Open Biceps Tenodesis: A Biomechanical Comparison of 6 Fixation Techniques

Diaz, Miguel; Shi, Brendan Y.; Baker, Matthew; Binkley, Matthew; Belkoff, Stephen M.; Srikumaran, Uma

doi:10.3928/01477447-20200107-03

Cited by 15 publications

(19 citation statements)

References 31 publications

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“…7 However, other studies have found equivalence in biomechanical performance of all-suture anchors and interference screws, 2,12 with some cadaveric studies suggesting that interference screw may even be inferior with load-to-failure testing. 4 While that may be the case, all cadaveric studies are implicitly time zero and do not allow for tissue remodeling, nor do they necessarily simulate what happens physiologically in vivo, where healing is primarily periosteal. 23,26 The authors of this study postulate that interference screws may be superior because they cause apposition of tendon tissue to cortical bone, which is superior to any suture construct in which suture material can pull through the longitudinally oriented fibers of the biceps tendon.…”

Section: Discussionmentioning

confidence: 99%

No Difference in Clinical Outcomes for Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis at Midterm Follow-up: A Randomized Prospective Analysis

et al. 2022

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Background: We have previously reported the 1-year outcomes of arthroscopic suprapectoral biceps tenodesis (ASPBT) versus open subpectoral biceps tenodesis (OSPBT) for the management of long head of the biceps tendon (LHBT) pathology. While patients had similar 1-year biceps muscle strength and pain, longer-term functional outcomes are unknown. Purpose: To directly compare clinical outcomes of ASPBT versus OSPBT with interference screw fixation, distal to the bony bicipital groove, at a minimum of 2 years’ follow-up. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 85 patients undergoing biceps tenodesis (BT) for LHBT disease were randomized into the ASPBT or OSPBT group. Both techniques utilized polyether ether ketone inference screws for tenodesis fixation. Patients completed American Shoulder and Elbow Surgeons (ASES), Constant subjective, and Single Assessment Numeric Evaluation (SANE) questionnaires preoperatively and again at 6 months, 12 months, and at the final follow-up at a minimum of 24 months. Results: A total of 73 patients (37/42 randomized to ASPBT [88%]; 36/42 randomized to OSPBT [86%]) with a mean age of 50.4 ± 10.3 years and a mean body mass index of 29 ± 7.9 were included in clinical outcome analyses. The mean final follow-up was 2.9 years (ASPBT, 3 years; OSPBT, 2.8 years [range 2-5.2 years]). Comparison of demographic characteristics and intraoperative findings showed no significant differences in age, sex, concomitant procedures, and rotator cuff disease. No statistically significant differences in the ASES ( P = .25), Constant subjective ( P = .52), and SANE scores ( P = .61) were found at the final follow-up. Clinical outcomes scores showed no significant improvement from a mean of 12.6 months to the final follow-up at 34.5 months (ASPBT: ASES, P = .43; Constant, P = .25; SANE, P = .45 vs OSPBT: ASES, P = .65; Constant, P = .78; SANE, P = .70). No patients required revision of BT in either group. Conclusion: This study reported a minimum of 2-year follow-up of patients undergoing ASPBT or OSPBT, utilizing the same interference screw technique, for the management of LHBT pathology in the setting of concomitant shoulder procedures. There were no significant differences in patient-reported outcomes and complication rates found at any time point. Registration: NCT02192073 (ClinicalTrials.gov identifier).

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Section: Discussionmentioning

confidence: 99%

No Difference in Clinical Outcomes for Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis at Midterm Follow-up: A Randomized Prospective Analysis

et al. 2022

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“…8 Various methods have been used to increase time-zero fixation strength. 9 However, the best methods are still being pursued. We believe that the described 2-position fixation method may shed some light on the treatment of LHB disorders.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Extra-articular 2-Position Fixation of the Long Head of the Biceps

Tang

Zhao

2020

Arthroscopy Techniques

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Disorders of the long head of the biceps (LHB) are common conditions that lead to an impediment of shoulder function. Fixation of the LHB is an effective way to alleviate LHB-related symptoms while maintaining its muscular function. However, fixation failure usually occurs after LHB tenodesis with routine 1-position fixation. To reduce the fixation failure rate, we introduce a 2-position LHB fixation technique. This includes locating the extra-articular part of the LHB efficiently, thorough debridement of the anterior subdeltoid space and the region around the LHB, and 2-position fixation with knotless suture anchors at the superior edge of the pectoralis major and at the proximal end of the bicipital groove. Our clinical experience indicates that this procedure can be performed safely and effectively when certain guidelines are followed. We believe that the introduction of this technique will provide a special fixation option for patients with LHB disorders.

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“…Fixation devices for biceps tenodesis have been well studied, with multiple devices on the market. 1,6,7,11 However, it is unclear whether these affect clinical outcomes despite biomechanical differences. Dekker et al 5 performed a metaanalysis of biomechanical studies evaluating biceps tenodesis and found no difference in fixation type (interference screw vs. other tenodesis techniques) or location (suprapectoral vs. subpectoral).…”

Section: In Replymentioning

confidence: 99%