps tenodesis with an all-suture anchor, the transtendinous biceps tenodesis technique. The LHB tenodesis is performed by using the Y-Knot anchor (1.3-mm). A standard suprapectoral approach is used for the tenodesis. A 1.3-mm drill bit is used to drill through the midportion of the biceps tendon and underlying bone to make a pilot hole.
    Arthroscopic Transtendinous Biceps Tenodesis With All-Suture Anchor
  • Technical Note
    Open Access

    A Modification of the Active Compression Test for the Shoulder Biceps-Labrum Complex

    Arthroscopy Techniques
    Vol. 6Issue 3e859–e862Published online: June 26, 2017
    • Ekaterina Urch
    • Samuel A. Taylor
    • Helen Zitkovsky
    • Stephen J. O'Brien
    • Joshua S. Dines
    • David M. Dines
    Cited in Scopus: 4
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    The active compression test (O'Brien Sign) is widely used by physicians to aid in the diagnosis of biceps-labrum complex disease. This maneuver has been particularly criticized in the literature, however, with regard to interobserver reliability. Criticisms may in fact stem from inaccurate and inconsistent practice of the examination maneuver, stemming from both patient- and physician-related errors. In this Technical Note, we introduce an easy modification to the O'Brien Sign that limits such errors and improves test uniformity.
    A Modification of the Active Compression Test for the Shoulder Biceps-Labrum Complex
  • Technical Note
    Open Access

    A Simple, All-Arthroscopic, Knotless Suture Lasso Loop Technique for Suprapectoral Biceps Tenodesis

    Arthroscopy Techniques
    Vol. 6Issue 3e635–e639Published online: May 22, 2017
    • David Saper
    • Xinning Li
    Cited in Scopus: 5
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    A variety of pathology of the long head of the biceps tendon can contribute to anterior shoulder pain in adults that can be managed with either arthroscopic tenotomy or tenodesis when conservative treatment fails. Biceps deformity or the Popeye sign is a major concern in patients after tenotomy. Biceps tenodesis can be performed in a variety of ways with different sized anchors and at different locations (suprapectoral or subpectoral). Several studies have shown that patient outcomes and complication rates are similar between all-arthroscopic suprapectoral biceps tenodesis and open subpectoral biceps tenodesis.
    A Simple, All-Arthroscopic, Knotless Suture Lasso Loop Technique for Suprapectoral Biceps Tenodesis
  • Technical Note
    Open Access

    The Wiese Knot: A Sliding-Locking Arthroscopic Knot

    Arthroscopy Techniques
    Vol. 6Issue 1e21–e24Published online: January 2, 2017
    • Stephen A. Parada
    • K. Aaron Shaw
    • Josef K. Eichinger
    • Nathan T. Boykin
    • David M. Gloystein
    • Cheryl L. Ledford
    • and others
    Cited in Scopus: 4
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    Despite recent advances in knotless suture devices for arthroscopic surgical procedures, arthroscopic knot tying remains a necessary skill for the arthroscopic surgeon. Successful completion of arthroscopic knot tying relies on a thorough understanding of the chosen technique, proper suture management, adequate knot tensioning and securement, and the ability to reproducibly create the knot. We introduce a technique that serves as both a sliding and locking knot while being simple to master and reproducible to perform.
    The Wiese Knot: A Sliding-Locking Arthroscopic Knot
  • Technical Note
    Open Access

    Biceps Tenoscopy: Arthroscopic Evaluation of the Extra-articular Portion of the Long Head of Biceps Tendon

    Arthroscopy Techniques
    Vol. 5Issue 6e1461–e1465Published online: December 19, 2016
    • Adnan Saithna
    • Alison Longo
    • Jeff Leiter
    • Peter MacDonald
    • Jason Old
    Cited in Scopus: 6
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    The recent literature shows that imaging modalities, physical examination tests, and glenohumeral arthroscopy all have low sensitivities and specificities with respect to the diagnosis of the long head of biceps tendon pathology. Biceps tenoscopy is a strategy that aims to reduce the rate of missed diagnoses by improving visualization of the extra-articular part of the tendon. This is an area of predilection of pathology that is not adequately visualized with conventional arthroscopic techniques.
    Biceps Tenoscopy: Arthroscopic Evaluation of the Extra-articular Portion of the Long Head of Biceps Tendon
  • Technical Note
    Open Access

    Bridge Tenodesis: A Secure Fixation Technique for Biceps Long Head Tendinopathy During Arthroscopic Rotator Cuff Repair Using a Suture-Bridge Technique

    Arthroscopy Techniques
    Vol. 5Issue 5e1077–e1081Published online: September 26, 2016
    • Jin-Young Park
    • Jae-Hyung Lee
    • Kyung-Soo Oh
    • Seok-Won Chung
    • Jin-Young Bang
    • Young-Min Noh
    Cited in Scopus: 4
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    Tendinopathy of the long head of the biceps is often found as an intra-articular pathology in the glenohumeral joint. Because long head of the biceps lesions are common, surgical intervention to properly manage the long head of the biceps has become an important issue. Both tenodesis and tenotomy have been shown to provide benefits in biceps long head tendinopathy. But because of concerns about muscle power reduction, cramping, and “Popeye's deformity,” which may result from biceps tenotomy, biceps tenodesis is a good option for treating biceps lesions.
    Bridge Tenodesis: A Secure Fixation Technique for Biceps Long Head Tendinopathy During Arthroscopic Rotator Cuff Repair Using a Suture-Bridge Technique
  • Technical Note
    Open Access

    Reverse Flipping Technique: An Alternate Approach to Tie Reversing Half-Hitches on Alternating Posts

    Arthroscopy Techniques
    Vol. 5Issue 2e403–e405Published online: April 25, 2016
    • Alexander C.M. Chong
    • Daniel J. Prohaska
    • Ryan C. Pate
    Cited in Scopus: 3
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    Arthroscopic knot tying requires practice and attention to detail, especially tying the 3 reversing half-hitches on alternating posts (RHAPs) in a knot. Mistakes can occur that result in an unintentional tension (>10 N) applied to the wrapping suture limb, and by placing tension in the wrong limb, the previously “flipped” half-hitch is converted from a series of RHAPs into a series of identical half-hitches on the same post, thereby producing insecure knots or suture loops. This was hypothesized to be a source of knot failure by knot slippage.
    Reverse Flipping Technique: An Alternate Approach to Tie Reversing Half-Hitches on Alternating Posts
  • Technical Note
    Open Access

    Tenoscopic Suprapectoral Biceps Tenodesis

    Arthroscopy Techniques
    Vol. 5Issue 1e55–e62Published online: January 18, 2016
    • Dirk Maier
    • Kaywan Izadpanah
    • Martin Jaeger
    • Peter Ogon
    • Norbert P. Südkamp
    Cited in Scopus: 4
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    Existing arthroscopic techniques of proximal biceps tenodesis may be complicated by difficulty of tendon identification, restoration of length-tension relation, cosmetic deformity, persistent biceps pain, and shoulder stiffness requiring surgical revision in a relevant proportion of cases. In this context, biceps tenoscopy, an emerging discipline of shoulder endoscopy, offers major benefits. Tenoscopy comprises endoscopic treatment of tendons and tendon sheaths. The presented technique of tenoscopic suprapectoral biceps tenodesis (TSBT) substantially facilitates tendon identification and reduces invasiveness by avoidance of unnecessary surgical involvement of the deltoid space and bursa.
    Tenoscopic Suprapectoral Biceps Tenodesis
  • Technical Note
    Open Access

    A Percutaneous Knotless Technique for SLAP Repair

    Arthroscopy Techniques
    Vol. 5Issue 1e33–e35Published online: January 11, 2016
    • Duncan Tennent
    • Eyiyemi Pearse
    Cited in Scopus: 1
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    We describe a percutaneous technique for repair of type II SLAP lesions. Through the Neviaser portal, a spinal needle is used to pass a FiberStick suture (Arthrex, Naples, FL) through the labrum to create 2 mattress sutures that are secured with PushLock anchors (Arthrex). This technique is simple, reproducible, and knotless and requires no cannulas. At the end of the procedure, minimal suture material remains in the joint.
    A Percutaneous Knotless Technique for SLAP Repair
  • Technical Note
    Open Access

    All-Arthroscopic Suprapectoral Biceps Tenodesis

    Arthroscopy Techniques
    Vol. 4Issue 6e855–e861Published online: December 21, 2015
    • Rueben Nair
    • Cynthia A. Kahlenberg
    • Ronak M. Patel
    • Michael Knesek
    • Michael A. Terry
    Cited in Scopus: 8
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    Biceps tenodesis is a common treatment for pathology of the long head of the biceps tendon. Several authors have described various arthroscopic and open techniques for biceps tenodesis. Open techniques have been associated with complications such as wound infection and nerve injury. Previously described arthroscopic techniques have placed the tenodesis site within the bicipital groove, which may lead to persistent pain. We describe an all-arthroscopic suprapectoral biceps tenodesis technique that places the tenodesis site distal to the bicipital groove.
    All-Arthroscopic Suprapectoral Biceps Tenodesis
  • Technical Note
    Open Access

    Simplified Knotless Mattress Repair of Type II SLAP Lesions

    Arthroscopy Techniques
    Vol. 4Issue 6e763–e767Published online: November 30, 2015
    • Marcus Robert Chia
    • Cameron Hatrick
    Cited in Scopus: 2
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    Arthroscopic repair of lesions of the superior labrum and biceps anchor has been shown to provide good to excellent results. We describe a simplified arthroscopic surgical technique using a single knotless anchor with a mattress suture configuration. This technique provides an effective and reproducible method to reattach and re-create the normal appearance of the superior labrum and biceps anchor in a time-efficient manner without the need for knot tying.
    Simplified Knotless Mattress Repair of Type II SLAP Lesions
  • Technical Note
    Open Access

    The Double-Pulley Anatomic Technique for Type II SLAP Lesion Repair

    Arthroscopy Techniques
    Vol. 4Issue 5e545–e550Published online: October 12, 2015
    • Nata Parnes
    • Mario Ciani
    • Brian Carr
    • Paul Carey
    Cited in Scopus: 6
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    The annual incidence and number of repairs of SLAP lesions in the United States are constantly increasing. Surgical repairs of type II SLAP lesions have overall good success rates. However, a low satisfaction rate and low rate of return to preinjury level of play remain a challenge with elite overhead and throwing athletes. Recent anatomic studies suggest that current surgical techniques over-tension the biceps anchor and the superior labrum. These studies suggest that restoration of the normal anatomy will improve clinical outcomes and sports performance.
    The Double-Pulley Anatomic Technique for Type II SLAP Lesion Repair
  • Technical Note
    Open Access

    A Knotless Labro-Bicipital Repair Technique for SLAP Lesions

    Arthroscopy Techniques
    Vol. 4Issue 5e493–e497Published online: September 28, 2015
    • Özgür Koyuncu
    • Ilker Eren
    • Aksel Seyahi
    • Serkan Uludag
    • Mehmet Demirhan
    Cited in Scopus: 3
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    Fixation methods for SLAP lesions are still controversial, and the strength of the fixation, suture and knot irritation, and placement and number of anchors are still being discussed. This uncertainty is directly related to the function and anatomy of the superior labrum and attached biceps. Knotless fixation methods close to the biceps anchorage at the 12-o'clock position are favored in recent literature. We describe a practical SLAP repair technique, with a mattress configuration through the biceps anchorage, using a single knotless anchor.
    A Knotless Labro-Bicipital Repair Technique for SLAP Lesions
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