Arthroscopic assisted mini-open biceps tenodesis: surgical technique

Biomechanical Evaluation of Humerus Fracture After Subpectoral Biceps Tenodesis With Interference Screw Versus Unicortical Button

PURPOSE

To compare the torsional failure strength of the humerus after subpectoral biceps tenodesis with an interference screw versus a unicortical button in a human cadaveric model.

METHODS

Thirteen matched pairs of fresh-frozen human cadaveric upper extremities were randomized to receive either 2.6 × 12 mm unicortical button or 6.25-mm interference screw subpectoral biceps tenodesis. After the procedure, the humeri were loaded into a materials testing machine. The humeri were loaded in external rotation with respect to the elbow at 1.0°/s until failure. Rotation angle to failure, failure torque, energy absorbed, and stiffness were compared by paired t-tests with alpha set at 0.05.

RESULTS

Humeri that were fixed with unicortical buttons showed statistically significant higher rotation to failure (26.87 ± 5.83 vs 19.04 ± 3.86°, P < .001), failure torque (54.11 ± 22.01 vs 44.95 ± 17.47 Nm, P < .001), and energy absorbed (883.93 ± 582.28 vs 451.40 ± 216.19 Nm-Deg, P = .002) than humeri fixed with interference screws.

CONCLUSIONS

In a cadaveric biomechanical model, at time 0, the use of a 2.7 × 12-mm unicortical button fixation in biceps tenodesis resulted in higher loads required to fracture the humerus when compared with a 6.25-mm interference screw fixation in a torsion model.

CLINICAL RELEVANCE

This study demonstrates a significant biomechanical difference with regards to fracture of the humerus, between 2 commonly used fixations methods and implant sizes, interference screw, and unicortical button. The results of this study can aid surgeons in implant selection as well as help to improve patient education prior to surgery.

The new LassoLoop360° technique for biomechanically superior tissue grip

PURPOSE

Suprapectoral tenodesis is a frequently used technique for treating pathologies of the long head of the biceps brachii (LHBB) tendon. However, so far, no Gold Standard treatment exist. Hence, the arthroscopic LassoLoop360 (LL360) technique is introduced aiming to provide secure fixation and improved biomechanical properties. It was hypothesized, that the LL360 technique would show superior biomechanical response to cyclic loading and ultimate load-to-failure testing compared to the commonly used simple Lasso Loop (SLL).

METHODS

Twenty-two porcine superficial flexor digitorum tendons were prepared using a No. 2 suture according to either the SLL or the LL360 technique. Displacement after cyclic loading (1.000 cycles) between 5 and 30 N, ultimate load-to-failure (ULTF), mode of failure as well as the construct stiffness were tested.

RESULTS

Significantly less displacement was found in the LL360 group (SLL 2.25 ± 0.51 mm; LL360 1.67 ± 0.37 mm; p = 0.01). Ultimate Load to Failure was significantly higher in the LL360 (168.6 ± 29.6 N) as compared to the SLL (124.1 ± 25.8 N, p = 0.02). The LL360 also revealed a significant higher stiffness compared to the SLL (SLL 13.1 ± 0.9 N/mm vs. LL360 19.1 ± 1.0 N/mm, p < 0.001). The most common mode of failure was the suture cutting through the tendon, with a significantly less suture cutting through for the LL360 compared with the SLL (p < 0.05).

CONCLUSION

The LassoLoop360-technique offers superior biomechanical characteristics regarding the tendon-suture-interface compared to the SLL. In the initial healing phase, the suture-tendon-interface is the most vulnerable part of the tendon-suture-anchor construct, the aim of this new technique is to reduce this weakest part of the chain (Ponce et al., Am J Sports Med 39:188-194, 2011). This technique may therefore be beneficial for arthroscopic suprapectoral biceps tenodesis at the entrance of the bicipital groove.

Management of Biceps Tendon Pathology: From the Glenoid to the Radial Tuberosity

Management of proximal and distal biceps tendon pathology is evolving. The long head of the biceps tendon, if inflamed, may be a pain-producing structure. In appropriately indicated patients, a symptomatic long head of the biceps tendon can be surgically managed via tenotomy, tenodesis, and/or superior labrum anterior to posterior repair. In some patients, primary superior labrum anterior to posterior pathology can be managed via biceps tenodesis. Determining which procedure is most appropriate and which technique and implant are preferred for a given patient with biceps tendon pathology is controversial. Less debate exists with regard to the timing of distal biceps tendon repair; however, considerable controversy exists with regard to selection of an appropriate surgical technique and implant. In addition, the treatment of patients with a chronic and/or retracted distal biceps tendon tear and patients in whom distal biceps tendon repair fails is extremely challenging. Orthopaedic surgeons should understand the anatomy of, nonsurgical and surgical treatment options for, and outcomes of patients with proximal or distal biceps tendon pathology.

Identifying and Exposing the Proximal Biceps in Its Groove: The "Slit" Technique

Proximal biceps tendon pathology is a common source of shoulder symptoms. Thus, visualization of the entire extent of the biceps tendon is often required for both diagnostic and therapeutic purposes. Accurately recognizing the presence and extent of biceps pathology intraoperatively is made more difficult, however, due to the extra-articular location of a significant portion of the biceps tendon as it courses within the bicipital groove. Unfortunately, identification of the biceps groove in the subacromial space is often challenging due to the lack of visual and tactile landmarks. A technique that facilitates efficient and reliable bicipital groove identification and biceps tendon visualization along its entire course within the groove is presented.

Suprapectoral biceps tenodesis using a suture plate: clinical results after 2 years

PURPOSE

Several techniques for performing a tenodesis of the long head of biceps (LHB) are described. Only few outcome studies are published. This note describes a unicortical fixation via a suture plate-comparable to a distal biceps refixation-performed arthroscopically or mini-open via standard suprapectoral approach. The aim of this study is to show the clinical outcome after 6, 12, and 24 months.

MATERIALS AND METHODS

A consecutive series of 50 (35 male, 15 female) patients at the mean age of 49 years (range 23-75) who underwent tenodesis of the LHB were followed for 2 years. All patients were operated by a single surgeon (CS). The clinical evaluation included Constant score, Scheibel LHB score and VAS. Structural integrity of the tenodesis was checked by ultrasound control. Integrity of the tenodesis was evaluated indirectly by detecting the LHB-tendon up to the ultrasound-reflex of the button. No tendon at the button-reflex was considered as failure of the tenodesis. An independent examiner who was not the operating surgeon performed all evaluations. (MG evaluated the patients operated by CS).

RESULTS

Mean follow-up was 29.5 (range 22-32) months. The mean pre-operative Constant Murley score (CMS) was 67.4 points (range 45-78) and increased to 84.7 points (range 51-99) after 2 years. LHB Score was 90.8 after 24 months. We identified 2 failed biceps fixations (4%). Pain relief was achieved in most patients within the first 12 weeks. After 2 years, the mean biceps flexion strength averaged 84% of the healthy arm.

CONCLUSIONS

Tenodesis of the LHB with a unicortical suture plate is a safe fixation technique with good-to-excellent clinical results after a minimum follow-up of 2 years. Long-term follow-up is needed.

Biomechanical characterization of unicortical button fixation: a novel technique for proximal subpectoral biceps tenodesis

PURPOSE

Proximal biceps tenodesis is one method for treating biceps-related pain. Tenodesis protects the length-tension relationship of the biceps muscle, maintains strength, and provides a better cosmetic appearance than tenotomy. The purpose of this investigation was to compare the mechanical properties of a unicortical metal button and an interference screw in proximal biceps tenodesis.

METHODS

Six pairs of fresh-frozen shoulders were dissected, leaving the proximal biceps tendon as a free graft. On each pair of shoulders, a biceps tenodesis was performed using an interference screw or a unicortical metal button. The specimens were mounted and a cyclic load (10-60 N) was applied at 1 Hz for 200 cycles, followed by an axial load to failure. The displacement, ultimate load to failure, and mode of failure were recorded.

RESULTS

Displacement in response to cyclic loading was 3.7 ± 2.2 mm for the interference screw and 1.9 ± 1.0 mm for the cortical button (P = 0.03). Load at failure for the interference screw was 191 ± 64 N (stiffness: 24 ± 11 N/mm) and 183 ± 61 N (stiffness: 24 ± 7. N/mm) for the unicortical button (P = n.s. for both cases).

CONCLUSIONS

As a novel technique for subpectoral biceps tenodesis, a unicortical button demonstrated significantly less displacement in response to cyclic loading than the interference screw. The ultimate load to failure and stiffness for the two methods were not different. In this way, a unicortical button may provide a reliable alternative method of fixation with a potentially lower risk of post-operative humeral fracture and a construct that permits early mobilization following biceps tenodesis.

Arthroscopic suprapectoral and open subpectoral biceps tenodesis: a comparison of restoration of length-tension and mechanical strength between techniques

PURPOSE

This study aimed to (1) evaluate the ex vivo restoration of the long head biceps length-tension for both arthroscopic suprapectoral biceps tenodesis (ASPBT) and open subpectoral biceps tenodesis (OSPBT) techniques and (2) assess how location in the proximal humerus affects pullout strength for tenodesis using an interference screw implant.

METHODS

Eighteen matched cadaveric shoulders were randomized to OSPBT or ASPBT groups (9 each). Tenodesis was performed using clinical techniques. Preoperatively, a metallic bead was placed in the biceps tendon and a fluoroscopic image was obtained. Postoperatively, an image was obtained to evaluate the location of the tenodesis and the metallic bead and determine tensioning. Biomechanical load-to-failure testing was then performed.

RESULTS

The ASPBT technique resulted in an average of 2.15 ± 0.62 cm of biceps overtensioning compared with 0.78 ± 0.35 cm (P < .001) in the OSPBT group. The average load to failure in the ASPBT group was 138.8 ± 29.1 N compared with 197 ± 38.6 N (P = .002) in the OSPBT group. Failure caused by implant pullout was significantly more frequent in the ASPBT group (7 of 9) than in the OSPBT group (1 of 9).

CONCLUSIONS

The described ASPBT technique using an interference screw implant has the tendency to overtension the biceps and has a significantly decreased ultimate load to failure compared with an open subpectoral technique in matched cadaveric specimens.

CLINICAL RELEVANCE

This study shows differences in the biomechanical properties of OSPBT and ASPBT. Modification of currently published ASPBT techniques may be necessary to improve restoration of the physiological length-tension relationship of the biceps. Clinical studies may need to clarify if the lower ultimate load to failure for the ASPBT technique is clinically significant.

Suprapectoral biceps tenodesis: a biomechanical comparison of a new "soft anchor" tenodesis technique versus interference screw biceps tendon fixation

BACKGROUND

The interference screw technique is commonly used in tenodesis of the long head of the biceps for its well-documented robust fixation strength. Some complications may occur after tenodesis with interference screw such as persistent pain, bone fracture and cyst formation. A new technique using a small "soft anchor" has been proposed to avoid the risk of occurrence of the above-mentioned complications associated with the use of the interference screw. However, the proposed technique must provide adequate fixation strength. This study investigated the mechanical performance of the new technique and compared it with interference screw fixation.

METHODS

Fourteen human humeri and proximal biceps were tested after tenodesis using the two techniques. The fixation constructs were cycled 500 times between 20N and 100N at 1Hz to simulate some level of post-operative physical activity. Then, a tensile test to failure was performed to determine the strength of the two tenodesis constructs.

FINDINGS

The ultimate strength was 238N (SD 96N) and 172N (SD 58N) for the "soft anchor" and the interference screw, respectively (P=0.14). In two out of seven repetitions in both groups, failure occurred at low load level due to inaccuracies in performing tenodesis. Considering these cases as outliers, the strength values increased up to 290N (SD 40N) and 202N (SD 32N) for the "soft anchor" and the interference screw, respectively (P=0.02).

INTERPRETATION

The "soft anchor" technique provides a fixation strength comparable with the interference screw, but without using a screw. It could be considered as an alternative for suprapectoral biceps tenodesis.

Arthroscopic suprapectoral and open subpectoral biceps tenodesis: a comparison of minimum 2-year clinical outcomes

BACKGROUND

While a vast body of literature exists describing biceps tenodesis techniques and evaluating the biomechanical aspects of tenodesis locations or various implants, little literature presents useful clinical outcomes to guide surgeons in their decision to perform a particular method of tenodesis.

PURPOSE/HYPOTHESIS

To compare the clinical outcomes of open subpectoral biceps tenodesis (OSPBT) and arthroscopic suprapectoral biceps tenodesis (ASPBT). Our null hypothesis was that both methods would yield satisfactory results with regard to shoulder and biceps function, postoperative shoulder scores, pain relief, and complications.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Patients who underwent either ASPBT or OSPBT for isolated superior labrum or long head of the biceps lesions with a minimum follow-up of 2 years were evaluated with several validated clinical outcome measures and physical examinations including range of motion and strength.

RESULTS

Between 2007 and 2011, a total of 82 patients met all inclusion and exclusion criteria, which included 32 patients with ASPBT and 50 patients with OSPBT; 27 of 32 (84.4%) patients with ASPBT and 35 of 50 (70.0%) patients with OSPBT completed clinical follow-up. Overall outcomes for both procedures were satisfactory. No significant differences were noted in postoperative Constant-Murley (ASPBT: 90.7; OSPBT: 91.8; P = .755), American Shoulder and Elbow Surgeons (ASPBT: 90.1; OSPBT: 88.4; P = .735), Single Assessment Numeric Evaluation (ASPBT: 87.4; OSPBT: 86.8; P = .901), Simple Shoulder Test (ASPBT: 10.4; OSPBT: 10.6; P = .762), long head of the biceps (ASPBT: 91.6; OSPBT: 93.6; P = .481), or Veterans RAND 36-Item Health Survey (ASPBT: 81.0; OSPBT: 80.1; P = .789) scores. No significant range of motion or strength differences was noted between the procedures.

CONCLUSION

Both ASPBT and OSPBT yield excellent clinical and functional results for the management of isolated superior labrum or long head of the biceps lesions. No significant differences in clinical outcomes as determined by several validated outcome measures were found between the 2 tenodesis methods, nor were any significant range of motion or strength deficits noted at a minimum 2 years postoperatively.

Increased incidence of postoperative stiffness after arthroscopic compared with open biceps tenodesis

PURPOSE

To determine the incidence of postoperative stiffness after open and arthroscopic biceps tenodesis, compare the incidence between each method, and determine relevant risk factors for its occurrence.

METHODS

A consecutive series of patients who underwent biceps tenodesis during a 3-year period were retrospectively reviewed.

RESULTS

We evaluated 249 patients, which included 143 who underwent open subpectoral tenodesis and 106 who underwent arthroscopic suprapectoral tenodesis. The mean overall follow-up period for the arthroscopic group was 9.9 months (range, 5.1 to 33.5 months). The mean overall follow-up period for the open group was 9.5 months (range, 4.7 to 49.2 months). There was no significant difference in overall follow-up duration between groups (P = .627). A significantly increased incidence of postoperative stiffness was found in the arthroscopic group compared with the open group (17.9% v 5.6%, P = .002). Within the arthroscopic group, patients with postoperative stiffness were more frequently female patients than those without stiffness (63.2% v 33.3%, P = .016) and were more likely to be smokers than those without stiffness (36.8% v 16.1%, P = .040). The tenodesis site was located significantly more proximal in the arthroscopic group of patients with postoperative stiffness compared with patients without postoperative stiffness (32.44 ± 7.8 mm from the top of the humeral head v 50.34 ± 7.8 mm, P < .0001).

CONCLUSIONS

Our results show a notably increased incidence of postoperative stiffness after arthroscopic suprapectoral biceps tenodesis compared with open subpectoral biceps tenodesis. This appears to occur more commonly in female patients and smokers and may have a relation to the position of the tenodesis, with a more superiorly placed tenodesis site being a potential influencing factor. On the basis of this series, this complication most commonly will improve over time and with symptom-based management.

LEVEL OF EVIDENCE

Level III, therapeutic case-control study.

[Proximal and distal rupture of the m. biceps brachii]

Ruptures of the biceps tendon account for a high percentage of tendon ruptures. The aetiology of proximal ruptures of the long head of the biceps tendon is often degenerative and they are frequently associated with lesions of the rotator cuff. The clinical findings are often not specific and long lasting. Distal ruptures of the biceps tendon mostly occur during eccentric contraction of the biceps muscle.Clinical tests, the associated haematoma and a distalisation or proximalisation of the muscle belly in combination with ultrasound or MRI to rule out combined diseases lead to the diagnosis. The possible options include conservative and operative treatment. Tenotomy and tenodesis lead to comparable results in the literature. Therefore, conservative treatment is mostly recommended in proximal ruptures. Operative treatment is preferred in distal ruptures of the biceps tendon in order to achieve an anatomical reconstruction of the muscle function. Chronic ruptures of the distal biceps tendon can be successfully treated with free autografts or allografts.

Long head of the biceps tendon rupture in professional wrestlers: treatment with a mini-open tenodesis

BACKGROUND

The aim of this study is to assess the validity of a mini-open tenodesis of the long head of the biceps tendon (LHBT) performed on 5 professional wrestlers injured while fighting.

METHODS

Five professional wrestlers with an acute rupture of the LHBT were treated with a mini-open tenodesis procedure without arthroscopic assistance. This technique is performed with 2 miniscule incisions of the skin. The tendon is prepared with biological fibrin glue and with a No. 2 Fiberwire; after that, the tendon is sutured to the bicipital groove with a suture anchor. At the follow-up exam (average 7.6 years; range, 2-13), clinical assessments were obtained with the Constant score (CS) and Mayo Elbow Performance Score (MEPS). Forearm flexion strength was measured with a dynamometer, and a magnetic resonance image was also obtained.

RESULTS

At the follow-up, the average age of the patients was 32.6 years (range, 28-40). The average CS of the involved shoulder was 95 points (range, 92-98), compared to 97 points (range, 94-98) of the contralateral side (P = .37). The MEPS was 99.76 for the elbow of the involved side and 99.84 for the contralateral one (P = .34). No significant difference was noted for the forearm flexion strength (P = .31).

DISCUSSION

In this study, patients were all high-demand wrestlers and biceps tenodesis was mandatory. Mini-opening without arthroscopic assistance tenodesis of the long head of the bicep tendon to the bicipital groove has been used for these professional wrestlers. Functional and cosmetic results of this technique have been excellent, and it allowed athletes to return shortly to their sport activity.

Minimally invasive proximal biceps tenodesis: an anatomical study for optimal placement and safe surgical technique

BACKGROUND

An anatomic study specifically investigating the optimal location for proximal biceps tenodesis and detailing the topographic relationship to neurovascular structures has not been conducted.

METHODS

Twelve cadaveric upper extremities were dissected to identify the proximal biceps musculotendinous junction and topographic relationships to neighboring neurovascular structures.

RESULTS

The musculotendinous junction of the long head of the biceps tendon was on average 2.2 cm distal to the superior border and 3.1 cm proximal from the inferior border of the pectoralis major tendon. The musculocutaneous nerve was on average 2.6 cm medial to the long head of the biceps at the musculotendinous junction. The distance from the lesser tuberosity to the musculotendinous junction of the long head of the biceps averaged 5.4 cm. The distance from the anterior humeral circumflex vessels to the musculotendinous junction of the long head of the biceps was 4.6 cm on average. The distance from the musculotendinous junction of the long head of the biceps to the musculocutaneous nerve as it pierces the coracobrachialis was 4.6 cm.

CONCLUSION

In order to restore the appropriate length-tension relationship of the biceps muscle, proximal biceps tenodesis should possibly be placed closer to the superior border of the pectoralis major tendon than previously thought. The lesser tuberosity can be used as a tactile landmark for appropriate intraoperative placement. Although there is a relatively safe "buffer zone" between the location of the tenodesis and adjacent neurovascular structures, extreme caution must be used.

Biceps tenodesis with interference screw fixation: a biomechanical comparison of screw length and diameter

PURPOSE

To evaluate the effect of screw length and diameter on the mechanical properties of biceps tenodesis (BT) with an interference screw in 2 different locations (proximal and distal).

METHODS

We randomized 42 fresh-frozen human cadaveric shoulders (mean age, 65 ± 8 years) into 6 groups (n = 7): arthroscopic proximal BT using 7 × 15-, 7 × 25-, 8 × 15-, or 8 × 25-mm interference screws or distal subpectoral BT with 7 × 15- or 8 × 15-mm interference screws. Each repaired specimen was mounted onto a materials testing machine, preloaded to 5 N for 2 minutes, cycled from 5 to 70 N for 500 cycles (1 Hz), and loaded to failure (1 mm/s). Displacement during cyclical loading, pullout stiffness, and ultimate load to failure were computed, and the mechanism of failure was noted.

RESULTS

All failures occurred at the tendon-screw interface. There was no statistically significant difference in ultimate displacement among all groups in the ultimate load to failure, displacement at peak load, and stiffness.

CONCLUSIONS

There is no difference in ultimate load to failure, displacement at peak load, and stiffness of BT with regard to screw length or diameter at both proximal and distal tenodesis locations. These data would support use of a smaller-diameter and shorter implant for BT both proximally and distally.

CLINICAL RELEVANCE

The results may serve as a guide to the orthopaedic surgeon performing proximal BT in selecting the appropriate interference screw. When possible, we recommend using the smallest screw size available to minimize risk of stress fracture at the tenodesis site.

Interference screw versus suture anchor fixation for subpectoral tenodesis of the proximal biceps tendon: a cadaveric study

PURPOSE

The purpose of this study was to compare the biomechanical properties of 2 fixation methods for subpectoral proximal biceps tenodesis.

METHODS

In 9 matched pairs of cadaveric shoulders, an open subpectoral tenodesis was performed 1 cm proximal to the inferior border of the pectoralis major tendon by use of either an 8 x 12-mm Bio-Tenodesis screw (Arthrex, Naples, FL) with No. 2 FiberWire sutures (Arthrex) or a 5.5-mm Bio-Corkscrew double-loaded suture anchor (Arthrex) with No. 2 FiberWire sutures. The specimens were dissected and mounted in a material testing machine. Cyclic loading (20 to 60 N, 100 cycles, 0.5 mm/s, 5-N preload) was performed, followed by an unloaded 30-minute rest, a 5-N preload, and a load-to-failure protocol (1.25 mm/s) with a 100-lb load cell. Ultimate load (in Newtons), stiffness (in Newtons per millimeter), and modes of failure were recorded. Data were analyzed by use of paired t tests and Wilcoxon signed rank tests.

RESULTS

Proximal biceps tenodeses with Bio-Tenodesis screws had a significantly higher mean load to failure (169.6 +/- 50.5 N; range, 99.6 to 244.7 N) than those with Bio-Corkscrew suture anchors (68.5 +/- 33.0 N; range, 24.2 to 119.4 N) (P = .002). Bio-Tenodesis screws also had a significantly higher stiffness (34.1 +/- 9.0 N/mm; range, 20.6 to 48.9 N/mm) than Bio-Corkscrews (19.3 +/- 10.5; range, 5.9 to 32.9 N/mm) (P = .038).

CONCLUSIONS

In this cadaveric study the Bio-Tenodesis screw showed a statistically significantly higher load to failure and significantly higher stiffness than the Bio-Corkscrew anchor when used for tenodesis of the proximal biceps tendon in a subpectoral location.

CLINICAL RELEVANCE

Biomechanical comparison of these 2 fixation techniques provides information on stiffness and load to failure of alternate fixation methods.

Preventing the popeye deformity after release of the long head of the biceps tendon: an alternative technique and biomechanical evaluation

PURPOSE

The purpose of this biomechanical study is to compare the pullout strength of a traditional biceps release with an alternative method of releasing the biceps in which a portion of the superior labrum is included in the release.

METHODS

Five pairs of shoulders were arbitrarily separated into 2 groups: biceps tendons to be released "without labrum" or "with labrum." The biceps tendons of shoulders in the without-labrum group were released at the tendon-labrum junction. In the shoulders in the with-labrum group, the biceps was released with a portion of the superior labrum equal to twice the width of the biceps tendon and half the height of the superior labrum. The force required to pull the biceps tendon through the bicipital groove was then measured with a servohydraulic frame (858 Bionix; MTS Systems, Minneapolis, MN). The mean force required to pull the tendon out of the groove was compared by use of parametric and nonparametric statistical tests.

RESULTS

The mean force required to pull the tendon through the bicipital groove was 25.0 N (95% confidence interval, 8.8 to 41.1) in the without-labrum group and 73.2 N (95% confidence interval, 57.1 to 89.3) in the with-labrum group (P = .001 by paired t test and P = .042 by Wilcoxon signed-rank test).

CONCLUSIONS

Release of the biceps tendon with a portion of the superior labrum significantly increases the force required to pull the biceps tendon through the bicipital tunnel.

CLINICAL RELEVANCE

The described method of releasing the biceps tendon with some of the superior labrum may prevent complete biceps retraction and may result in fewer Popeye deformities after biceps release.

Interference screw vs. suture anchor fixation for open subpectoral biceps tenodesis: does it matter?

BACKGROUND

Bioabsorbable interference screw fixation has superior biomechanical properties compared to suture anchor fixation for biceps tenodesis. However, it is unknown whether fixation technique influences clinical results.

HYPOTHESIS

We hypothesize that subpectoral interference screw fixation offers relevant clinical advantages over suture anchor fixation for biceps tenodesis.

STUDY DESIGN

Case Series.

METHODS

We performed a retrospective review of a consecutive series of 88 patients receiving open subpectoral biceps tenodesis with either interference screw fixation (34 patients) or suture anchor fixation (54 patients). Average follow up was 13 months. Outcomes included Visual Analogue Pain Scale (0-10), ASES score, modified Constant score, pain at the tenodesis site, failure of fixation, cosmesis, deformity (popeye) and complications.

RESULTS

There were no failures of fixation in this study. All patients showed significant improvement between their preoperative and postoperative status with regard to pain, ASES score, and abbreviated modified Constant scores. When comparing IF screw versus anchor outcomes, there was no statistical significance difference for VAS (p = 0.4), ASES score (p = 0.2), and modified Constant score (P = 0.09). One patient (3%) treated with IF screw complained of persistent bicipital groove tenderness, versus four patients (7%) in the SA group (nonsignificant).

CONCLUSION

Subpectoral biceps tenodesis reliably relieves pain and improves function. There was no statistically significant difference in the outcomes studied between the two fixation techniques. Residual pain at the site of tenodesis may be an issue when suture anchors are used in the subpectoral location.

Tenodesis of the long head of biceps brachii: cyclic testing of five methods of fixation in a porcine model

For pathologies of the long head of the biceps brachii, various surgical treatment options have been described, ranging from tenotomy to different open and arthroscopic techniques for tenodesis. We analyzed the biomechanical properties of 5 widely used operative techniques for tenodesis of the long head of the biceps brachii: an interference screw (7 x 23-mm Arthrex BioTenodesis screw), a suture anchor (5 x 15-mm Arthrex BioCorkscrew), a ligament washer, the keyhole technique, and the bone tunnel technique. Ten porcine humeri for each technique were used to evaluate the ultimate failure load and cyclic displacement. Tenodesis with the interference screw showed a significantly greater ultimate failure load compared with every other technique (480.9 +/- 116.5 N, P < .005) and the least displacement after 200 cycles, significantly less in comparison to the keyhole and bone tunnel techniques (4.28 +/- 1.44 mm, P < .05). Interference screw fixation has superior biomechanical properties with respect to cyclic displacement and primary fixation strength.

Proximal biceps rupture: management of an unusual injury in an arm wrestler

Arm wrestling may cause unusual injuries, which may require operative repair in the sporting individual. Injury to the proximal biceps as a consequence of arm wrestling has not been reported previously. The diagnosis and treatment of a 36-year-old man who sustained a proximal biceps rupture while arm wrestling and his operative management are described.

The biomechanical evaluation of four fixation techniques for proximal biceps tenodesis

PURPOSE

The purpose of this study was to compare the cyclic displacement and ultimate failure strength of 4 proximal biceps tendon tenodesis fixation methods: the open subpectoral bone tunnel (SBT) biceps tenodesis, the arthroscopic suture anchor (SA) tenodesis, the open subpectoral interference screw (SIS) fixation technique, and the arthroscopic interference screw (AIS) technique.

TYPE OF STUDY

Biomechanical experimental control.

METHODS

Twenty fresh-frozen cadaver shoulders were dissected free of soft tissues, leaving the proximal humerus and the proximal biceps tendon as a free graft. Specimens were randomized to 1 of 4 groups with 5 total specimens in each group. A proximal biceps tenodesis was performed according to the techniques listed above. The specimens were mounted for an axial pull of the biceps tendon on a servohydraulic materials testing system with a 100-N load cycled at 1 Hz for 5,000 cycles, followed by an axial load to failure test. Cyclic displacement, ultimate load to failure, and site of failure were recorded for each specimen.

RESULTS

The mean cyclic displacement recorded for each experimental group was as follows: SBT group, 9.39 +/- 2.82 mm; AIS group, 5.26 +/- 2.60 mm; SIS group, 1.53 +/- 0.60 mm; and SA group, 3.87 +/- 2.11 mm. The mean ultimate failure loads after 5,000 cycles were as follows: SBT group, 242.4 +/- 51.33 N; AIS group, 237.6 +/- 27.58 N; SIS group, 252.4 +/- 68.63 N; and SA group, 164.8 +/- 37.47 N. Each specimen failed at the tenodesis site.

CONCLUSIONS

The SBT group showed statistically significant greater displacement than the other tenodesis methods. There were no statistically significant differences in ultimate failure strength between any of the biceps tenodesis methods tested.

CLINICAL RELEVANCE

The data serve as a guide to the surgeon performing a proximal biceps tenodesis in choosing a fixation method.