With both sutures pulling distally, the biceps stump is directed into the central hole and advanced distally into the medullary canal. With the patient's elbow in full extension, the end of one limb of the lead suture is passed with a free needle through the overlying biceps tendon and tied to the other strand, locking the tendon in position. The fixation is tested by pulling distally on the biceps tendon. It should be noted that, with proper tension, the marker suture placed in the tendon should be at the level of the central hole in the upper portion of the groove. This ensures that the resting length of the biceps tendon remains physiologic.
Full activity is delayed for three months to allow for the tenodesis to mature.
The suture Shuttle Relay tm consists of a twisted wire core 30 inches long with a nylon coating. There is a I cm eyelet in the center of the Shuttle formed by removing a segment of the nylon covering and spreading the wire core. The Shuttle Relay allows the surgeon to pass any type of suture material using any of the conventional arthroscopic suture passing instruments, such as the slotted-jaw suture punch or suture hook, which previously only allowed use of monofilament sutures.