Modified Open Suprapectoral EndoButton Tension Slide Tenodesis Technique of Long Head of Biceps with Restored Tendon Tension–Length

Background: The vast majority of biceps tendon ruptures occurs at the proximal insertion and almost always involves the long head. There are several options for long head of biceps (LHB) tenodesis with advantage and disadvantages of each technique. We believe that the suprapectoral LHB tenodesis described in this article enables the restoration of the anatomic length-tension relation in a technically reproducible manner, when following the guidelines set forth in this article, and restores biceps contour and function adequately with a low risk of complications. Method: We present a case of a young man who had a sudden jerk of his flexed right elbow, while involved in water skiing sports and sustained complete rupture of proximal end of long head of biceps tendon. In this article, we describe a modified surgical technique of open supra-pectoral long head of biceps tenodesis using an EndoButton tension slide technique, reproducing an anatomic length-tension relationship. Results: By the end of one year, patient regained symmetrical muscle bulk, shape and contour of biceps compared to other side. There were no signs of dislodgement or loosening of the EndoButton on follow-up radiographs. He regained full muscle power in the biceps without any possible complications, such as humeral fracture, infection, or nerve injury, associated with this technique. Conclusion: This technique is a safe, easy to reproduce, cost-effective, less time consuming and an effective method that uses a small drill hole, conserving bone, minimizing trauma to the tendon, and decreasing postoperative complications. It does not need any special instrumentation and is suitable especially for use in centers where arthroscopy facility or training is not available.