Clinical Evaluation of an Arthroscopic Knotless Suprapectoral Biceps Tenodesis Technique: Loop ’n’ Tack Tenodesis

Duerr, Robert A.; Nye, Darin D.; Paci, James M.; Akhavan, Sam

doi:10.1177/2325967118779786

Cited by 20 publications

(30 citation statements)

References 14 publications

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“…These results indicate that the biomechanics of the Loop ’n’ Tack technique as at least equivalent to commonly used techniques in terms of failure strength and demonstrate that it is a viable option for tenodesis surgery, especially in the proximal biceps. Prior work by Brady et al 2 and Duerr et al 3 has shown that suprapectoral proximal biceps tenodesis is an acceptable treatment option with acceptable outcomes, and we believe our work adds to the validity of the proximal tenodesis while potentially limiting its downside. A retrospective analysis of the Loop ’n’ Tack proximal biceps tenodesis technique demonstrated high patient satisfaction and shoulder outcome scores with minimal postoperative complications.…”

Section: Discussionmentioning

confidence: 60%

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The Loop ’n’ Tack Knot: Biomechanical Analysis of a Novel Suture Technique for Proximal Biceps Tenodesis

Acosta

Rinaldi

Guth

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Secure tendon grasping is critical to the success of any tenodesis procedure. Several techniques currently used for tendon grasping can result in longitudinal splitting of the tendon, causing construct failure and failure of the tenodesis. Purpose: To compare the Loop ’n’ Tack knot as a tendon-grasping technique with other common suture techniques. We investigated the biomechanical strength and mode of failure. Study Design: Controlled laboratory study. Methods: Eleven matched pairs of proximal biceps were harvested from fresh-frozen cadaveric shoulders. One tendon from each pair was stitched using 1 of 4 different techniques. The suture techniques evaluated included the Loop ’n’ Tack with 2 different types of high-strength nonabsorbable suture, a double half-racking stitch, and a Krakow stitch. Samples were cyclically loaded between 5 and 20 N for 100 cycles, followed by a pull to failure at 33 mm/s. Results: The Loop ’n’ Tack techniques were equivalent to the double half-racking and Krakow techniques for load to ultimate failure ( P = .817 and P = .984, respectively). The double half-racking technique was the stiffest construct, which was significantly greater than the second-stiffest group, the Loop ’n’ Tack method with both FiberLink suture ( P = .012) and SutureTape ( P = .002), which had greater stiffness than the Krakow group ( P < .001). The most common failure mode for the Loop ’n’ Tack stitch was suture breakage compared with the Krakow and double half-racking methods, where the most common mode of failure was suture pullout from the tendon ( P < .001). Conclusion: Biomechanical testing found that the Loop 'n’ Tack techniques had similar ultimate load to failure values when compared with the double half-racking and Krakow methods. Mode-of-failure analysis showed that the Loop 'n’ Tack construct typically failed by suture breakage, whereas the other techniques failed by suture pullout. Clinical Relevance: The Loop 'n’ Tack technique allows for secure grasping of tissue without the need for externalization of the tendon. This technique may be beneficial in compromised or poor-quality tissue without reducing overall pullout strength when compared with a standard half-racking or Krakow stitch.

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Section: Discussionmentioning

confidence: 60%

“…A retrospective analysis of the Loop 'n' Tack proximal biceps tenodesis technique demonstrated high patient satisfaction and shoulder outcome scores with minimal postoperative complications. 3…”

Section: Discussionmentioning

confidence: 99%

The Loop ’n’ Tack Knot: Biomechanical Analysis of a Novel Suture Technique for Proximal Biceps Tenodesis

Acosta

Rinaldi

Guth

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…1,12,13,18,33 Although open techniques tended to have higher rates of morbidity, including nerve injury and wound complications, no study detected a clinically significant difference between the 2 techniques. 1,12,13,18,33 Duerr et al 10 reported an increase in ASES scores from 42.6 preoperatively to 91.0 postoperatively with their described arthroscopic suprapectoral biceps tenodesis. Our results are similar to these previous studies in that those patients undergoing our allarthroscopic technique had satisfactory clinical results with no complications at an average of 2 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of an All-Arthroscopic Biceps Tenodesis Using the Anterolateral Anchor During Concomitant Double-Row Rotator Cuff Repair

Meghpara

Schulz

Buerba

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Pathology of the long head of the biceps tendon frequently occurs concomitantly with rotator cuff tears, necessitating a surgical treatment, often in the form of a tenodesis procedure. Many techniques for a tenodesis exist; however, they often require additional implants or a separate incision. Purpose: To report an average of 2-year outcomes of an all-arthroscopic biceps tenodesis employing the stay sutures from the anterolateral anchor during concomitant double-row rotator cuff repair (RCR). Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected and retrospectively reviewed for all patients who underwent an all-arthroscopic biceps tenodesis during concomitant double-row RCR by the senior author between January 2014 and May 2018. Patients were included if they underwent this procedure and had baseline preoperative patient-reported outcomes (PROs) with a minimum of 1 year of postoperative PROs for the American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) for pain score. Additionally, patient data, surgical history, postoperative complications, and satisfaction were reported. Results: Fifteen patients were eligible for the study. There were 12 (80%) men and 3 (20%) women with a mean age of 50.0 years (range, 35-64 years). The mean follow-up time was 25.2 months (range, 13-63 months). Six of 15 (40%) patients also had an arthroscopic subscapularis repair performed. ASES shoulder scores improved from 37.1 preoperatively to 94.1 postoperatively ( P < .001), and VAS scores improved from 6.4 preoperatively to 0.5 postoperatively ( P < .001). One patient who underwent concomitant subscapularis repair reported continued anterior groove pain. No patients experienced biceps cramping, developed a deformity, or required a repeat operation at the final follow-up. Overall, 93.3% of the patients reported being highly satisfied with their surgery. Conclusion: This study presents the clinical results of an all-arthroscopic technique for concomitant double-row RCR and biceps tenodesis, which resulted in high rates of patient satisfaction and significant improvement in reported shoulder outcome and pain scores. Additionally, this technique offers the potential benefits of avoiding a secondary incision, which may decrease surgical morbidity while also decreasing cost by eliminating the need for an extra, tenodesis-specific implant.

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“…Certainly, 1 This technique has been highly successful. Although I have converted to the onlay "loop 'n' tack" technique, 5 I still perform this technique high in the groove. I frequently use the sutures emanating from this tenodesis site for additional repairs, including upper subscapularis or anterior supraspinatus repairs.…”

Section: See Related Article On Page 2975mentioning

confidence: 99%

Editorial Commentary: Biceps Tenodesis Location May Not Matter: Go High…Go Low…Go Wherever You Want to Go!

Brady

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Tenodesis of the long head of the biceps tendon has long been a source of dialogue, discussion, debate, and dogma. In general, the shoulder literature has been exhaustive regarding various biceps tenodesis techniques and outcomes, and studies have shown positive clinical outcomes of tenodesis, regardless of location, along the proximal humerus. Fewer studies have evaluated the outcomes of revision tenodesis; however, those that have looked at this have generally found that a revision to a subpectoral tenodesis site is usually quite successful.

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Clinical Evaluation of an Arthroscopic Knotless Suprapectoral Biceps Tenodesis Technique: Loop ’n’ Tack Tenodesis

Cited by 20 publications

References 14 publications

The Loop ’n’ Tack Knot: Biomechanical Analysis of a Novel Suture Technique for Proximal Biceps Tenodesis

The Loop ’n’ Tack Knot: Biomechanical Analysis of a Novel Suture Technique for Proximal Biceps Tenodesis

Clinical Outcomes of an All-Arthroscopic Biceps Tenodesis Using the Anterolateral Anchor During Concomitant Double-Row Rotator Cuff Repair

Editorial Commentary: Biceps Tenodesis Location May Not Matter: Go High…Go Low…Go Wherever You Want to Go!

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