I just want to say that the only thing in my practice that's 11 on 10 is my home EV system, so. Thank you, Rick. May I have my video on? All of us know that the biceps tendon is the main pain generator of the shoulder. So, in this case, it's the biceps. So, if we fix the biceps, we'll do great. This is my financial disclosure, which is the AAOS website. It's a pleasure, and thank you, Michael and Sachin, for the opportunity to discuss these cases with Joe and with Rick Ryu. Rick is always the kingpin. If we focus in this case, these pictures are of this case, precisely. You can see this. He's 40 years old, heavy duty. He has fluid at the bicipital groove, and with regards to the calf tear, it's a very partial calf tear, interstitial, grade one. So, in the rotator calf like this, less is more, and PRP or BMAC is more than enough for this calf tear. The issue is the biceps need the further evaluation, the dynamic bicep evaluation with ultrasound, and maybe, as you see on the left side of the screen, an infiltration to really know where the pain comes from. We operate this patient in B chair position. We use four portals. In these cases where you only have a partial calf tear, you need to open the rotator interval in order to identify the bicep from above, and you need to release the biceps all the way down to the pectoralis major tendon. That is pretty easy. You need to stay lateral to avoid bleeding. Usually, we use a loop around the biceps tendon and then penetrate the tendon, the loop, and then penetrate the tendon and grab the suture from below the tendon and deliver a knotless anchor for this loop and tuck technique. I think that the weak link of this bicep fixation is the tendon. So, the anchor has an extra additional suture, and we perform a lasso loop. We penetrate the tendon with this renal and then make a loop and grab the suture inside the loop. So, we mix an American technique, the loop and tuck, and a French technique, the lasso loop, to perform this double row bicep stenodesis. But for winning this battle, I would like to show you a technique without any anchor and without any immobilization needed. We deliver two cinches through the tendon. We do the same technique that we do in any shoulder prosthesis. Then we deliver these sutures behind the co-joint tendon, and the idea is to do the stenodesis of the long head of the bicep to the short head of the biceps and co-joint tendon. After delivering the sutures behind the co-joint tendon, this is a two-hand technique. We can see the four sutures in a matrix configuration in the co-joint tendon. We have no problem with the length, no problem with the tension of the tendon, and we proceed to the tenotomy of the tendon at the right near the labrum. And as you can see here, the short and the long biceps tendon are working together without any need of immobilization and any need of any anchor. For practice this technique, please join us in the Knee and Shoulder Cadaver Lab next April in Florida, and for sure definitely in Munich next year. Thank you so much.

biceps tendon

shoulder pain

biceps tenodesis

ultrasound evaluation

surgical procedure