Dr. Garcia demonstrates his technique for arthroscopic biceps tenodesis.

In this video, Dr. Grant Garcia demonstrates his precise surgical technique for an all-arthroscopic biceps tenodesis. Similar to an open subpectoral approach, this procedure treats severe biceps tendonitis, tearing, or instability by detaching the long head of the biceps tendon from the shoulder joint and anchoring it lower down into a bone socket. However, this variation is performed entirely through minimally invasive arthroscopic portals without an open skin incision.

The procedure is broken down into the following key surgical stages:

• Tendon Mobilization and Harvest: Working through an anterolateral portal equipped with a flexible Passport cannula, Dr. Garcia uses a Kingfisher suture retriever to pull the long head of the biceps tendon out of its anatomical groove. To pull a maximum length of tendon outside the joint for easy manipulation, the patient's arm is placed into significant abduction (moved away from the body) and forward flexion.
• Tendon Preparation & Suture Weaving: The surgeon trims away any heavily frayed, degenerated portions of the proximal tendon. He then weaves a heavy suture tape loop up and down through the robust tissue to establish a solid handle on the tendon. Dr. Garcia notes that careful tension calculation is critical here to avoid over-tensioning the muscle belly, which can alter the patient's natural "Popeye" muscle contour or cause cramping.
• Groove and Socket Reaming: The Passport cannula is repositioned, and focus shifts to preparing the surgical site within the bicipital groove. Dr. Garcia drills a central guide wire into the groove to a depth of roughly 25 millimeters. He then uses a 6.5 mm surgical reamer over the guide wire to drill a bone socket roughly 20 millimeters deep. A combination of a shaver and a radiofrequency (RF) wand clears away internal bone fragments and soft debris.
• Knotless Interference Fixation: The prepared tendon tip and the loose suture tape limbs are loaded directly onto the tip of a 6.25 mm SwivelLock anchor. The anchor is driven down straight into the prepared bone socket, creating a high-strength interference fit. This hardware mechanically wedges the tendon flat against the raw bone walls of the socket to facilitate bone-to-tendon integration.

Once the anchor is fully seated, the traction lines are released, and Dr. Garcia uses an arthroscopic probe to manually check the construct, confirming a highly rigid, biomechanically stable fixation under physical tension.