Arthroscopic suprapectoral biceps tenodesis provided earlier shoulder function restoration compared with open subpectoral biceps tenodesis during the recovery phase

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.

Higher complication rate is associated with suprapectoral biceps tenodesis as compared to subpectoral tenodesis: a systematic review and meta-analysis of comparative studies

INTRODUCTION

Biceps tenodesis techniques can be grouped into open or arthroscopic according to surgical approach, and into subpectoral or suprapectoral according to location of fixation. The purpose of this meta-analysis is to critically analyse the current evidence with regard to comparing two methods of biceps tenodesis, viz subpectoral vs supratenodesis.

METHODS

Primary electronic search was conducted on MEDLINE (PubMed), Embase, Scopus, and Cochrane Library databases for published literature from year of inception to August 2024. The current review included any prospective or retrospective English studies that evaluated the outcomes of suprapectoral versus subpectoral. Primary outcomes of interest were American shoulder and elbow society (ASES) score, constant score (CS), UCLA score, SST score, VAS, and complications. The secondary outcomes of interest was range of movements.

RESULTS

Thirteen studies were included in our quantitative analysis, comprising three RCTs and ten non-randomized comparative studies. ASES score was slightly higher in most of studies in favour of subpectoral tenodesis [95% CI (- 1.35, 0.10); I2 = 43%] (P > 0.05). We found no statistically significant difference between the two groups (P = 0.81), although the subpectoral tenodesis group had slightly higher mean CS 95% CI (- 0.95, 0.85), p = 0.81, I2 = 0%]. Our meta-analysis found a slightly higher SST in suprapectoral tenodesis group [95% CI (- 0.18, 0.49); I2 = 0%], while higher UCLA scores [P = 0.98; 95% CI (- 0.52, 0.50); I2 = 45%] in the subpectoral group (P > 0.05). Higher overall complication rate was noted with suprapectoral tenodesis group [OR 2.65; 95% CI (1.57, 4.45), I2 = 49%] (P = 0.0002).

CONCLUSION

Both the techniques of biceps tenodesis have shown comparable functional outcomes in most of the trials. On performing meta-analysis, suprapectoral tenodesis was associated with higher rate postoperative complications. Hence, it is advisable to choose subpectoral tenodesis, as and when possible.

Polynucleotides High Purification Technology (PN HPTTM) Injection Improves Pain Status and Functional Impairment in Hip and Shoulder Tendinitis

Background/Objectives: Tendinopathy is the preferred term to describe various tendon pathologies, including paratendinitis, tendinitis, and tendinosis, in the absence of histopathological evidence in biopsy specimens. The management of tendinopathies is challenging; rest, physiotherapy (such as eccentric training), injections, shock waves, orthotics, medical therapy, and surgery are the main therapeutic options offered to the patient. The conservative treatment of tendinopathies is still difficult, but several options have been proposed, including the use of anti-inflammatory molecules. In this retrospective study, we aimed to assess the efficacy of a conservative approach in improving pain and functional improvement in hip bursitis (HB) and biceps tendinitis (BT) patients. Methods: A series of data concerning the application of Polynucleotides High Purification Technology (PN HPTTM) in 47 patients with BT and HB was analyzed. All patients received three bi-weekly injections of PN HPTTM (T0-T2). Follow-up visits were performed at T3 (8 weeks from T2) and T4 (24 weeks from T2). Both the visual analog scale (VAS) for pain assessment and functional impairment (FI) scores were processed in the form of anonymized series for clinical improvement evaluations. Results: Statistically significant differences (p < 0.001) in pain reduction (-85%) and functional improvement (+86%) were found at the end of treatment. The levels of patient satisfaction (PS) and Clinical Global Improvement-Impression (CGI-I) were equal to 93% and 98%, respectively. According to the analyses, other patient data (e.g., gender, age, and BMI) did not appear to influence the positive treatment outcomes. Conclusions: The application of High Purification Technology (PN HPTTM) was shown to improve both pain and functional deterioration in patients with tendonitis in a similar manner to other conservative treatments. These retrospective analyses may open up new avenues for the implementation of conservative approaches in patients with tendinitis.

Long head of the biceps tendon versatility in reconstructive shoulder surgery: a narrative review of arthroscopic techniques and their biomechanical principles with video presentation

The management of the long head of the biceps tendon (LHBT) during shoulder arthroscopy has been a subject of controversy for many years, with evolving discussions and trends. Despite long-standing debate, the nature of the surgical indication regarding how to treat concomitent LHBT injuries has undergone changes in recent years. It now extends beyond the timing of tenotomy to encompass considerations of alternative methods for preserving the LHBT, along with an ongoing exploration of how it can be effectively utilized in reconstructive shoulder surgery. Recent techniques describe approaches to using LHBT in a wide range of procedures, from shoulder instability to rotator cuff tears. Additionally, LHBT-based reconstructive techniques have surfaced for addressing what were formerly denoted as irreparable rotator cuff tears. While current literature provides detailed anatomical descriptions of the LHBT and many reports of novel, advanced techniques, there is still much debate regarding the decision-making process in each case. Because of the growing number of emerging techniques and the escalating debate in the subsequent paper, a decision has been made to present the current literature review concerning the potential utilization of LHBT in shoulder arthroscopy. In a dedicated video, we demonstrate the main arthroscopic techniques employed by the authors in their daily practice.