|
1
|
Forsythe B, Berlinberg EJ, Khazi-Syed D, Patel HH, Forlenza EM, Okoroha KR, Williams BT, Yanke AB, Cole BJ, Verma NN. Greater Postoperative Biceps Tendon Migration After Arthroscopic Suprapectoral or Open Subpectoral Biceps Tenodesis Correlates With Lower Patient-Reported Outcome Scores. Arthroscopy 2025; 41:1302-1313.e2. [PMID: 39173686 DOI: 10.1016/j.arthro.2024.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 07/19/2024] [Accepted: 07/20/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE To assess the relation between tendon migration, as measured by radiostereometric analysis, and patient-reported outcome measures (PROMs) after biceps tenodesis (BT); to determine the likelihood of achieving clinically significant outcomes (CSOs) after BT; and to identify factors that impact CSO achievement. METHODS Patients undergoing arthroscopic suprapectoral or open subpectoral BT at a single, high-volume academic medical center were prospectively enrolled. A tantalum bead sutured to the tenodesis construct was used as a radiopaque marker. Biceps tendon migration was measured on calibrated radiographs at 12 weeks postoperatively. PROMs (Constant-Murley, Single Assessment Numeric Evaluation [SANE], and Patient-Reported Outcomes Measurement Information System-Upper Extremity [PROMIS-UE] scores) were collected preoperatively and at minimum 2-year follow-up. RESULTS Of 115 patients enrolled, 94 (82%) were included (median age, 52 years; median body mass index, 31.4). At a mean follow-up of 2.9 years, the median Constant-Murley, SANE, and PROMIS-UE scores were 33 (interquartile range [IQR], 26-35), 90 (IQR, 80-99), and 47 (IQR, 42-58), respectively. Median tantalum bead migration was 6.5 mm (IQR, 1.8-13.8 mm). There were significant correlations between migration and Constant-Murley score (r2 = 0.222; β = -0.554 [95% confidence interval (CI), -1.027 to -0.081]; P = .022), SANE score (r2 = 0.238; β = -0.198 [95% CI, -0.337 to -0.058]; P = .006), and PROMIS-UE score (r2 = 0.233; β = -0.406 [95% CI, -0.707 to -0.104]; P = .009). On univariable analysis, higher body mass index was associated with achievement of substantial clinical benefit (unadjusted odds ratio [OR], 1.078 [95% CI, 1.007 to 1.161]; P = .038). Greater bead migration was negatively associated with achievement of the minimal clinically important difference (unadjusted OR, 0.969 [95% CI, 0.943 to 0.993]; P = .014) and patient acceptable symptomatic state (unadjusted OR, 0.965 [95% CI, 0.937 to 0.989]; P = .008) on all 3 instruments. CONCLUSIONS A 1-cm increase in post-tenodesis biceps tendon migration was associated with a decrease in the Constant-Murley, SANE, and PROMIS-UE scores of 6, 2, and 4 points, respectively, at a mean of 2.9 years after surgery. Most patients achieved CSOs for these PROMs by latest follow-up, and greater biceps tendon construct migration was negatively associated with the likelihood of CSO achievement. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- Brian Forsythe
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A..
| | - Elyse J Berlinberg
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.; Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Daanish Khazi-Syed
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.; The University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Harsh H Patel
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A.; St. Joseph's Health, Paterson, New Jersey, U.S.A
| | | | | | - Brady T Williams
- University of Colorado Anschutz Medical Center, Denver, Colorado, U.S.A
| | - Adam B Yanke
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | | |
Collapse
|
|
2
|
Yu J, Mi J, Huang K, Qi R. Knotted single lasso loop has a lower stiffness and comparable ultimate failure strength compared with knotless whipstitch fixation in onlay tenodesis. J Orthop Surg Res 2025; 20:348. [PMID: 40189558 PMCID: PMC11974151 DOI: 10.1186/s13018-025-05757-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2025] [Accepted: 03/25/2025] [Indexed: 04/09/2025] Open
Abstract
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.
Collapse
Affiliation(s)
- Jiong Yu
- Department of Sports Medicine, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No 999, Binhu District, Wuxi, Jiangsu, China.
| | - Jingyi Mi
- Department of Sports Medicine, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No 999, Binhu District, Wuxi, Jiangsu, China
| | - Kai Huang
- Orthopaedic Institute, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China
| | - Renfei Qi
- Orthopaedic Institute, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China
| |
Collapse
|
|
3
|
Kuan FC, Hsu KL, Lin FH, Hong CK, Chen Y, Shih CA, Su WR. Biomechanical comparisons of all--suture suspensory button vs. interference screw for inlay subpectoral bicep tenodesis. J Shoulder Elbow Surg 2025; 34:163-171. [PMID: 38762151 DOI: 10.1016/j.jse.2024.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND All-suture buttons (ASBs) and interference screw (IS) are commonly utilized in the inlay subpectoral biceps tendon tenodesis. However, the biomechanical characteristics of these two methods have not been compared directly. The aim of present study was to compare the biomechanical properties of ASB vs. IS for inlay subpectoral biceps tendon tenodesis in a human cadaveric model. METHODS Sixteen fresh-frozen human cadaveric shoulders were randomly divided into two experimental inlay biceps tenodesis groups: ASB or IS. After tenodesis, every specimen was preloaded at 5 N for 2 minutes, followed with a cyclic loading test from 5 to 70 N for 500 load cycles. Then the load-to-failure test was performed. Afterward, the humerus was placed in a cylinder tube and secured with anchoring cement. Lastly, a two-point bending test was performed to determine the strength of the humerus. Destructive axial force was applied, and the failure strength and displacement were recorded. RESULTS No difference in stiffness was observed between the two groups (ASB = 27.4 ± 3.5 N/mm vs. IS = 29.7 ± 3.0 N/mm; P = .270). Cyclic displacement was significantly greater in the ASB group (6.8 ± 2.6 mm) than the IS group (3.8 ± 1.1 mm; P = .021). In terms of failure load, there were no statistical differences among the two groups (P = .234). The ASB group was able to withstand significantly greater displacement (11.9 ± 1.6 mm) before failure than the IS group (7.8 ± 1.5 mm; P = .001). During the humeral bending test, the ASB group exhibited significantly greater maximal load (2354.8 ± 285.1 N vs. 2086.4 ± 296.1 N; P = .046) and larger displacement (17.8 ± 2.8 mm vs. 14.1 ± 2.8 mm; P = .027) before fracture. CONCLUSIONS In inlay subpectoral bicep tenodesis, ASB fixation appears to offer comparable stiffness and failure load to that of IS fixation. Additionally, the ASB group exhibited greater resistance to load and displacement before humeral fracture. However, the ASB group did demonstrate increased cyclic displacement compared to IS group.
Collapse
Affiliation(s)
- Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Fang-Hsien Lin
- Department of Physical Medicine and Rehabilitation, Tainan Municipal An-Nan Hospital, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Kaohsiung Veterans General Hospital Tainan Branch, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
|
4
|
Teo BJX, Yew A, Tan MWP, Chou SM, Lie DTT. The double-lasso loop technique of Biceps tenodesis has lower displacement after cyclic loading, compared to interference screw fixation: Biomechanical analysis in an ovine model. Shoulder Elbow 2023; 15:602-609. [PMID: 37981968 PMCID: PMC10656979 DOI: 10.1177/17585732221095766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/03/2022] [Indexed: 11/21/2023]
Abstract
Background Biceps tenodesis is an effective treatment for symptomatic long head of biceps tendon pathology. Recently the arthroscopic "double lasso-loop" suture anchor (DLSA) technique was described, advantaged by reduced cost, complexity, and operative time. We aimed to compare the in vitro strength of DLSA with conventional interference screws (IS). Methods A biomechanical analysis was conducted on 14 sheep shoulders (8 DLSA, 6 IS), consisting of a 500-cycle cyclic loading experiment of 5-70 N and ultimate failure load (UFL) test where each specimen was pulled until failure. Displacement (mm) was recorded every 100 cycles, while stiffness and UFL were observed. Results Cyclic displacement was significantly lower with DLSA at 100 cycles, but not above. During the UFL test, IS was stiffer (27.68 ± 6.56 N/mm versus 14.10 ± 5.80 N/mm, p = .005) and had higher UFL (453.67 ± 148.55 N versus 234.22 ± 44.57 N, p = .001) than DLSA. All DLSA failures occurred with suture/anchor pull-out, while all IS constructs failed at the muscle/tendon. Discussion Comparison of the novel DLSA technique with a traditional IS method found lower initial displacement. While our IS constructs could withstand higher UFL, peak load characteristics of DLSA were similar to previous ovine studies. Hence, the DLSA technique is a viable alternative to IS for biceps tenodesis with its purported non-biomechanical advantages.
Collapse
Affiliation(s)
- Bryon JX Teo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Andy Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Marcus Wei Ping Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Siaw Meng Chou
- School of Mechanical & Aerospace Engineering, College of Engineering, Nanyang Technological University, Singapore, Singapore
| | | |
Collapse
|
|
5
|
Nicolay RW, Jahandar A, Retzky JS, Kontaxis A, Verma NN, Fu MC. Biomechanical properties of suprapectoral biceps tenodesis with double-anchor knotless luggage tag sutures vs. subpectoral biceps tenodesis with single-anchor whipstitch suture using all-suture anchors. JSES Int 2023; 7:2393-2399. [PMID: 37969507 PMCID: PMC10638590 DOI: 10.1016/j.jseint.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background As the use of all-suture anchors continues to increase, limited biomechanical data on the use of these anchors in various configurations for tenodesis of the long head biceps tendon (LHBT) exists. The aim of this study was to compare the biomechanical properties of a 2-anchor luggage tag suprapectoral biceps tenodesis (Sup-BT) vs. a single-anchor whipstitch subpectoral biceps tenodesis (Sub-BT) using all-suture anchors. The hypothesis was that the Sub-BT will have a higher ultimate load to failure and less creep relative to the Sup-BT construct. Methods Eighteen fresh frozen cadaveric humeri were used. The specimens were randomly divided into 2 groups of 9; i) The Sup-BT were performed with 2 1.8 mm knotless all-suture anchors using a luggage-tag fixation configuration, ii) The Sub-BT were performed using a single 1.9 mm all-suture anchor and a whipstitch suture configuration with a tied knot. The humeri were tested on a hydraulic MTS machine where the specimens were preloaded at 5 N for 2 minutes and then cyclically loaded from 5 to 50 N for 1000 cycles at 1 Hz while maximum displacement was recorded with a motion system and markers attached to the bone and bicep tendon. The tendon was then tensioned at a rate of 1 mm/s to obtain the ultimate load to failure. CT scans of the specimens were used to calculate the bone mineral density at the site of the anchor/bone interface and video recordings were captured during load to failure to document all modes of failure. Results There was no significant difference in the average load to failure of the Sup-BT and Sub-BT groups (197 N ± 45 N (SD), 164 N ± 68 N (SD) respectively; P = .122) or creep under fatigue between the Sup-BT vs. Sub-BT specimens (3.1 mm, SD = 1.5 vs. 2.2 mm, SD = 0.9; P = .162). The bone mineral density was statistically different between the 2 groups (P < .001); however, there were no observed failures at the anchor/bone interface and no correlation between failure load and bone mineral density. Conclusion The ultimate load to failure and creep between a Sup-BT with 2 knotless all-suture anchors using a luggage tag suture configuration was equivalent to a Sub-BT with 1 all-suture anchor using a whipstitched suture configuration and a tied knot. Surgeons can perform either technique confidently knowing that they are biomechanically equivalent in a cadaver model at time zero, and they offer similar strength to other fixation methods cited in the literature.
Collapse
Affiliation(s)
- Richard W. Nicolay
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Amirhossein Jahandar
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Julia S. Retzky
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Andreas Kontaxis
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Nikhil N. Verma
- Section of Shoulder and Elbow Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael C. Fu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| |
Collapse
|
|
6
|
Colasanti CA, Azam MT, Bi AS, Fariyike B, Kirschner N, Neal WH, Owusu-Sarpong S, Stone JW, Kennedy JG. Reproducible and Effective Biceps Tenodesis Method Utilizing In-Office Nano-Arthroscopy. Arthrosc Tech 2023; 12:e1797-e1802. [PMID: 37942114 PMCID: PMC10628057 DOI: 10.1016/j.eats.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/19/2023] [Indexed: 11/10/2023] Open
Abstract
Biceps tendinopathy is a common cause of chronic anterior shoulder pain characterized by altered joint mechanics with considerable deficits in range of motion secondary to pain. The benefits of in-office nano-arthroscopy (IONA) include the ability to diagnosis and treat biceps tendinopathy, quicker patient recovery, reduced cost, and improved patient satisfaction. The purpose of this technical report is to describe the technique for performing IONA for biceps tendinopathy (biceps tenotomy/biceps tenodesis), with special consideration for obtaining adequate local anesthesia, proper indications, adequate visualization, and the advantages of performing these procedures in the office rather than the operating room.
Collapse
Affiliation(s)
| | - Mohammad T. Azam
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Andrew S. Bi
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Babatunde Fariyike
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - Noah Kirschner
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | - William H.E. Neal
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| | | | - James W. Stone
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - John G. Kennedy
- NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York, U.S.A
| |
Collapse
|
|
7
|
Forsythe B, Patel HH, Berlinberg EJ, Forlenza EM, Okoroha KR, Williams BT, Yanke AB, Cole BJ, Verma NN. A Radiostereometric Analysis of Tendon Migration After Arthroscopic and Mini-Open Biceps Tenodesis: Interference Screw Versus Single Suture Anchor Fixation. Am J Sports Med 2023; 51:2869-2880. [PMID: 37548005 DOI: 10.1177/03635465231187030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Studies suggest that similar clinical results are achieved via arthroscopic and open biceps tenodesis (BT) techniques. PURPOSE To quantify the postoperative migration of the BT construct between arthroscopic suprapectoral BT (ASPBT) and open subpectoral BT (OSPBT) techniques via interference screw (IS) or single-suture suture anchor (SSSA) fixation using radiostereometric analysis. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Distal migration of the biceps tendon after OSPBT with a polyetheretherketone IS, OSPBT with 1 SSSA, ASPBT with polyetheretherketone IS, and ASPBT with 2 SSSAs was measured prospectively. Patients with symptomatic biceps tendinopathy and preoperative patient-reported outcome measures (PROMs) including Constant-Murley subjective, Single Assessment Numeric Evaluation, or Patient-Reported Outcomes Measurement Information System-Upper Extremity scores were included. A tantalum bead was sutured on the proximal end of the long head of the biceps tendon before fixation of tendon tissue. Anteroposterior radiographs were performed immediately postoperatively, at 1 week, and at 3 months. Bead migration was measured, and preoperative PROMs were compared with those at latest follow-up. RESULTS Of 115 patients, 94 (82%) were available for final follow-up. IS fixation yielded the least tendon migration with no difference between the open and arthroscopic approaches (4.31 vs 5.04 mm; P = .70). Fixation with 1 suture anchor demonstrated significantly greater migration than that achieved with an IS at both 1 week (6.47 vs 0.1 mm, 6.47 vs 1.75 mm, P < .001;) and 3 months (14.76 vs 4.31 mm, 14.76 vs 5.04 mm, P < .001) postoperatively. Two-suture anchor fixation yielded significantly greater migration than IS fixation at 1 week (7.02 vs 0.1 mm, P < .001; 7.02 vs 1.75 mm, P = .003) but not 3 months postoperatively (8.06 vs 4.31 mm, P = .10; 8.06 vs 5.04 mm, P = .07). Four patients with suture anchor fixation (3 patients in the OSPBT 1 SSSA group, 9.4%, and 1 patient in the ASPBT 2 SSSAs group, 3.8%) developed a Popeye deformity, whereas no Popeye deformities occurred in the IS groups. Mean 3-month bead migration in patients with and without a Popeye deformity was 60.8 and 11.2 mm, respectively (P < .0001). PROMs did not differ among groups at final follow-up. CONCLUSION Interference screw fixation yielded the least tendon migration whether achieved arthroscopically or open. The available data indicated that fixation with 1 SSSA but not 2 SSSAs resulted in significantly greater migration than that achieved with an IS. Despite variations in tendon migration, PROMs were similar among all groups. When SSSAs are used, tendon migration may be minimized by using ≥2 anchors.
Collapse
Affiliation(s)
| | - Harsh H Patel
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | | | | | - Kelechi R Okoroha
- Mayo Clinic Orthopedics and Sports Medicine, Minneapolis, Minnesota, USA
| | - Brady T Williams
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Adam B Yanke
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | | |
Collapse
|
|
8
|
Tayne S, Kim BI, Lau BC. Physeal Sparing Medial Patellofemoral Ligament Reconstruction With Suture Anchor for Femoral Fixation of Graft. VIDEO JOURNAL OF SPORTS MEDICINE 2022; 2:26350254221115202. [PMID: 40308312 PMCID: PMC11923549 DOI: 10.1177/26350254221115202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/09/2022] [Indexed: 05/02/2025]
Abstract
Background Patellar instability is a common problem in the active pediatric population. Physeal sparing medial patellofemoral ligament (MPFL) reconstruction using a soft suture anchor for femoral graft fixation has the proposed advantages of diminishing volumetric bony removal from the epiphysis, increasing the margin of safety with respect to notch, trochlear, and/or physeal damage, as well as reducing the risk of thermal damage to the physis during socket reaming. Indications MPFL reconstruction is indicated in patients with recurrent patellar instability with MPFL tear or attenuation on magnetic resonance imaging or failure of conservative treatment. Physeal sparing techniques are necessary in the pediatric population to prevent growth disturbance and deformities that can lead to significant long-term disability. Technique Description The patient was placed in supine position. Following examination under anesthesia, diagnostic arthroscopy was performed to assess for patellofemoral chondral defects. The surgical technique required 6 steps: (1) medial patellar dissection, (2) patellar anchor placement with 1.8-mm suture anchors, (3) medial femoral dissection over Schottle's point, (4) femoral anchor placement using 2.8-mm double loaded anchor, (5) allograft femoral fixation, and (6) allograft patellar fixation. After skin closure, examination under anesthesia was repeated. Results The patient was weight-bearing as tolerated immediately after surgery, using a brace for the first 6 weeks. Rehabilitation progressed from regaining range of motion, strengthening of the operative extremity, and returning to sport activities. In the senior author's experience using this technique, there have been no recurrent patellar dislocations and no evidence of growth disturbance or angulation. One patient did find that the graft was prominent over the femoral epicondyle and returned to the operating room for debulking at 9 months postoperatively. Discussion/Conclusion In conclusion, we propose that physeal sparing MPFL reconstruction using soft anchors for patellar and femoral fixation offers a simple and safe technique with reproducible anatomic graft placement and favorable clinical outcomes. This technique is technically simple and can be easily learned by surgeons familiar with adult MPFL reconstruction techniques.The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Collapse
Affiliation(s)
- Samantha Tayne
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Billy I. Kim
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Brian C. Lau
- Department of Orthopaedic Surgery, Duke Sports Sciences Institute, Duke University, Durham, North Carolina, USA
| |
Collapse
|
|
9
|
Jenkins SM, Hwang IM, Del Sol SR, Guzman AJ, Dela Rueda T, McGahan P, Chen J. Subpectoral Biceps Tenodesis Using an All-Suture Anchor. Arthrosc Tech 2022; 11:e555-e562. [PMID: 35493061 PMCID: PMC9051893 DOI: 10.1016/j.eats.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/04/2021] [Indexed: 02/03/2023] Open
Abstract
Long head biceps tendon pathology is a substantial contributor to anterior shoulder pain and often requires surgical intervention to offer a return to normal functionality. Surgical treatment options consist of both open and arthroscopic tenodesis or tenotomy of the long head biceps brachii. Several techniques exist for tenodesis and tenotomy of the biceps, although current debate continues regarding which surgical approach is the optimal intervention for symptomatic bicep pathology. In this technical note, we describe a subpectoral biceps tenodesis of the long head bicep tendon using an all-suture anchor. Our technique offers the advantages of using an all-suture anchor that incorporates a self-tensioning mechanism with direct visualization of the tendon during biceps tenodesis and anchor insertion.
Collapse
Affiliation(s)
- Sarah M. Jenkins
- Advanced Orthopedics and Sports Medicine, San Francisco, California,Address correspondence to Sarah M. Jenkins, Advanced Orthopedics and Sports Medicine, 450 Sutter St., Suite 400, San Francisco, CA 94108, U.S.A.
| | - Inga M. Hwang
- Advanced Orthopedics and Sports Medicine, San Francisco, California
| | - Shane Rayos Del Sol
- Advanced Orthopedics and Sports Medicine, San Francisco, California,University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Patrick McGahan
- Advanced Orthopedics and Sports Medicine, San Francisco, California
| | - James Chen
- Advanced Orthopedics and Sports Medicine, San Francisco, California
| |
Collapse
|
|
10
|
Lalehzarian SP, Agarwalla A, Liu JN. Management of proximal biceps tendon pathology. World J Orthop 2022; 13:36-57. [PMID: 35096535 PMCID: PMC8771414 DOI: 10.5312/wjo.v13.i1.36] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/10/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
The long head of the biceps tendon is widely recognized as an important pain generator, especially in anterior shoulder pain and dysfunction with athletes and working individuals. The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures, function, and relevant clinical information such as evaluation, treatment options, and complications in hopes of helping orthopaedic surgeons counsel their patients. An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally. The biceps-labral complex has been identified and broken down into different regions that can further enhance a physician's knowledge of common anterior shoulder pain etiologies. Although various physical examination maneuvers exist meant to localize the anterior shoulder pain, the lack of specificity requires orthopaedic surgeons to rely on patient history, advanced imaging, and diagnostic injections in order to determine the patient's next steps. Nonsurgical treatment options such as anti-inflammatory medications, physical therapy, and ultrasound-guided corticosteroid injections should be utilized before entertaining surgical treatment options. If surgery is needed, the three options include biceps tenotomy, biceps tenodesis, or superior labrum anterior to posterior repair. Specifically for biceps tenodesis, recent studies have analyzed open vs arthroscopic techniques, the ideal location of tenodesis with intra-articular, suprapectoral, subpectoral, extra-articular top of groove, and extra-articular bottom of groove approaches, and the best method of fixation using interference screws, suture anchors, or cortical buttons. Orthopaedic surgeons should be aware of the complications of each procedure and respond accordingly for each patient. Once treated, patients often have good to excellent clinical outcomes and low rates of complications.
Collapse
Affiliation(s)
- Simon P Lalehzarian
- The Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, United States
| | - Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Joseph N Liu
- USC Epstein Family Center for Sports Medicine, Keck Medicine of USC, Los Angeles, CA 90033, United States
| |
Collapse
|
|
11
|
Kim TM, Shin MH, Baek S, Lee DR, Chung SW. Can a Two Simple Stitches Method Provide Secure Fixation Strength in Biceps Tenodesis?: Biomechanical Evaluation of Various Suture Techniques. Clin Orthop Surg 2022; 14:426-433. [PMID: 36061853 PMCID: PMC9393283 DOI: 10.4055/cios21186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/26/2022] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
Background The purpose of this study was to compare the initial fixation strength between four different suture methods for the long head of the biceps. Methods Forty-eight fresh frozen porcine flexor hallucis longus tendons (mean width at suture site, 8.5 ± 0.9 mm) and phalanx bones were randomly assigned to one of the four arthroscopic biceps tenodesis techniques: simple stitch (SS), mattress suture (MS), lasso-loop (LL), and two simple stitches (2SS). A biceps tenodesis was performed according to the four techniques using all-suture type suture anchors (1.9-mm SUTUREFIX anchor with No. 1 ULTRABRAID sutures). Biomechanical evaluations were performed to test load to failure (N), stiffness (N/mm), stress (N/m2), and mode of failure. Results As for the SS, MS, LL, and 2SS, the mean load to failure was 50.9 ± 14.61 N, 82.3 ± 24.8 N, 116.2 ± 26.7 N, and 130.8 ± 22.5 N (p < 0.001), respectively; mean stiffness was 6.1 ± 1.3 N/mm, 6.7 ± 2.6 N/mm, 7.8 ± 1.4 N/mm, and 8.1 ± 4.2 N/mm, respectively (p = 0.258); and mean stress was 0.7 ± 0.3 N/m2, 1.4 ± 0.8 N/m2, 2.9 ± 0.7 N/m2, and 2.7 ± 0.8 N/m2, respectively (p < 0.001). All the failures happened by the suture cutting through the tendon along its longitudinal fibers. Conclusions Neither the SS nor the MS method was enough to securely fix the biceps tendon with a significantly lower mechanical strength; however, the 2SS method showed similar initial fixation strength as the LL technique.
Collapse
Affiliation(s)
- Tae Min Kim
- Department of Orthopaedic Surgery, Center for Shoulder and Elbow Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Myung Ho Shin
- Department of Orthopaedic Surgery, Center for Hand and Elbow Surgery, CM Hospital, Seoul, Korea
| | - Samuel Baek
- Department of Orthopaedic Surgery, Center for Hand and Elbow Surgery, Red Cross Hospital, Seoul, Korea
| | - Dong Ryun Lee
- Department of Orthopaedic Surgery, Center for Hand and Elbow Surgery, Konkuk University School of Medicine Hospital, Seoul, Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Center for Hand and Elbow Surgery, Konkuk University School of Medicine Hospital, Seoul, Korea
| |
Collapse
|
|
12
|
Migliorini F, Baroncini A, Eschweiler J, Tingart M, Maffulli N. Interference screws vs. suture anchors for isolated medial patellofemoral ligament femoral fixation: A systematic review. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:123-129. [PMID: 33259964 PMCID: PMC8847917 DOI: 10.1016/j.jshs.2020.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/02/2020] [Accepted: 10/19/2020] [Indexed: 06/12/2023]
Abstract
PURPOSE The present study aimed to systematically review and compare 2 femoral autograft fixation techniques, namely, interference screws and suture anchors, for isolated medial patellofemoral ligament reconstruction in patients with recurrent patellofemoral instability at mid- to long-term follow-up. METHODS A literature search was performed in September 2020. All studies reporting the outcomes of primary isolated medial patellofemoral ligament reconstruction for recurrent patellofemoral instability were considered for inclusion. Only studies reporting the type of femoral autograft fixation under examination were considered. Studies reporting data from patients with elevated tibial tuberosity-tibial groove, patella alta, and/or Dejour's trochlear dysplasia types C and D, were not included. Only articles reporting data with a minimum follow-up period of 18 months were considered. RESULTS Data from 19 studies (615 patients) were retrieved. The overall age was 24.4 ± 6.7 years (mean ± SD). The mean follow-up was 46.5 ± 20.9 months. There were 76 patients in the anchor group and 539 in the screw group. Comparability was found with regard to age and follow-up duration between the 2 study groups. There was comparability between the Kujala, Lysholm, and Tegner scores at baseline. At the last follow-up, no worthy differences were found in terms of mean Kujala (+2.1%; p = 0.04), Lysholm (+1.7%; p = 0.05), and Tegner (+15.8%; p = 0.05) scores. Although complications occurred almost exclusively in the screw cohort, no statistically significant difference was found. CONCLUSION Femoral autograft fixation through interference screws or suture anchors report similar clinical scores and rate of apprehension test, persistent joint instability, re-dislocations, and revisions. These results must be interpreted within the limitations of the present study.
Collapse
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Clinic, Aachen 52074, Germany.
| | - Alice Baroncini
- Department of Orthopaedics, University Clinic Aachen, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Clinic, Aachen 52074, Germany
| | - Jörg Eschweiler
- Department of Orthopaedics, University Clinic Aachen, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Clinic, Aachen 52074, Germany
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen University Clinic, Aachen 52074, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi 84081, Italy; School of Pharmacy and Bioengineering, School of Medicine, Keele University, Stoke on Trent ST4 7QB, UK; Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, London E1 4DG, UK
| |
Collapse
|
|
13
|
Gendre P, Boileau P. The Injured Shoulder in High-Level Male Gymnasts, Part 2: Can Athletes Return to Competition After Surgery? Orthop J Sports Med 2021; 9:23259671211043468. [PMID: 34631907 PMCID: PMC8493319 DOI: 10.1177/23259671211043468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/04/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The results of surgical treatment of shoulder injuries in high-level male gymnasts have not yet been documented. PURPOSE To evaluate the functional and subjective results after surgical treatment of shoulder injuries in high-level gymnasts and the possibilities to return to sport at the same level. STUDY DESIGN Case series; Level of evidence, 4. METHODS Over a 20-year period (1994-2014), 23 high-level male gymnasts (26 shoulders) underwent surgery by a single experienced shoulder surgeon. At the time of surgery, 7 gymnasts competed at the international level, 12 at the national elite level, and 4 at the regional level. According to symptoms and anatomic lesions, the shoulders were classified into 2 groups: painful shoulders (n = 11) and unstable shoulders (n = 15). Fifteen capsulolabral repairs, 10 cuff debridements, 1 cuff repair, 4 SLAP (superior labral anterior and posterior) repairs, and 8 suprapectoral biceps tenodesis were performed. Twelve shoulders (46%) had >1 procedure performed. Outcomes assessment was performed by an independent observer at a mean of 5 years (range, 2-15 years) postoperatively. In addition, patients completed the Subjective Shoulder Value (range, 0%-100%). RESULTS After shoulder surgery, 21 (91%) of the 23 gymnasts returned to competitive gymnastics, and 20 gymnasts (87%) regained their preinjury level of sport. All international-level gymnasts returned to their preinjury level of sport. Three athletes (13%) underwent revision surgery, and 1 athlete (4%) ended his career without returning to competition. The postoperative period before resumption of competitive gymnastics was 9 ± 3.5 months (mean ± SD). Of the 15 gymnasts treated for shoulder instability with arthroscopic stabilization, 12 were able to return to their previous level of sport. All 8 gymnasts who had arthroscopic biceps tenodesis were able to return to their previous level of sport, as opposed to only 2 of 4 gymnasts treated with SLAP repair. The gymnastics-specific Subjective Shoulder Value score was 80% ± 11%. CONCLUSION Most gymnasts who required surgical treatment for a shoulder injury were able to return to competition at their previous level, although there was a considerable postoperative recovery period. Current arthroscopic reconstruction techniques were effective for treating structural lesions and allowing return to high-level gymnastics.
Collapse
|
|
14
|
Keeling LE, Looney AM, Curley AJ, Ehlers CB, Galel AM, Khalafallah YM, Vippa TK, Bryant BJ, Chang ES. Early Versus Delayed Active Range of Motion After Open Subpectoral Biceps Tenodesis. Orthop J Sports Med 2021; 9:23259671211026619. [PMID: 34458384 PMCID: PMC8392820 DOI: 10.1177/23259671211026619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background Little is known regarding the effect of early active elbow range of motion (ROM) protocols on failure rates and outcomes after open subpectoral biceps tenodesis. Hypothesis We hypothesized that patients managed using an early active ROM protocol after open subpectoral biceps tenodesis would demonstrate similar failure rates and functional outcomes compared to patients managed using a traditional delayed active ROM protocol. Study Design Cohort study; Level of evidence, 3. Methods We evaluated 63 patients who underwent open subpectoral biceps tenodesis with unicortical suture button fixation. Based on surgeon preference, 22 patients were managed using an early active motion protocol consisting of no restrictions on elbow flexion or forearm supination, while 41 patients were managed using a delayed motion protocol postoperatively. Primary outcome measures included failure of biceps tenodesis and American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores. Secondary outcomes included shoulder and elbow ROM at 6 months postoperatively. Results The mean follow-up for the 63 patients was 24.2 months postoperatively. One patient (2.4%) in the delayed active motion cohort and no patients in the early active motion cohort experienced failure. Final outcome scores as well as 6-month shoulder and elbow ROM indicated excellent functional outcomes, with no significant difference between motion cohorts. The median postoperative ASES scores were 97.99 in the early active motion cohort (mean ± standard deviation [SD], 95.49 ± 7.68) and 95.42 in the delayed motion cohort (mean ± SD, 90.93 ± 16.08), while median postoperative SANE scores were 96 in the early motion cohort (mean ± SD, 94.23 ± 6.68) and 95 in the delayed motion cohort (mean ± SD, 88.39 ± 17.98). Subgroup analysis demonstrated no significant difference in outcome scores based on the performance of concomitant rotator cuff repair or hand dominance. Conclusion Early active ROM after open subpectoral biceps tenodesis with unicortical suture button fixation resulted in low failure rates and excellent clinical outcomes, comparable to the results of patients managed using delayed active ROM protocols. This suggests that patients undergoing open subpectoral biceps tenodesis may be managed using either early or delayed active motion protocols without compromising functional outcome.
Collapse
Affiliation(s)
- Laura E Keeling
- Department of Orthopaedics, Georgetown University Hospital, Washington DC, USA
| | - Austin M Looney
- Department of Orthopaedics, Georgetown University Hospital, Washington DC, USA
| | - Andrew J Curley
- Department of Orthopaedics, Georgetown University Hospital, Washington DC, USA
| | - Cooper B Ehlers
- Georgetown University School of Medicine, Washington, DC, USA
| | - Alexandra M Galel
- Department of Orthopaedics, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | | | - Tarun K Vippa
- Department of Orthopaedics, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Brandon J Bryant
- Department of Orthopaedics, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Edward S Chang
- Department of Orthopaedics, Inova Fairfax Hospital, Falls Church, Virginia, USA
| |
Collapse
|
|
15
|
Christensen GV, Smith KM, Kawakami J, Chalmers PN. Surgical Management of Superior Labral Tears in Athletes: Focus on Biceps Tenodesis. Open Access J Sports Med 2021; 12:61-71. [PMID: 33981168 PMCID: PMC8107051 DOI: 10.2147/oajsm.s266226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/21/2021] [Indexed: 01/02/2023] Open
Abstract
Superior labrum anterior-posterior (SLAP) lesions are common in overhead athletes. Though some patients have asymptomatic lesions, many tears cause pain and diminished athletic performance. Accurate diagnosis of SLAP lesions can be challenging as the sensitivity and specificity of both the physical exam and advanced imaging is questionable. Management is also difficult, as treatment can be life-altering or career-ending for many athletes. If first-line nonoperative treatment fails, surgical options may be considered. The optimal surgical management of SLAP lesions in athletes is debated. Historically, return to play (RTP) rates among athletes who have undergone arthroscopic SLAP repair have been unsatisfactory, prompting clinicians to seek alternate surgical options. Biceps tenodesis (BT) has been postulated to eliminate biceps tendon-related pain in the shoulder and is increasingly used as a primary procedure for SLAP lesions. The purpose of this text is to review the current literature on the surgical management of SLAP lesions in athletes with an emphasis on the role of BT.
Collapse
Affiliation(s)
- Garrett V Christensen
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Karch M Smith
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Jun Kawakami
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT, USA
| |
Collapse
|
|
16
|
Dini AA, Mizels JE, Sadeghpour S, O'Brien MJ, Savoie FH, Getelman MH. Implant-Free Subpectoral Biceps Tenodesis Is Biomechanically at Higher Risk of Spiral Fracture of the Humerus Compared With Implant-Free Suprapectoral Biceps Tenodesis. Arthrosc Sports Med Rehabil 2021; 3:e73-e78. [PMID: 33615250 PMCID: PMC7879170 DOI: 10.1016/j.asmr.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 08/26/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To compare the likelihood of spiral fracture of the humerus using torsional load to failure after intraosseous biceps tenodesis at the position of the arthroscopic suprapectoral tenodesis versus the subpectoral meta-diaphyseal location. Methods Eight matched pairs of humeri were dissected. Unicortical tenodesis holes were drilled, either at the bottom of the bicipital groove (group 1) or just below the pectoralis major tendon insertion (subpectoral) in the humeral diaphysis (group 2). Tenodesis was performed in a 7-mm bone tunnel, with suture fixation distal to this site using 2 separate 2-mm holes, secured with No. 2 polyester suture. Each humerus was potted in plaster and mounted to a hydraulic torsional load frame, consistent with previously validated models for creating humeral spiral fractures. External rotation torque was applied to each humerus distally until fracture occurred. The paired t test was used to compare the 2 groups. Results Fracture occurred at the subpectoral cortical drill hole in all 8 specimens in group 2. In group 1, only 2 fractures occurred through the tenodesis hole, with spiral fracture resulting in the diaphysis of the humerus in 6 of 8 specimens. Average torque to failure measured 31.35 Nm in group 1 and 25.08 Nm in group 2; the difference was statistically significant (P < .0001). Conclusions Subpectoral cortical drill holes for biceps tenodesis were shown to be a stress riser for humeral spiral fracture. Suprapectoral cortical drill holes were shown to be significantly less of a stress riser. The amount of torque required to fracture the humerus through the subpectoral drill holes was less than with the suprapectoral drill holes. Only 2 fractures occurred through the suprapectoral tenodesis holes, and significantly more torque was required to create these fractures. Clinical Relevance Clinically, the difference between suprapectoral and subpectoral tenodesis fracture potential should be considered when selecting a tenodesis location.
Collapse
Affiliation(s)
| | - Joshua E Mizels
- Morsani College of Medicine, University of South Florida, Tampa, Florida, U.S.A
| | - Sohale Sadeghpour
- Memorial Hermann Memorial City Medical Center, Houston, Texas, U.S.A
| | - Michael J O'Brien
- Department of Sports Medicine, Tulane University, New Orleans, Louisiana, U.S.A
| | - Felix H Savoie
- Department of Sports Medicine, Tulane University, New Orleans, Louisiana, U.S.A
| | - Mark H Getelman
- Southern California Orthopedic Institute, Van Nuys, California, U.S.A
| |
Collapse
|
|
17
|
Erdle NJ, Osier CJ, Hammond JE. Humerus Fractures After Open Subpectoral Biceps Tenodesis: Three Cases with 2-year Functional Outcome Data and Review of the Literature. JBJS Case Connect 2021; 10:e0033. [PMID: 31899721 DOI: 10.2106/jbjs.cc.19.00033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE The authors present 3 cases of humerus fracture after biceps tenodesis performed by 3 different surgeons with radiographs and outcome scores with a minimum of 30 months follow-up. Fractures occurred between 7 days and 4 months postoperatively and include 2 fractures where tenodesis had been performed with interference screw fixation and one fracture where tenodesis had been performed with a bicortical endobutton technique. CONCLUSIONS These case reports highlight the risk of this complication in biceps tenodesis with bony fixation. The authors review the previously reported cases and relevant biomechanical studies that elucidate risk factors for humerus fracture and discuss alternative means to treat biceps tendon pathology.
Collapse
Affiliation(s)
- Nicholas J Erdle
- Department of Orthopaedic Surgery, Naval Medical Center, Portsmouth, Virginia
| | - Charles J Osier
- Department of Orthopaedic Surgery, Naval Medical Center, Portsmouth, Virginia
| | - James E Hammond
- Department of Orthopaedic Surgery, Naval Medical Center, Portsmouth, Virginia
| |
Collapse
|
|
18
|
Dekker TJ, Peebles LA, Preuss FR, Goldenberg BT, Dornan GJ, Provencher MT. A Systematic Review and Meta-analysis of Biceps Tenodesis Fixation Strengths: Fixation Type and Location Are Biomechanically Equivalent. Arthroscopy 2020; 36:3081-3091. [PMID: 32619605 DOI: 10.1016/j.arthro.2020.05.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this meta-analysis and systematic review was to critically evaluate the biomechanical outcomes of different fixation constructs for a variety of biceps tenodesis techniques in cadaveric models based on both type of fixation and location. METHODS A PROSPERO-registered systematic review (CCRD42018109243) of the current literature was conducted with the terms "long head of biceps" AND "tenodesis" AND "biomechanics" and numerous variations thereof in the PubMed, Embase, and Cochrane databases, yielding 1,460 abstracts. After screening by eligibility criteria, 18 full-text articles were included. The individual biomechanical factors evaluated included ultimate load to failure (in newtons), stiffness (in newtons per millimeter), and cyclic displacement (in millimeters). After reviewing the included literature, we performed a quality analysis of the studies (Quality Appraisal for Cadaveric Studies scale score) and a meta-analysis comparing raw mean differences in data between the suprapectoral and subpectoral fixation location groups, as well as between the fixation construct groups. RESULTS Among the 18 included studies, 347 cadaveric specimens were evaluated for ultimate load to failure, stiffness, and cyclic displacement when comparing both location (suprapectoral vs subpectoral) and tenodesis fixation type (interference screw vs cortical button, suture anchor, or all-soft-tissue techniques). Interference screw fixation showed significantly greater mean stiffness by 8.0 N/mm (P = .013) compared with the other grouped techniques but did not show significant differences when evaluated for ultimate load to failure and cyclic displacement (P = .28 and P = .18, respectively). Additionally, no difference in construct strength was seen when comparing the fixation strength of suprapectoral versus subpectoral techniques for stiffness, ultimate load to failure, and cyclic loading (P = .47, P = .053, and P = .13, respectively). CONCLUSIONS In this meta-analysis, no significant biomechanical differences were found when the results were stratified by specific surgical technique (interference screw vs other tenodesis techniques) and location (suprapectoral vs subpectoral biceps tenodesis). CLINICAL RELEVANCE As a result of this study, when biomechanically evaluating specific tenodesis constructs, the individual clinician has the liberty of choosing the fixation technique based on his or her preference and knowledge of shortcomings of each type of fixation construct.
Collapse
Affiliation(s)
| | - Liam A Peebles
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | | | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Matthew T Provencher
- The Steadman Clinic, Vail, Colorado, U.S.A; Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
| |
Collapse
|
|
19
|
Hong CK, Su WR, Kuan FC, Chen Y, Chiang CH, Hsu KL. High-Tensile Strength Tapes Show Greater Ultimate Failure Load and Less Stiffness Than High-Tensile Strength Sutures in a Subpectoral Biceps Tenodesis Porcine Model. Arthrosc Sports Med Rehabil 2020; 2:e795-e801. [PMID: 33376994 PMCID: PMC7754602 DOI: 10.1016/j.asmr.2020.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose To compare the biomechanical properties of high-tensile strength tape and a high-tensile strength suture in subpectoral biceps tenodesis using a suture anchor in a porcine tendon model. Methods A total of 24 artificial composite (polymer and glass fiber) humeri and porcine flexor profundus tendons were used. Two types of suture materials, high-tensile strength sutures (group S) and high-tensile strength tapes (group T), were evaluated. After we inserted metallic suture anchors with either 2 sutures or tapes 5 cm from the superomedial corner of the greater tuberosity, a Krackow suture technique was used to secure the tendons. After a preload of 5 N for 2 minutes, a cyclic loading test from 5 to 70 N was conducted for 500 cycles. Finally, the specimen was loaded to failure at a rate of 1 mm/s. Results There were no significant between-group differences in elongation after cyclic loading and elongation at failure load for group S and group T (P = .977 and .630, respectively). The ultimate failure loads in group T (278.2 ± 54 N) were significantly greater than those in group S (249.4 ± 32 N) (P = .028). In contrast, the stiffness values in group T (28.5 ± 4.0 N/mm) were significantly lower than those in group S (32.3 ± 4.5 N) (P = .028). Ten specimens in group S and 8 specimens in group T failed, with tendons being cut through by the sutures, whereas the other 2 specimens in group S and 4 specimens in group T failed due to suture breakage. Conclusions Using high-tensile strength tapes in subpectoral biceps tenodesis using a suture anchor leads to significantly greater ultimate failure load as compared with using high-tensile strength sutures in a porcine model. Although lower levels of stiffness were found in high-tensile strength tape group, the difference in the means were not large between 2 groups. Clinical Relevance A strong suture–tendon structure may prevent clinical failure of a subpectoral biceps tenodesis using a suture anchor.
Collapse
Affiliation(s)
- Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Hospital, Tainan
| | - Chen-Hao Chiang
- Department of Orthopaedic Surgery, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Department of Biomedical Engineering, National Cheng Kung University, Tainan
| |
Collapse
|
|
20
|
Medial Epicondyle Fractures: Biomechanical Evaluation and Clinical Comparison of 3 Fixation Methods Used in Pediatric Patients. J Pediatr Orthop 2020; 40:474-480. [PMID: 32555045 DOI: 10.1097/bpo.0000000000001601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Screw fixation is the most commonly employed fixation strategy for displaced medial epicondyle fractures, but in younger patients with minimal ossification, the fracture fragment may not accommodate a screw. In these situations, Kirschner-wires (K-wire) or suture anchors may be utilized as alternatives. The purposes of this study were to examine the biomechanical properties of medial epicondyle fractures fixed with a screw, K-wires, or suture anchors, to evaluate clinical outcomes and complications of patients 10 years of age or younger treated with these approaches, and to perform a cost-analysis. METHODS Biomechanical assessment: Immature pig forelimbs underwent an osteotomy through the medial epicondyle apophysis, simulating a fracture. These were then fixed with a screw, K-wires or suture anchors. Cyclic elongation (mm), displacement (mm), load to failure (N), and stiffness (N/mm) were assessed. Clinical assessment: a retrospective review was performed of patients 10 years of age or younger with a medial epicondyle fracture fixed with these strategies. Radiographic outcomes, postoperative data and complications were compared. These data were used to perform a cost-analysis of each treatment approach. RESULTS Biomechanically, screws were stronger (P=0.047) and stiffer (P=0.01) than the other constructs. Clinically, 51 patients met inclusion criteria (screw=27, wires=11, anchor=13). Patients treated with K-wires were younger (P<0.05) and patients treated with screw fixation had a shorter casting duration (P=0.008). Irrespective of treatment strategy, all fractures healed (100%) and only 1 patient in the screw group lost reduction. Clinical outcomes and complications were similar between groups, but the suture anchor group was less likely to require a second surgery for implant removal (P<0.05). This lower reoperation rate led to a cost-saving of 10%. CONCLUSIONS Biomechanically, all 3 approaches provided initial fixation exceeding the forces observed across the elbow joint with routine motion. The screw construct was the strongest and stiffest. Clinically, all 3 strategies were acceptable, with screw fixation offering a shorter casting duration, but greater implant removal need with higher associated costs.
Collapse
|
|
21
|
Umatani N, Arai R, Kuriyama S, Matsuda S. Anatomic limitations of biceps tenodesis using an interference screw for Asian people: a cadaveric study. JSES Int 2020; 4:422-426. [PMID: 32939462 PMCID: PMC7479053 DOI: 10.1016/j.jseint.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Biceps tenodesis using an interference screw has been commonly performed in clinical practice because of pathologic changes. Especially, the tenodesis distal to the bicipital groove, such as suprapectoral tenodesis (SPT) and subpectoral tenodesis (SBT), has been performed to avoid residual anterior shoulder pain. However, the techniques were developed based on research tested on Western population, and it is unknown whether they are applicable to Asian individuals, who have a smaller humerus than Western. The purpose of this study was to investigate the anatomic limitations of the biceps tenodesis using an interference screw for Asians. Methods We analyzed 22 fixed Japanese cadavers. We measured the length of the suprapectoral tenodesis zone (STZ), which is the area from the distal end of the lesser tuberosity to the proximal border of the insertion of the pectoralis major muscle tendon (PMMT) along the course of the biceps tendon, for the SPT. We also measured the bone tunnel depths (BTDs) for the SPT just distal to the lesser tuberosity along the course of the biceps tendon and, similarly, for the SBT just distal to the PMMT insertion. Finally, we analyzed the sexual differences and correlations of the measured values with the entire humeral length. Results In 9 shoulders (40.9%), the proximal border of the PMMT insertion was attached more proximally than the distal end of the lesser tuberosity, and the length of the STZ was negative. The mean BTDs in the SPT and SBT zones were 19.6 and 14.9 mm, respectively. In 11 shoulders (50%), the BTD in the SBT zone was shorter than 15 mm. The lengths of the STZ or BTDs in the SPT and SBT zones did not show statistical differences between sexes and were not correlated with the entire humeral length. Conclusion Asian patients would have anatomic limitations as follows for the biceps tenodesis regardless of their sex or body size. In anomalous PMMT cases, when the SPT was performed just proximal to the PMMT insertion, the bone tunnel entered into the bicipital groove. On the other hand, when the SPT was performed distal to the lesser tuberosity, a part of the PMMT insertion would be injured. Regarding the SBT, an interference screw with a length of ≥12 mm, which is commonly used in Western countries, is too long for Asians.
Collapse
Affiliation(s)
- Naoki Umatani
- Department of Orthopaedic Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Ryuzo Arai
- Department of Orthopaedic Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
|
22
|
Kuan FC, Hsu KL, Yen JZ, Wen MJ, Yeh ML, Chen Y, Su WR. Using Interconnected Knotless Anchor for Suprapectoral Biceps Tenodesis Could Offer Improved Biomechanical Properties in a Cadaveric Model. Arthroscopy 2020; 36:2047-2054. [PMID: 32259645 DOI: 10.1016/j.arthro.2020.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical characteristics of the interconnected knotless anchor (IKA) fixation with the double knotless anchor (DKA) and interference screw (IS) fixation in the suprapectoral biceps tenodesis. METHODS In total, 24 fresh-frozen human cadaveric shoulders (mean age, 67.3 ± 6 years) were used for the study. All the specimens were randomly divided into 3 experimental biceps tenodesis groups (n = 8): IKA, DKA, and IS. After tenodesis, each specimen was preloaded at 5 N for 2 minutes, followed by a cyclic loading test from 5 to 70 N for 500 load cycles. Finally, a destructive axial load to failure test (1 mm/s) was performed. All the values, including ultimate failure load, stiffness, cyclic displacement, and mode of failure were evaluated. RESULTS The IKA provided the highest construct stiffness (38.9 ± 7.7 N/mm) and ultimate failure load (288.3 ± 47.6 N), the results for which were statistically better than the corresponding results in the IS and DKA groups. In terms of cyclic displacement, there were no statistical differences among the 3 fixation constructs. The most common failure mode was biceps tendon tearing in IS group (7/8) and IKA group (8/8). In the contrast, suture slippage accounted for the most common failure mode in DKA. CONCLUSIONS In suprapectoral bicep tenodesis, IKA fixation appears to offer improved construct stiffness and ultimate failure load while maintaining comparable suture slippage as compared with IS fixation or DKA fixation in the current biomechanical study. CLINICAL RELEVANCE The IKA fixation compares favorably with other techniques and could be an alternative clinical option for suprapectoral biceps tenodesis.
Collapse
Affiliation(s)
- Fa-Chuan Kuan
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Joe-Zhi Yen
- National Cheng Kung University, Tainan, Taiwan
| | - Miin-Jye Wen
- Department of Statistics, Institute of Data Science, and Institute of International Management, Tainan, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Hospital, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan.
| |
Collapse
|
|
23
|
Patzer T. Editorial Commentary: Shoulder Biceps Tenodesis Implant Selection Requires Consideration of Complications and Cost. Arthroscopy 2020; 36:2055-2056. [PMID: 32747054 DOI: 10.1016/j.arthro.2020.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 02/02/2023]
Abstract
The long head of biceps tendon (LHB) has been evaluated as one of the most important pain generators of the shoulder. In addition, an unstable LHB can cause cartilage lesions of the humerus. For the treatment of LHB lesions, tenodesis or tenotomy has been shown to be appropriate. A well-performed biceps tenodesis provides a lower rate of Popeye-sign deformities compared with tenotomy but must result in low implant complication rates and costs.
Collapse
|
|
24
|
梁 达, 蒯 声, 李 瑛, 丘 志, 李 盛, 吴 冰, 钟 名, 李 皓, 柳 海, 陆 伟. [Biomechanical comparative analysis of screw fixation and cortical endo-button fixation in Latarjet procedure for anterior dislocation of shoulder joint]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:602-607. [PMID: 32410428 PMCID: PMC8171848 DOI: 10.7507/1002-1892.201909124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/08/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To clarify the value of the cortical endo-button as an internal fixator in Latarjet procedure through biomechanical analysis. METHODS Ten pairs of shoulder joints from 6-7 months old male pigs were selected. Each pair was randomly divided into screw group and endo-button group. A 25% glenoid defect model was created, and the porcine infraspinatus tendon and its associated bone were used to simulate conjoint tendon and coracoid process in human body. The bone grafts were fixed with two 3.5 mm screws and double cortical endo-buttons with high-strength sutures in screw group and endo-button group, respectively. The prepared glenoid defect model was fixed on a biomechanical test bench and optical markers were fixed on the glenoid and the bone block, respectively. Then fatigue test was performed to observe whether the graft or internal fixator would failed. During the test, the standard deviations of the relative displacement between the graft and the glenoid of two groups were measured by optical motion measure system for comparison. Finally the maximum failure load comparison was conducted and the maximum failure loads of the two groups were measured and compared. RESULTS There was no tendon tear, bone fracture, and other graft or internal fixation failure in the two groups during the fatigue test. The standard deviation of the relative displacement of the screw group was (0.007 87±0.001 44) mm, and that of the endo-button group was (0.034 88±0.011 10) mm, showing significant difference between the two groups ( t=7.682, P=0.000). The maximum failure load was (265±39) N in screw group and (275±52) N in endo-button group, showing no significant difference between the two groups ( t=1.386, P=0.199). There were 3 ways of failure: rupture at bone graft's tunnel (6/10 from screw group, 3/10 from endo-button group), tendon tear at the cramp (2/10 from screw group, 2/10 from endo-button group), and tendon tear at the internal fixator interface (2/10 from screw group, 5/10 from endo-button group), showing no significant difference between the two groups ( P=0.395). CONCLUSION Although the endo-button fixation fails to achieve the same strong fixation stability as the screw fixation, its fixation stability can achieve the clinical requirements. The two fixation methods can provide similar fixation strength when being used in Latarjet procedure.
Collapse
Affiliation(s)
- 达强 梁
- 深圳大学第一附属医院（深圳市第二人民医院）运动医学科（广东深圳 518000）Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People’s Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - 声政 蒯
- 深圳大学第一附属医院（深圳市第二人民医院）运动医学科（广东深圳 518000）Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People’s Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - 瑛 李
- 深圳大学第一附属医院（深圳市第二人民医院）运动医学科（广东深圳 518000）Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People’s Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - 志河 丘
- 深圳大学第一附属医院（深圳市第二人民医院）运动医学科（广东深圳 518000）Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People’s Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - 盛 李
- 深圳大学第一附属医院（深圳市第二人民医院）运动医学科（广东深圳 518000）Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People’s Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - 冰 吴
- 深圳大学第一附属医院（深圳市第二人民医院）运动医学科（广东深圳 518000）Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People’s Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - 名金 钟
- 深圳大学第一附属医院（深圳市第二人民医院）运动医学科（广东深圳 518000）Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People’s Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - 皓 李
- 深圳大学第一附属医院（深圳市第二人民医院）运动医学科（广东深圳 518000）Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People’s Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - 海峰 柳
- 深圳大学第一附属医院（深圳市第二人民医院）运动医学科（广东深圳 518000）Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People’s Hospital), Shenzhen Guangdong, 518000, P.R.China
| | - 伟 陆
- 深圳大学第一附属医院（深圳市第二人民医院）运动医学科（广东深圳 518000）Department of Sports Medicine, the First Affiliated Hospital of Shenzhen University (Shenzhen Second People’s Hospital), Shenzhen Guangdong, 518000, P.R.China
| |
Collapse
|
|
25
|
Aida HF, Shi BY, Huish EG, McFarland EG, Srikumaran U. Are Implant Choice and Surgical Approach Associated With Biceps Tenodesis Construct Strength? A Systematic Review and Meta-regression. Am J Sports Med 2020; 48:1273-1280. [PMID: 31585053 DOI: 10.1177/0363546519876107] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite the increasing use of biceps tenodesis, there is a lack of consensus regarding optimal implant choice (suture anchor vs interference screw) and implant placement (suprapectoral vs subpectoral). PURPOSE/HYPOTHESIS The purpose was to determine the associations of procedural parameters with the biomechanical performance of biceps tenodesis constructs. The authors hypothesized that ultimate failure load (UFL) would not differ between sub- and suprapectoral repairs or between interference screw and suture anchor constructs and that the number of implants and number of sutures would be positively associated with construct strength. STUDY DESIGN Meta-analysis. METHODS The authors conducted a systematic literature search for studies that measured the biomechanical performance of biceps tenodesis repairs in human cadaveric specimens. Two independent reviewers extracted data from studies that met the inclusion criteria. Meta-regression was then performed on the pooled data set. Outcome variables were UFL and mode of failure. Procedural parameters (fixation type, fixation site, implant diameter, and numbers of implants and sutures used) were included as covariates. Twenty-five biomechanical studies, representing 494 cadaveric specimens, met the inclusion criteria. RESULTS The use of interference screws (vs suture anchors) was associated with a mean 86 N-greater UFL (95% CI, 34-138 N; P = .002). Each additional suture used to attach the tendon to the implant was associated with a mean 53 N-greater UFL (95% CI, 24-81 N; P = .001). Multivariate analysis found no significant association between fixation site and UFL. Finally, the use of suture anchors and fewer number of sutures were both independently associated with lower odds of native tissue failure as opposed to implant pullout. CONCLUSION These findings suggest that fixation with interference screws, rather than suture anchors, and the use of more sutures are associated with greater biceps tenodesis strength, as well as higher odds of native tissue failure versus implant pullout. Although constructs with suture anchors show inferior UFL compared with those with interference screws, incorporation of additional sutures may increase the strength of suture anchor constructs. Supra- and subpectoral repairs provide equivalent biomechanical strength when controlling for potential confounders.
Collapse
Affiliation(s)
- Hiroshi F Aida
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brendan Y Shi
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric G Huish
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Edward G McFarland
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
|
26
|
The Double Krackow Suture Technique Does Not Offer a Significant Benefit Compared to the Krackow Suture Technique in Subpectoral Biceps Tenodesis Using a Double-Loaded Suture Anchor. Arthroscopy 2020; 36:701-707. [PMID: 31973990 DOI: 10.1016/j.arthro.2019.11.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 10/30/2019] [Accepted: 11/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical properties of the double simple suture (DSS) technique, Krackow suture (KS) technique, and double Krackow suture (DKS) technique in subpectoral biceps tenodesis using a double-loaded suture anchor in a porcine tendon model. METHODS A total of 30 artificial composite (polymer and glass fiber) humeri and porcine flexor profundus tendons with diameter of 4.5 mm were used. The sample size was determined based on the results of the pilot study. Metallic suture anchors with double-loaded No. 2 braided sutures were inserted at the subpectoral tenodesis site, 5 cm from the superomedial corner of the greater tuberosity. Three suture techniques were used to fix the tendons: a DSS used as the control, a KS, and a DKS, which is an alternative tendon graft fixation technique. A preload of 5 N was applied for 2 minutes, followed by cyclic loading for 500 cycles ranging from 5 to 70 N; next, a load-to-failure test at 1 mm/s was performed. RESULTS The KS (283.5 ± 57 N) and DKS (270.4 ± 50 N) groups had significantly greater ultimate failure loads as compared with the DSS group (84.1 ± 6.4 N) (P < .001). Meanwhile, the peak displacement at failure loads in the KS group (9.3 ± 2.2 mm) and DKS group (7.8 ± 1.7 mm) were significantly smaller than that of the DSS group (11.3 ± 2.9 mm) (P = .015). Stiffness in the DSS group (36.4 ± 3.0 N/mm), KS group (39.6 ± 2.5 N/mm), and DKS group (36.9 ± 4.6 N/mm) was not significantly different (P = .125). All DSS constructs and 6 KS constructs failed with tendons being cut through by the sutures, whereas the other 4 KS constructs and all DKS constructs failed resulting from suture breakage. CONCLUSIONS In this subpectoral biceps tenodesis model, both the KS technique and the DKS technique had similar time 0 biomechanical properties that were better than those of the double simple suture technique. CLINICAL RELEVANCE A sturdy suture-tendon structure could prevent clinical failure of a subpectoral biceps tenodesis using a suture anchor.
Collapse
|
|
27
|
Diaz M, Shi BY, Baker MC, Binkley MT, Belkoff SM, Srikumaran U. Open Biceps Tenodesis: A Biomechanical Comparison of 6 Fixation Techniques. Orthopedics 2020; 43:e102-e108. [PMID: 31930414 DOI: 10.3928/01477447-20200107-03] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/04/2019] [Indexed: 02/03/2023]
Abstract
Tenodesis is used to treat pathology of the long head of the biceps tendon. The authors evaluated the biomechanical properties of 6 techniques for biceps tenodesis fixation. The authors dissected 42 fresh-frozen cadaveric shoulders (mean age, 71±9.8 years; 69% male specimens), leaving the proximal humerus, proximal biceps tendon, and pectoralis major insertion. Specimens were randomized to undergo biceps tenodesis with one of the following: (1) an interference screw; (2) a cortical button; (3) a double-loaded 2.9-mm polyetheretherketone anchor (DL-2.9); (4) a double-loaded 1.9-mm all-suture anchor (DL-1.9); (5) a single-loaded 1.7-mm all-suture anchor (SL-1.7); or (6) soft tissue tenodesis. Specimens then underwent load-to-failure axial traction testing. A generalized linear and latent mixed model with a random-effects term was used to account for specimen pairing. Mean failure loads ranged from 136 N (95% confidence interval, 103-169 N) in the cortical button group to 79 N (95% confidence interval, 58-99 N) in the interference screw group. Failure occurred most often when fixation sutures pulled out of the tendon; however, 7 specimens failed elsewhere. No significant differences in ultimate failure load were found by treatment group. The interference screw group showed significantly more weakness than the cortical button and DL-2.9 groups. Tendon quality and suture parameters are likely more important than the fixation technique in determining failure load. [Orthopedics. 2020;43(2):e102-e108.].
Collapse
|
|
28
|
Cagle PJ, London DA, Gluck MJ, Morel S, Parsons BO. Long head of biceps tenodesis at the superior aspect of the biceps groove: A biomechanical comparison of inlay and onlay techniques. Shoulder Elbow 2020; 12:12-17. [PMID: 32010228 PMCID: PMC6974887 DOI: 10.1177/1758573218815281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/01/2018] [Accepted: 10/20/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Pathology involving the long head of the biceps tendon is a common source of shoulder pain. Biceps tenodesis has been successfully used in areas below the pectoralis, above the pectoralis, and above the biceps groove. However, clinical data are lacking for additional techniques for tenodesis at the superior aspect of the biceps groove. METHODS A biomechanical comparison was completed examining six matched pairs of cadaveric shoulders. The ultimate load to failure was compared between an inlay and onlay biceps tenodesis at the superior aspect of the biceps groove. RESULTS The results demonstrate an average construct strength of 215 N for the inlay technique and 210 N for the onlay technique. The difference between the two techniques was not significant. CONCLUSIONS This study demonstrates similar biomechanical strength for both constructs.
Collapse
Affiliation(s)
- Paul J Cagle
- Paul J Cagle Jr, Icahn School of Medicine at
Mount Sinai, 425 West 59th Street, 5th Floor, New York, NY 10019, USA.
| | | | | | | | | |
Collapse
|
|
29
|
Huang Y, Shu H, He B, Zhang F, Zhang C, Peng C, Sun L. Modified keyhole technique for the treatment of biceps long head tendon rupture. Exp Ther Med 2019; 18:4090-4094. [PMID: 31641383 PMCID: PMC6796457 DOI: 10.3892/etm.2019.8053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 09/10/2019] [Indexed: 11/16/2022] Open
Abstract
The present study aimed to assess a novel modified keyhole fixation technique to treat long head of biceps (LHB) rupture. From May 2015 to July 2017, a total of 9 patients with LHB rupture, decreased muscle strength and pop-eye sign were treated using the keyhole fixation technique combined with extramedullary cortical bone microplate-suspending fixation. Measurements of visual analog scale (VAS) score, elbow joint rotation, flexion strength, the Shoulder Score of the University of California Los Angeles (UCLA) and the Rating Scale of American Shoulder Elbow Surgeons (ASES) score were used to evaluate surgical outcomes prior to and following surgery. The 9 patients with LHB rupture included in the study were followed up for one year post-surgery. The supination and flexion elbow strength of all patients after 1 year was grade V and shoulder pain was relieved. The VAS, UCLA shoulder and ASES scores at one year post-surgery were significantly improved compared with those prior to surgery. In conclusion, modified keyhole fixation for LHB rupture features low difficulty of operation, high safety and reliable fixation, and is therefore a promising novel technique for the treatment of LHB rupture.
Collapse
Affiliation(s)
- Yao Huang
- Department of Orthopedics, Sports Medicine Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Hao Shu
- Department of Orthopedics, Sports Medicine Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Bing He
- Department of Orthopedics, Sports Medicine Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Fucheng Zhang
- Department of Orthopedics, Sports Medicine Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Chunsheng Zhang
- Department of Orthopedics, Sports Medicine Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Chengjian Peng
- Department of Orthopedics, Sports Medicine Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Luning Sun
- Department of Orthopedics, Sports Medicine Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| |
Collapse
|
|
30
|
Taylor SA. Editorial Commentary: Size Matters: Biomechanical Analysis of All-Suture Suture-Anchor Fixation Compared to Conventional Suture Anchors and Interference Screws for Biceps Tenodesis. Arthroscopy 2019; 35:1769-1770. [PMID: 31159962 DOI: 10.1016/j.arthro.2019.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/07/2019] [Indexed: 02/02/2023]
Abstract
Anchors and screws demonstrate similar fixation properties for shoulder biceps tenodesis allowing healing, but anchors requiring smaller drill holes reduce the risk of postoperative fractures under torsional stress. Clinicians could create the smallest possible holes in the humerus, especially in throwing athletes who create large torsional stresses.
Collapse
|
|
31
|
Frank RM, Bernardoni ED, Veera SS, Waterman BR, Griffin JW, Shewman EF, Cole BJ, Romeo AA, Verma NN. Biomechanical Analysis of All-Suture Suture Anchor Fixation Compared With Conventional Suture Anchors and Interference Screws for Biceps Tenodesis. Arthroscopy 2019; 35:1760-1768. [PMID: 31072716 DOI: 10.1016/j.arthro.2019.01.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical properties of all-suture suture anchors (ASSAs) with conventional interference screws (CISs) and conventional suture anchors (CSAs) for long head of the biceps tendon fixation during proximal biceps tenodesis (BT). METHODS We randomized 21 fresh-frozen human cadaveric shoulders into 3 subpectoral BT treatment groups: ASSA, CSA, and CIS. Each construct was cyclically loaded from 5 to 70 N for 500 cycles (1 Hz). All specimens that survived cyclic loading were then pulled to failure (1 mm/s). Elongation, maximum load, energy, and failure mode were recorded. The humerus was stripped of tissue and then subjected to torsional displacement at a rate of 1°/s until fracture occurred. Maximum load, displacement, stiffness, and energy were recorded. RESULTS During tendon testing, 3 specimens (43%) in the CIS group failed early during cyclic testing by the tendon tearing at the screw-tendon interface. All other specimens in the CIS group, as well as all specimens in the ASSA and CSA groups, survived cyclic testing and failed during pull-to-failure testing. Failure occurred at the tendon-anchor or -screw interface in all specimens (100%), with no anchor or screw pullout. The CIS group had significantly decreased elongation (8.9 ± 2.23 mm) at maximum load compared with the ASSA (19.2 ± 5.2 mm) and CSA (18.9 ± 2.23 mm) groups (P = .001). During torsional testing, the ASSA group was able to withstand significantly greater torsional displacement (9.22° ± 0.86°) before failure and had greater energy to failure (497.3 ± 45 Nmm-degrees) than the CIS group (6.13° ± 1.24° and 256.6 ± 70.3 Nmm-degrees, respectively; P = .005). CONCLUSIONS This study shows that the biomechanical properties of ASSA, CSA, and CIS constructs are similar. The interference screw group had lower tendon elongation at maximum load but had several early failures compared with the suture anchor groups. The use of suture anchors results in maximum tendon and torsional bone loads similar to interference screws for the long head of the biceps tendon. Torsional testing of the CIS resulted in spiral fractures traversing the screw tunnel in 100% of the specimens, which was not found in the suture anchor groups. CLINICAL RELEVANCE The ASSA is a viable fixation method for BT in comparison with the CSA and CIS.
Collapse
Affiliation(s)
- Rachel M Frank
- Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Eamon D Bernardoni
- Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Shreya S Veera
- Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian R Waterman
- Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Justin W Griffin
- Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Elizabeth F Shewman
- Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Section of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| |
Collapse
|
|
32
|
Hassan S, Patel V. Biceps tenodesis versus biceps tenotomy for biceps tendinitis without rotator cuff tears. J Clin Orthop Trauma 2019; 10:248-256. [PMID: 30828187 PMCID: PMC6383069 DOI: 10.1016/j.jcot.2018.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/18/2018] [Accepted: 12/30/2018] [Indexed: 01/25/2023] Open
Abstract
Disorders of the long head of the biceps tendon (LHB) are a well-recognised cause of shoulder pain despite the function of the long head of the biceps remaining poorly understood. There has been a dramatic rise in the number of biceps tenodesis procedures being performed in the last decade. This may partly be attributed to concerns regarding residual cosmetic deformity and pain after biceps tenotomy though there is little evidence to suggest that functional outcomes of tenodesis are superior to biceps tenotomy. Current literature focuses on LHB disorders with concomitant rotator cuff tears. The aim of this review is to discuss the anatomy of the LHB, the pathogenesis of tendinopathy of the LHB, indications of biceps tenodesis and tenotomy and compare the current literature on the functional outcomes of these procedures for LHB disorders in the absence of rotator cuff tears.
Collapse
Affiliation(s)
| | - Vipul Patel
- Corresponding author. Department of Trauma and Orthopaedic Surgery, South West London Elective Orthopaedic Centre, Dorking Road, Epsom, KT18 7EG, United Kingdom
| |
Collapse
|
|
33
|
Liechti DJ, Mitchell JJ, Menge TJ, Hackett TR. Immediate physical therapy without postoperative restrictions following open subpectoral biceps tenodesis: low failure rates and improved outcomes at a minimum 2-year follow-up. J Shoulder Elbow Surg 2018; 27:1891-1897. [PMID: 29804912 DOI: 10.1016/j.jse.2018.02.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 02/14/2018] [Accepted: 02/17/2018] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS We aimed to determine patient-reported outcomes in patients undergoing open subpectoral biceps tenodesis with a dual-fixation construct who had no postoperative range-of-motion or weight-bearing restrictions. Our hypothesis was that patients without postoperative restrictions would have low failure rates with improved patient-reported outcomes. We further hypothesized that this technique would allow an earlier return to activity and similar functional outcomes when compared with those reported in the literature. METHODS In this institutional review board-approved retrospective outcome study, we evaluated 105 patients who underwent primary open subpectoral biceps tenodesis with a bicortical suture button and interference screw construct without postoperative restrictions. The primary outcome measure was failure of the biceps tenodesis. Postoperative outcome scores included the Short Form 12 (SF-12) Physical Component Score; SF-12 Mental Component Score; American Shoulder and Elbow Surgeons total score and subscales; and Disabilities of the Arm, Shoulder and Hand score. RESULTS A total of 98 patients (85%) were available for final follow-up at an average of 3.5 years. There were 2 failures (2.2%), at 5 weeks and 9 weeks postoperatively. Four patients underwent additional surgery unrelated to the previous tenodesis procedure. Final outcome scores indicated high levels of function, including the SF-12 Physical Component Score (mean, 51.5; SD, 7.8), SF-12 Mental Component Score (mean, 54.7; SD, 6.7), American Shoulder and Elbow Surgeons total score (mean, 89.4; SD, 14.2), and Disabilities of the Arm, Shoulder and Hand score (mean, 11.3; SD, 13.4). CONCLUSION Open subpectoral biceps tenodesis using a dual-fixation construct with no postoperative motion restrictions resulted in excellent outcomes with a low incidence of failure.
Collapse
Affiliation(s)
| | | | | | - Thomas R Hackett
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
| |
Collapse
|
|
34
|
Biomechanical properties of suprapectoral biceps tenodesis: double knotless screw fixation is superior to single knotless screw fixation. Arch Orthop Trauma Surg 2018; 138:1127-1134. [PMID: 29767346 DOI: 10.1007/s00402-018-2927-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The purpose of this study is to biomechanically evaluate a new technique of double knotless screw fixation for suprapectoral biceps tenodesis and compare the results with that of the single knotless screw fixation as well as the interference screw fixation. METHODS 24 fresh-frozen human cadaveric shoulders with a mean age of 68.3 ± 9 years were studied. The specimens were randomly divided into three experimental biceps tenodesis groups (n = 8): single knotless screw, double knotless screw and interference screw. Each tenodesis specimen was mounted on a mechanical testing machine, preloaded for 2 min at 5 N, tested with cyclic loading from 5 to 70 N for 500 load cycles and subjected to an axial load to failure test (1 mm/s). The ultimate failure load, stiffness, cyclic displacement and mode of failure were evaluated. RESULTS The interference screw fixation had the highest ultimate failure load (215.8 ± 43.1 N) and stiffness (25.7 ± 5.2 N/mm) which were significantly higher than the corresponding results for the single and double knotless screw groups (P = 0.0029). The double knotless screw group had the second highest ultimate failure load (162.8 ± 13.8 N) and stiffness (15.1 ± 4.1 N/mm) which were significantly higher than the corresponding results for the single knotless screw technique (P = 0.0002). The most common mode of failure was suture slippage for both the double (7/8) and single knotless screw (6/8) groups while biceps tendon tearing occurred most often for the interference screw group (6/8). CONCLUSION In this biomechanical study, the double knotless screw fixation was found to have a significantly greater ultimate failure load and stiffness than the single knotless screw fixation but lower values than the interference screw fixation.
Collapse
|
|
35
|
Biomechanical Evaluation of a Transtendinous All-Suture Anchor Technique Versus Interference Screw Technique for Suprapectoral Biceps Tenodesis in a Cadaveric Model. Arthroscopy 2018; 34:1755-1761. [PMID: 29482858 DOI: 10.1016/j.arthro.2018.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/23/2017] [Accepted: 01/02/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical properties of an transtendinous all-suture anchor technique with the commonly-accepted interference screw technique in a cadaveric model. METHODS Sixteen fresh-frozen human cadaveric shoulders (mean age, 67.6 ± 5.8 years) were used and were randomly divided into 2 experimental long head of the biceps brachii (LHB) tenodesis groups (n = 8), namely transtendinous all-suture anchor technique and interference screw technique. The location of tenodesis was in the bicipital groove, 1 cm distal to the proximal border of the bicipital groove. Tensile force parallel to the longitudinal axis of the humerus was applied to each specimen. A preload of 5 N was applied for 2 minutes, followed by cyclic loading for 500 cycles from 5 to 70 N at 1 Hz; then, a load-to-failure test at 1 mm/s was performed. The ultimate failure load, stiffness, cyclic displacement, failure displacement, and failure modes were recorded. RESULTS The transtendinous all-suture anchor technique provided similar ultimate failure load and stiffness as the interference screw technique. However, the cyclic and failure displacements of the transtendinous all-suture anchor technique were significantly greater than the interference screw technique (P = .009 and .021, respectively). Six specimens in the transtendinous all-suture anchor group failed because of suture anchor pullout, while failure of the other 2 was caused by tendon tear; by contrast, all specimens in the interference screw group failed because of tendon tear. CONCLUSIONS The transtendinous all-suture anchor technique for LHB tenodesis offered equivalent ultimate failure load and stiffness but had significantly larger cyclic and failure displacement values when compared with the interference screw technique in this cadaveric biomechanical study. CLINICAL RELEVANCE The transtendinous all-suture anchor technique is an alternative technique for suprapectoral LHB tenodesis; however, care should be taken because only time zero biomechanical data are available.
Collapse
|
|
36
|
Lansdown DA, Bernardoni ED, Verma NN. Surgical technique for arthroscopic onlay suprapectoral biceps tenodesis with an all-suture anchor. JSES OPEN ACCESS 2018; 2:69-73. [PMID: 30675570 PMCID: PMC6334878 DOI: 10.1016/j.jses.2017.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The long head of the biceps is a frequent pain generator in the shoulder. Tendinopathy of the long head of the biceps may be treated with biceps tenodesis. There has been great debate about the optimal technique for biceps tenodesis, without a clear distinction between different techniques. Biceps tenodesis fixation may include interference fixation, suspensory fixation, all-suture anchors, and soft tissue fixation. In this technical note, we describe an all-arthroscopic onlay suprapectoral biceps tenodesis with an all-suture anchor.
Collapse
Affiliation(s)
- Drew A Lansdown
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Nikhil N Verma
- Department of Orthopedic Surgery, Rush University, Chicago, IL, USA
| |
Collapse
|
|
37
|
Mellano CR, Frank RM, Shin JJ, Jain A, Zuke WA, Mascarenhas R, Shewman E, Cole BJ, Romeo AA, Verma NN, Forsythe B. Subpectoral Biceps Tenodesis With PEEK Interference Screw: A Biomechanical Analysis of Humeral Fracture Risk. Arthroscopy 2018; 34:806-813. [PMID: 29287950 DOI: 10.1016/j.arthro.2017.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 09/03/2017] [Accepted: 09/03/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify the torsional load to fracture for subpectoral biceps tenodesis with interference screw fixation. METHODS We randomized 28 specimens from 14 matched-pair full-length humeri (mean age, 55.3 years) into 3 groups: (1) empty ream group (ERG), (2) screw-only group (SOG), and (3) screw-plus-biceps tendon group (SBG). In each group, 1 humerus of each matched pair was prepared according to group allocation and the contralateral humerus remained intact as a control. In the ERG, an 8-mm unicortical hole was reamed 1 cm proximal to the inferior border of the pectoralis major tendon insertion; in the SOG, the humerus was filled with an 8-mm × 12-mm PEEK (polyether ether ketone) screw; and in the SBG, the humerus was filled with a PEEK screw and the cadaveric long head of the biceps tendon. Humeri were tested under torsional displacement at a rate of 1°/s until fracture. Maximum torque, energy to maximum torque, and linear stiffness were used to assess humerus strength. RESULTS Compared with contralateral intact specimens, the maximum torque to fracture was reduced by 28% in the ERG (P = .005), 30% in the SOG (P = .014), and 20% in the SBG (P = .046). Energy to maximum torque was similarly reduced in the ERG (P = .007), SOG (P = .023), and SBG (P = .049). Stiffness was increased by 4% in the ERG (P = .498), 9% in the SOG (P = .030), and 4% in the SBG (P = .439). CONCLUSIONS Drilling an 8-mm unicortical hole in zone 3 of the bicipital tunnel for open subpectoral biceps tenodesis reduces the torsional load to humeral fracture up to 28% at time 0. The addition of a PEEK tenodesis screw alone reduced the maximum torque by 30%, and the addition of a screw with the long head of the biceps tendon reduced the maximum torque by 20%. The total load to fracture was reduced in all settings. Stiffness was not significantly different for the ERG and SBG, but stiffness was significantly higher for the SOG compared with the intact matched humeri at time 0. CLINICAL RELEVANCE When performing a biceps tenodesis, humeral fracture susceptibility is increased with an applied torsional load at time 0. Thus providers must be aware of this reduced integrity when a subpectoral biceps tenodesis is used.
Collapse
Affiliation(s)
- Christopher R Mellano
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Rachel M Frank
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jason J Shin
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Akshay Jain
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - William A Zuke
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Randy Mascarenhas
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Elizabeth Shewman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Anthony A Romeo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| |
Collapse
|
|
38
|
Hamstring Autograft Reconstruction of the Peroneus Brevis. TECHNIQUES IN FOOT AND ANKLE SURGERY 2018. [DOI: 10.1097/btf.0000000000000158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
|
39
|
Abstract
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.
Collapse
|
|
40
|
Clinical and sonographic evaluation of subpectoral biceps tenodesis with a dual suture anchor technique demonstrates improved outcomes and a low failure rate at a minimum 2-year follow-up. Arch Orthop Trauma Surg 2018; 138:63-72. [PMID: 29038845 DOI: 10.1007/s00402-017-2810-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the clinical outcomes and integrity of an open subpectoral biceps tenodesis using a dual suture anchor construct. MATERIALS AND METHODS Patients with at least 2 years of follow-up were retrospectively evaluated for simple shoulder test (SST), American Shoulder and Elbow Surgeons (ASES) score, and visual analog scales (VAS) for pain, function and satisfaction. A physical exam assessed shoulder range of motion and elbow strength. Ultrasonography visualized construct integrity. RESULTS Of 43 eligible patients, 36 completed questionnaire evaluation and 22 completed an additional physical examination. Indications included superior labral anterior-posterior (SLAP) lesions (4), partial thickness tears (6), instability (6), and tenosynovitis of the biceps tendon (20). Eighteen patients (50%) had an associated rotator cuff tear. Patient-reported outcomes improved pre- vs postoperatively: ASES score (45.4 vs 78.6, P < 0.001), SST (5.1 vs 9.6, P < 0.001), pain-VAS (4.8 vs 2.0, P < 0.001), and function-VAS (4.9 vs 2.3, P < 0.001). Satisfaction-VAS was 8.3 postoperatively. Patient-reported outcomes did not differ for patients with an associated rotator cuff tear compared to those without (P ≥ 0.427). None of the physical exam measures were lower on the operative side compared to the healthy side (P ≥ 0.516). Sonographic evaluation revealed preserved integrity of the tenodesis construct in all cases. No complications were noted. CONCLUSIONS Subpectoral biceps tenodesis utilizing a dual suture anchor technique is a treatment option for SLAP lesions, partial thickness tears, subluxation, and tenosynovitis of the long head of the biceps with high rates of postoperative patient satisfaction, a low failure rate, and improved outcome scores. The presence of a concomitant rotator cuff tear did not influence clinical outcomes.
Collapse
|
|
41
|
Hufeland M, Kolem C, Ziskoven C, Kircher J, Krauspe R, Patzer T. The influence of suprapectoral arthroscopic biceps tenodesis for isolated biceps lesions on elbow flexion force and clinical outcomes. Knee Surg Sports Traumatol Arthrosc 2017; 25:3220-3228. [PMID: 26564214 DOI: 10.1007/s00167-015-3846-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/22/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE To prospectively evaluate elbow flexion force, cosmetic and clinical outcome of all-arthroscopic suprapectoral biceps tenodesis for isolated biceps lesions. METHODS Tenodesis was performed using a 6.25-mm absorbable interference screw for intraosseous fixation. Seventeen out of 24 patients (70.8 %, median age 49.0 ± 10.1 years; 10 = male) could be included for 24 months follow-up. Elbow flexion strength in 10° and 90° elbow flexion, the upward-directed force of the upper arm in the O'Brien position, objective evaluation of a Popeye-sign deformity and validated clinical scores (CMS, SST, ASES) were assessed preoperatively, 3, 6, 12 and 24 months postoperatively. RESULTS Elbow flexion strength in 90° improved significantly from 12 months onwards (P = 0.001) without significant difference to the contralateral arm from 3 months postoperatively (n.s.). At 24 months, an average increase of 46.4 % (median 37.7 %) from preoperative could be seen. The dominant arm was affected in 70.6 %. All scores showed a significant improvement 3 months postoperatively: SST (P = 0.003), ASES (P = 0.006) and total CMS (P < 0.001). Three patients (17.6 %) developed a distalization of the maximum biceps circumference of more than 20 % compared to preoperative. CONCLUSIONS All-arthroscopic proximal suprapectoral intraosseous single-limb biceps tenodesis for the treatment of isolated biceps lesions provides good-to-excellent clinical results with significant improvement of elbow flexion strength and clinical scores and no significant difference to the unaffected contralateral arm. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Martin Hufeland
- Department of Orthopaedics, University Hospital of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Carina Kolem
- Department of Orthopaedics, University Hospital of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Christoph Ziskoven
- Department of Orthopaedics, University Hospital of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Jörn Kircher
- Department of Orthopaedics, University Hospital of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Rüdiger Krauspe
- Department of Orthopaedics, University Hospital of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Thilo Patzer
- Department of Orthopaedics, University Hospital of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| |
Collapse
|
|
42
|
A cadaveric assessment of the risk of nerve injury during open subpectoral biceps tenodesis using a bicortical guidewire. Knee Surg Sports Traumatol Arthrosc 2017; 25:2858-2863. [PMID: 26740085 DOI: 10.1007/s00167-015-3972-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the risk of neurological injury from the placement of a bicortical guidewire during subpectoral biceps tenodesis. METHODS Ten forequarter cadaver specimens were evaluated. A bicortical guidewire was placed, and measurements to important local neurological structures were made with digital calipers at open dissection. RESULTS The mean (range, SD) distances from the guidewire to the respective nerves was as follows: axillary nerve posteriorly, 15.7 mm (10-22 mm, 3.4); axillary nerve laterally, 18.7 mm (12-27 mm, 4.3); radial nerve posteriorly, 26.2 mm (16-35 mm, 7.0); radial nerve medially, 25 mm (16-33 mm, 4.4); and musculocutaneous nerve, 20.1 mm (12-26 mm, 5.2). CONCLUSIONS There has been some disagreement in the literature regarding the proximity of a bicortical guidewire to the axillary nerve posteriorly. The results of this study concur with reports from several other authors and demonstrate that this nerve is at risk of iatrogenic injury when using this technique. The clinical relevance of this work is to allow surgeons to better understand the proximity of the nerve to a bicortical guidewire and to highlight that this risk is avoided with a unicortical technique.
Collapse
|
|
43
|
Schoch C, Geyer M, Drews B. Suprapectoral biceps tenodesis using a suture plate: clinical results after 2 years. Arch Orthop Trauma Surg 2017; 137:829-835. [PMID: 28374091 DOI: 10.1007/s00402-017-2664-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Indexed: 12/16/2022]
Abstract
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.
Collapse
Affiliation(s)
- Christian Schoch
- St. Vinzenz Klinik Pfronten, Kirchweg 15, 87459, Pfronten, Germany.
| | - Michael Geyer
- St. Vinzenz Klinik Pfronten, Kirchweg 15, 87459, Pfronten, Germany
| | - Björn Drews
- Klinik für Unfall-, Hand-, Plastische und Wiederherstellungschirurgie, Zentrum für Chirurgie, Universitätsklinikum Ulm, Ulm, Germany
| |
Collapse
|
|
44
|
Park JS, Kim SH, Jung HJ, Lee YH, Oh JH. A Prospective Randomized Study Comparing the Interference Screw and Suture Anchor Techniques for Biceps Tenodesis. Am J Sports Med 2017; 45:440-448. [PMID: 28146397 DOI: 10.1177/0363546516667577] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several methods are used to perform biceps tenodesis in patients with superior labrum-biceps complex (SLBC) lesions accompanied by a rotator cuff tear. However, limited clinical data are available regarding the best technique in terms of clinical and anatomic outcomes. PURPOSE To compare the clinical and anatomic outcomes of the interference screw (IS) and suture anchor (SA) fixation techniques for biceps tenodesis performed along with arthroscopic rotator cuff repair. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS A total of 80 patients who underwent arthroscopic rotator cuff repair with SLBC lesions were prospectively enrolled and randomly divided according to the tenodesis method: the IS and SA groups. Functional outcomes were evaluated with the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Constant score, Korean Shoulder Score (KSS), and long head of the biceps (LHB) score at least 2 years after surgery. The anatomic status of tenodesis was estimated using magnetic resonance imaging or ultrasonography, and the anatomic failure of tenodesis was determined when the biceps tendon was not traced in the intertubercular groove directly from the insertion site of the IS or SA. RESULTS Thirty-three patients in the IS group and 34 in the SA group were monitored for more than 2 years. All postoperative functional scores improved significantly compared with the preoperative scores (all P < .001) and were not significantly different between the groups, including the LHB score (all P > .05). Nine anatomic failures of tenodesis were observed: 7 in the IS group and 2 in the SA group ( P = .083). In a multivariate analysis using logistic regression, IS fixation ( P = .003) and a higher (ie, more physically demanding) work level ( P = .022) were factors associated with the anatomic failure of tenodesis significantly. In patients with tenodesis failure, the LHB score ( P = .049) and the degree of Popeye deformity by the patient and examiner ( P = .004 and .018, respectively) were statistically different compared with patients with intact tenodeses. CONCLUSION Care must be taken while performing biceps tenodesis in patients with a higher work level; IS fixation appears to pose a higher risk in terms of the anatomic failure of tenodesis than SA fixation, although functional outcomes were not different.
Collapse
Affiliation(s)
- Ji Soon Park
- Department of Orthopaedic Surgery, Sheikh Khalifa Specialty Hospital, Ras al Khaimah, United Arab Emirates.,Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sae Hoon Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Jin Jung
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Ye Hyun Lee
- Department of Orthopaedic Surgery, National Police Hospital, Seoul, Korea
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| |
Collapse
|
|
45
|
Gigi R, Dolkart O, Sharfman ZT, Goldstein Y, Brosh T, Rath E, Maman E, Chechik O. Biomechanical evaluation of two arthroscopic techniques for biceps tenodesis: triple loop suture versus simple suture. J Shoulder Elbow Surg 2017; 26:165-169. [PMID: 27499518 DOI: 10.1016/j.jse.2016.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/23/2016] [Accepted: 05/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Several techniques and procedures have been described to treat long head of the biceps pathology; however, tenodesis and tenotomy are the 2 most common procedures performed. This study evaluated the initial fixation strength of the biceps tenodesis triple loop suture (TLS) technique and compared it with that of the simple suture technique (SST). METHODS Twenty fresh frozen cadaveric human shoulders (humeral head and neck with attached biceps tendons) were harvested. The biceps tendon was tenotomized proximally before reattachment to the bicipital groove of the matching humerus using suture anchors. Tenodesis was performed using the SST or the TLS technique. Specimens were tested biomechanically for load to failure, stress, and stiffness. The mechanism of failure was evaluated and compared between the 2 suture techniques. RESULTS Maximal load to failure was significantly greater using the TLS technique (122.2 ± 26.73 N) than the SST (46.12 ± 14.37 N, P < .001). There was no difference in the mean stiffness (SST: 7.33 ± 4.41 N/mm, TLS: 7.46 N/mm ± 2.67, P = .94). The failure mechanism in all SST samples occurred by suture cutout through the longitudinal fibers of the tendon. In all TLS samples, the failure occurred by suture slippage. CONCLUSION This study demonstrated superior load to failure of the TLS compared with the SST technique for biceps tenodesis. Furthermore, this study provides the first description of the TLS technique as a possible application in biceps tenodesis. Clinical application of the TLS must be carefully considered, because although it achieved a superior biomechanical profile, experience with this stitch is limited.
Collapse
Affiliation(s)
- Roy Gigi
- Shoulder Unit, Orthopaedic Surgery Division, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oleg Dolkart
- Shoulder Unit, Orthopaedic Surgery Division, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Zachary T Sharfman
- Shoulder Unit, Orthopaedic Surgery Division, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Goldstein
- Shoulder Unit, Orthopaedic Surgery Division, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Brosh
- Biomechanics Laboratory, School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Rath
- Shoulder Unit, Orthopaedic Surgery Division, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Maman
- Shoulder Unit, Orthopaedic Surgery Division, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Chechik
- Shoulder Unit, Orthopaedic Surgery Division, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
|
46
|
Ramos CH, Coelho JCU. Avaliação biomecânica da fixação do tendão da cabeça longa do bíceps braquial por três técnicas: modelo em ovinos. Rev Bras Ortop 2017. [DOI: 10.1016/j.rbo.2016.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
|
47
|
Ramos CH, Coelho JCU. Biomechanical evaluation of the long head of the biceps brachii tendon fixed by three techniques: a sheep model. Rev Bras Ortop 2017; 52:52-60. [PMID: 28194382 PMCID: PMC5290131 DOI: 10.1016/j.rboe.2016.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/18/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To evaluate the biomechanical properties of the fixation of the long head of the biceps brachii into the humeral bone with suture anchors, interference screw, and soft tissue suture, comparing strength, highest traction load, and types of fixation failure. METHODS Thirty fresh-frozen sheep shoulders were used, separated into three groups of ten for each technique. After fixation, the tendons were subjected to longitudinal continuous loading, obtaining load-to-failure (N) and displacement (mm). RESULTS The mean load-to-failure for suture anchors was 95 ± 35.3 N, 152.7 ± 52.7 N for interference screw, and 104.7 ± 23.54 N for soft tissue technique. There was a statistically significant difference (p < 0.05), with interference screw demonstrating higher load-to-failure than suture anchor fixation (p = 0.00307) and soft tissue (p = 0.00473). The strength of interference screw was also superior when compared with the other two methods (p = 0.0000127 and p = 0.00000295, respectively). There were no differences between suture anchors and soft tissue technique regarding load-to-failure (p = 0.9420) and strength (p = 0.141). CONCLUSION Tenodesis of the long head of the biceps brachii with interference screw was stronger than the suture anchors and soft tissue techniques. The other two techniques did not differ between themselves.
Collapse
|
|
48
|
Arthroscopic Suprapectoral and Open Subpectoral Biceps Tenodesis: Radiographic Characteristics. Arthroscopy 2016; 32:2234-2242. [PMID: 27265249 DOI: 10.1016/j.arthro.2016.03.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To provide a detailed account of the location of the long head of the biceps (LHB) tenodesis tunnels using an all-arthroscopic suprapectoral technique in a prospective group of patients. These patients were then compared with a retrospective group of open subpectoral tenodesis patients of similar characteristics. METHODS Postoperative radiographs from a prospective group of all-arthroscopic suprapectoral LHB tenodeses were compared with a retrospective group of open subpectoral tenodeses. Digital anteroposterior images were used to measure distances from clinically pertinent radiographic landmarks to tenodesis tunnel sites. RESULTS Forty patients (20 all-arthroscopic, 20 open) met the inclusion criteria. The inferior border of the bicipital groove was located a mean distance of 33.7 ± 6.9 mm from the top of the humeral head. The mean distance measured in the open group was approximately 28 mm (P < .001) distal compared with the arthroscopic group. The humeral diameter was 7.5 ± 5.4 mm narrower at the subpectoral tenodesis site (P < .001). All 20 patients in the open subpectoral group had tenodesis tunnels placed distal to the bicipital groove compared with 17 of 20 patients (85%) in the all-arthroscopic group. There were 2 cases of lateral wall cortical reaming during subpectoral tenodesis but no periprosthetic humeral fractures. There were 2 cases of bicortical reaming during the all-arthroscopic tenodesis with no known complications. CONCLUSIONS The location of biceps tenodesis significantly differs between all-arthroscopic suprapectoral and open subpectoral techniques, and the open subpectoral method achieves fixation in a significantly narrower region of the humerus. LEVEL OF EVIDENCE Level III, retrospective comparative study.
Collapse
|
|
49
|
Lissy M, Esquivel A, Cracchiolo A, Lemos S. Biomechanical properties of tenotomy versus biceps knot in a cadaver model. J Orthop 2016; 13:177-80. [PMID: 27408492 DOI: 10.1016/j.jor.2016.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/03/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Biceps tenotomy and biceps tenodesis are the primary methods of treating biceps pathology. This study describes a new technique of tenotomy with the goal of autotenodesis to give the biceps a higher load to failure and decreased chance of a Popeye deformity. PURPOSE The purpose of this study was to evaluate the strength of the "biceps knot", which is an outlet tenodesis of the biceps tendon and compare the biomechanical properties of this technique to tenotomy. METHODS Ten matched cadaver shoulder pairs were used. In the tenotomy group, an arthroscopic tenotomy was performed at the labral biceps junction using a narrow angled biter. For the biceps knot group, a self-retrieving suture passing device was used to pass a suture as far lateral as possible. The suture was passed from just distal to the biceps insertion on the superior labrum and tied with a standard non-sliding arthroscopic knot. The humerus and biceps tendon were rigidly fixed to a materials testing machine and cyclically loaded at 10-20 N for 100 cycles at 1 Hz. After cyclic testing, a 2 N preload was placed on the tendon and the tendon was pulled in line with the bicipital groove until failure. RESULTS The peak load to failure for the biceps knot was 58.9 N (SEM 8.2 N) and 37.3 N (SEM 4.6 N) for the tenotomy group (p = 0.046). The average stiffness for the biceps knot group was 4.2 N/mm (SEM 0.4 N/mm) and 3.2 N/mm (SEM 0.2 N/mm) for the tenotomy group (p = 0.031). CONCLUSION Performing the biceps knot is a quick, easy and cost effective alternative to the current tenodesis options available.
Collapse
Affiliation(s)
- Micah Lissy
- Detroit Medical Center Sports Medicine, United States; Detroit Medical Center Sports Medicine, Orthopaedic Surgery Sports Medicine Fellowship Program, United States
| | | | | | - Stephen Lemos
- Detroit Medical Center Sports Medicine, United States; Detroit Medical Center Sports Medicine, Orthopaedic Surgery Sports Medicine Fellowship Program, United States
| |
Collapse
|
|
50
|
Chiang FL, Hong CK, Chang CH, Lin CL, Jou IM, Su WR. Biomechanical Comparison of All-Suture Anchor Fixation and Interference Screw Technique for Subpectoral Biceps Tenodesis. Arthroscopy 2016; 32:1247-52. [PMID: 27039966 DOI: 10.1016/j.arthro.2016.01.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 10/26/2015] [Accepted: 01/08/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical characteristics of the subpectoral Y-knot all-suture anchor fixation with those of the interference screw technique. METHODS Sixteen fresh-frozen human cadaveric shoulders with a mean age of 67.6 ± 5.8 years (range, 52 to 74 years) were studied. The specimens were randomly grouped into 2 experimental biceps tenodesis groups (n = 8): Y-knot all-suture anchor or interference screw. The specimens were cyclically tested to failure by applying tensile forces parallel to the longitudinal axis of the humerus. A preload of 5 N was applied for 2 minutes prior to cyclic loading for 500 cycles from 5 to 70 N at 1 Hz; subsequently, a load-to-failure test at 1 mm/s was performed. The ultimate failure load, stiffness, displacement at cyclic and failure loading, and mode of failure were recorded. RESULTS The all-suture anchor technique displayed values of ultimate failure load and stiffness comparable to that of the interference screw technique. The displacement at cyclic and failure loading of the all-suture anchor trials were significantly greater than the interference screw (P = .0002). The all-suture anchor specimens experienced anchor pullout and tendon tear equally during the trials, whereas the interference screw group experienced tendon tear in most of the cases and screw pullout in 2 trials. CONCLUSIONS The Y-knot all-suture anchor fixation provides equivalent ultimate failure load and stiffness when compared with the interference screw technique in tenodesis of the proximal biceps tendon from a subpectoral approach. However, the interference screw technique demonstrates significantly less displacement in response to cyclic and failure loading. CLINICAL RELEVANCE The all-suture anchor fixation is an alternative technique for subpectoral biceps tenodesis even at greater displacement when compared with the interference screw fixation during cyclic and failure loading.
Collapse
Affiliation(s)
- Florence L Chiang
- University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, Texas, U.S.A
| | - Chih-Kai Hong
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsun Chang
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Li Lin
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheung Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - I-Ming Jou
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheung Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheung Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|