title: The low-anterolateral portal for arthroscopic biceps tenodesis: description of technique and cadaveric study.
abstract: OBJECTIVE
  Arthroscopic biceps tenodesis surgery is an important procedure for the correction of biceps tendonitis or in conjunction with rotator cuff repair with biceps symptoms. Recent trends have developed in placing the biceps tendon lower in the bicipital groove for a tenodesis. However, a more distal biceps tenodesis location is technically challenging when carried out arthroscopically with standard posterior and lateral portals. We aimed to establish the safety of a low-anterolateral portal location for direct access to the lowest aspect of the bicipital groove.
  
  
  METHODS
  An anatomical study design was used to examine portal to neurovascular structural measurements in 23 cadaveric shoulders. These shoulders had undergone low-anterolateral portal placement over the inferior most aspect of the bicipital groove as determined by palpation and direct arthroscopic visualization. No arthroscopic irrigation was performed. Following this, the shoulders underwent open dissection with the cannula in place to evaluate for any potential damage to any portion of the axillary nerve.
  
  
  RESULTS
  All of the resultant portals in this study provided direct access to the inferior most aspect of the bicipital groove, and the dissection revealed that the portal was touching a small distal axillary nerve branch on the undersurface of the anterior deltoid in nearly half of the shoulders.
  
  
  CONCLUSIONS
  The placement of a low-anterolateral portal for arthroscopic biceps tenodesis at the distal bicipital groove does not produce significant neurovascular damage; the portal trajectory comes close to distal anterior branches of the axillary nerve. Given these findings, this portal should be placed bluntly to best protect these underlying neurovascular structures.
authors: Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Ave S #R200, Minneapolis, MN, 55454, USA.
authors: Michael L
authors: ML
authors: Knudsen
authors: Jason C
authors: JC
authors: Hibbard
authors: David J
authors: DJ
authors: Nuckley
authors: Jonathan P
authors: JP
authors: Braman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply / Q000294:innervation / Q000601:surgery; D012785:Shoulder Joint / Q000098:blood supply / Q000294:innervation / Q000601:surgery*; D052256:Tendinopathy / Q000601:surgery*; D053656:Tenodesis / Q000295:instrumentation / Q000379:methods*
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