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LIFESTYLE

Shoulder Surgery with:

1.2. Y Shape Biceps Tenotomy (physiologic tenodesis)

The decision to perform Y-shaped tenotomy is based on patient
factors and associated pathology and doesńt differ from

indications for classic biceps tenotomy. Once the decision is
made, the biceps anchor is prepared by using an arthroscopic
radiofrequency device to dissect a portion of the anterior-

superior and posterior-superior labrum off of the superior
glenoid tubercle in continuity with the biceps tendon. This is

performed by starting with the anterior-superior labrum, using
the radiofrequency device to dissect both under the labrum

where a superior labrum, anterior to posterior (SLAP) tear would
occur and then posterior to the biceps anchor as well. The

dissection is continued laterally until a “Y” is formed between
the LHB and the two limbs of the labrum. This essentially

creates a complete dissection of the superior labrum that stays
connected with the LHB. This “Y” morphology locks the stump
of the biceps in the entry of the biceps groove and prevents it 03

from displacing distally in the bicipital groove.

This obviously is not meant to recreate a true tenodesis, but 2.1. Minimally invasive, rotator cuff sparing
in our follow-up, it creates a cosmetic appearance which is technique (2)

improved to that of the simple tenotomy, usually resulting in a The mainstay of this technique is basically to accomplish the
one centimeter or less asymmetry in the proximal position of the entire procedure through the rotator interval without violate

biceps when compared to the contralateral side.
any of the rotator cuff tendons and to have unrestricted
postoperative rehabilitation. This technique can be performed
We have not found that debriding this superior aspect of the
labrum is detrimental in any way to the patient clinically and there via superior (transdeltoid) approach or using the classic
deltopectoral.
have been no reported cased of post-operative instability noted;
this looks logical as there is no ligament attachement at the In the case of a large inferior osteophyte, we favor the
deltopectoral approach in order to have a better access to
upper part of the glenoid. This new technique is an alternative
to either biceps tenotomy or tenodesis in the appropriate setting the inferior part of the humeral head. In the case of posterior
and offers the benefit of a cosmetic appearance with minimal glenoid tilt in type B1 and B2 glenoids, we prefer the superior

operative time and without the need of additional implants there approach in order to be facing the glenoid.
by reducing operating costs; the quality of care delivered is
The ideal candidates are:
maintained and there is no delay in the rehabilitation process • Mild to moderate primary glenohumeral osteoarthritis
secondary to this technical gesture.
• Intact rotator cuff

2. Management of the Subscapularis tendon • Mobile glenohumeral joint
during Anatomic Shoulder Replacement
The technique is generally contraindicated in patients with
Total shoulder arthroplasty [TSA] in selected patients with an gross glenohumeral deformity or immobile joints, as frequent
intact rotator cuff, remains the gold standard for treatment
position changes of the arm are needed to facilitate access
of osteoarthritis, rheumatoid arthritis, fractures sequelae and via the superior and inferior “windows”. Revisions, obese
avascular necrosis. It provides predictable pain relief with and/or very muscular patients are relative contraindications. If

proven good to excellent long term functional outcomes; needed, at any stage, the procedure can be easily converted
with classic deltopectoral approach subscapularis tenotomy to the traditional technique via subscapularis detachment.

or osteotomy is generally performed; as a result we have to
be cautious in the postoperative care for the first 6 weeks to
protect the repair. Non healing of the subscapularis tendon “... now, when I operate

has long been recognised as a potential source of poor patient
outcomes and often, when it occurs, is an indication for early I have in my mind, ‘what

repair or revision surgery.
would Laurent do next ?’,

To avoid this complication associated with failure, several and this always helps me
techniques have been developed, including lesser tuberosity

osteotomy rather than tenotomy; trans-acromial, trans- through difficult surgical
supraspinatus approaches; Below we described in detail our
situations”
variants of two other surgical options focused in maximize
subscapularis tendon healing or preservation (Figure 3).
–Simon Fogerty

12 ISAKOS NEWSLETTER 2014: Volume II