Editorial Commentary: The Long Head of the Biceps Tendon Is Useful for Shoulder Reconstruction Including Glenohumeral Stabilization: From Biceps Killers to Biceps Users

Knotted single lasso loop has a lower stiffness and comparable ultimate failure strength compared with knotless whipstitch fixation in onlay tenodesis

BACKGROUND

Suture and knotless anchor onlay tenodesis are two common treatments for biceps lesions; however, there is a paucity of biomechanical studies evaluating the efficacy and structural integrity of these techniques.

METHODS

Tendons were harvested from four lower extremity fresh cadaver specimens, including the extensor digitorum longus, peroneus longus, peroneus brevis, and anterior tibialis tendons. Each tendon diameter was recorded using a digital Vernier caliper. Sixteen 3D printed proximal humeri models were allocated to either the single lasso loop with suture anchor (SLL) group or the whipstitch with knotless suture anchor (WSA) group. Each tenodesis model was initially tested on an electrodynamic material testing instrument under a cyclic load ranging from 5 to 70 N at a speed of 1.25 mm/s. The force on the tendon was then returned to 5 N, which was pulled until the ultimate failure of the construct. Displacement during cyclic loading, ultimate failure load, stiffness, and failure modes were assessed.

RESULTS

Fourteen tenodesis models were validated, and two models were discarded due to technical errors. No significant differences between the two groups were observed regarding tendon diameter, ultimate failure load, and displacement at ultimate failure load. However, the construct stiffness for the SLL group was lower than that of the WSA group (58.02 ± 5.62 N/mm vs. 72.24 ± 15.63 N/mm, P = 0.043).

CONCLUSION

The SLL group had a lower construct stiffness than the WSA group, whereas construct displacement and ultimate failure load were similar in both groups. Therefore, SLL biceps tenodesis may offer a convenient alternative, with lower tendon migration fixation, while performing an arthroscopic biceps tenodesis.

LEVEL OF EVIDENCE

Basic Science Study.

Long head of the biceps tendon plays a role in stress absorption and humeral head restriction during the late cocking and deceleration phases of overhead throwing: a finite element study

BACKGROUND

Emerging evidence suggests that the long head of the biceps (LHBT) may play a role in stabilizing the glenohumeral joint, and this has led to controversy around the efficacy of biceps tenotomy for superior labral anterior and posterior (SLAP) lesions. Therefore, the aim of this finite element analysis (FEA) study was to determine the stress absorption and humeral head translation restriction effects of the LHBT within the glenohumeral joint during the late cocking and deceleration phases of overhead throwing with a view to resolving the controversy around tenotomy.

METHODS

Eight FEA models were created using computed tomography and magnetic resonance imaging data from normal glenohumeral joints. The models represented 4 LHBT conditions: uninjured, subpectoral tenodesis, tenotomy, and type II SLAP lesions. The late cocking and deceleration phases of the overhead throwing were simulated for each model. The impacts of the 4 LHBT conditions on glenohumeral joint stress absorption and humeral head displacement restriction were studied based on 1) stress and related distributions on the cartilage, labrum, capsule, and LHBT; and 2) humeral head translation variation.

RESULTS

The FEA analysis showed that the magnitude of the contact stress on the articular cartilage, labrum, and capsule was the lowest in the uninjured models, followed by the subpectoral tenodesis, tenotomy, and type II SLAP lesion models. Humeral head translation was the most restricted in the subpectoral tenodesis models, followed by the tenotomy and type II SLAP lesion models.

CONCLUSION

FEA demonstrated that the LHBT plays a significant role in stress absorption and displacement restriction in the late cocking and deceleration phases of overhead throwing. Subpectoral tenodesis of the LHBT exhibited lesser amount of stress and humeral head translation than those of tenotomy, thereby making it a better option for patients who engage in overhead throwing.

Long Head of the Biceps Tendon Pediculated Autograft Augmentation of Subscapularis Repair During Total Shoulder Arthroplasty

Access to the glenohumeral joint during a deltopectoral approach to total shoulder arthroplasty (TSA) often requires some form of subscapularis (SSc) tendon detachment, which may lead to iatrogenic damage and insufficiency of a previously healthy structure. Despite optimization of SSc management techniques, the overall repair failure rate remains high. Although various biological and structural augmentation methods have been advocated to enhance healing of rotator cuff repairs, few options have yet been explored for SSc repair after TSA. In this Technical Note, we describe a method involving the long head of the biceps tendon as a pediculated autograft to reinforce the SSc repair after anatomic or reverse TSA. After long head of the biceps tendon tenodesis, its proximal part is released from the supraglenoid tubercle while remaining in its groove to be subsequently placed at the rotator interval and sutured either to the SSc, the supraspinatus, or the entire anterosuperior rotator cuff on an individual basis. Repurposing the otherwise-discarded tendon brings several mechanical and biological advantages for SSc repair healing at low cost and without donor-site morbidity.

Dynamic Anterior Stabilization with Hill-Sachs Remplissage Can be Employed in Skeletally Immature Patients-Operative Technique

BACKGROUND

Numerous studies indicate that glenoid bony augmentation raises the risk of complications during and after surgery. On the other hand, repairing the labrum alone in cases with subcritical glenoid bone loss results in recurrent instability and persistent apprehension. As a result, recent advancements in shoulder instability surgery prioritize fully restoring the anterior shoulder restraint.

OPERATIVE TECHNIQUE

A novel method for treating recurrent anterior shoulder instability with subcritical glenoid bone loss and off-track Hill-Sachs lesion in skeletally immature patients is suggested: the use of dynamic anterior stabilization technique incorporating the long head of the biceps tendon onto the anterior glenoid rim via trans-subscapular transfer, in conjunction with Hill-Sachs remplissage. A practical, step-by-step surgical technique for a complete reconstruction of the anterior capsule-labral-ligamentous complex is provided. This involves utilizing a soft-tissue dynamic anterior sling, achieved through the trans-subscapularis transfer of the long head of the biceps tendon at the glenoid level. The procedure concludes with a Hill-Sachs remplissage to further prevent off-track events and alleviate apprehension.

CONCLUSION

Dynamic anterior stabilization is a suitable approach for addressing recurring anterior shoulder instability in skeletally immature patients who have subcritical glenoid bone loss and bipolar bone lesions.