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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 Following Biceps Tenodesis Correlates with Lower Patient Reported Outcomes Scores. Arthroscopy 2024:S0749-8063(24)00570-X. [PMID: 39173686 DOI: 10.1016/j.arthro.2024.07.037] [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: 01/06/2024] [Revised: 07/19/2024] [Accepted: 07/20/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE To assess the relationship between tendon migration, as measured by radiostereometric analysis (RSA), and patient-reported outcome measures (PROMs) following biceps tenodesis (BT); to determine the likelihood of achieving clinically significant outcomes (CSOs) following 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 utilized as a radio-opaque marker. Biceps tendon migration was measured on calibrated radiographs at 12 weeks postoperatively. PROMs (Constant-Murley score [Constant], Single Assessment Numeric Evaluation [SANE], and Patient-Reported Outcomes Measurement Information Systemic-Upper Extremity [PROMIS-UE]) were collected preoperatively and at ≥2 years follow-up. RESULTS Of 115 patients enrolled, 94 (82%) patients were included (median age=52 years and BMI=31.4 kg/m2). At a mean follow-up of 2.9 years, median Constant, SANE, and PROMIS-UE 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). There was a significant correlation between migration and Constant (r2 = 0.222, beta= -0.554, 95% CI -1.027- [-0.081], P=0.022), SANE (r2 = 0.238, beta= -0.198, 95% CI -0.337 - [-0.058], P=0.006) and PROMIS-UE (r2 = 0.233, beta= -0.406, 95% CI -0.707 - [-0.104], P=0.009). In univariable analysis, higher BMI was associated with achievement of substantial clinical benefit (SCB, unadj-OR=1.078, 95%CI 1.007-1.161, P=0.038). Greater bead migration was negatively associated with achievement of minimal clinically important difference (MCID, unadj-OR=0.969, 95% CI 0.943-0.993, P=0.014) and patient acceptable symptomatic state (PASS, unadj-OR 0.965, 95% CI 0.937-0.989, P=0.008) on all 3 instruments. CONCLUSION A 1 cm-increase in tenodesed biceps tendon migration was associated with a decrease in Constant, SANE, and PROMIS-UE of 6, 2, and 4 points, respectively, at a mean of 2.9 years after surgery. Most patients achieved clinically significant outcomes (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 IV, retrospective case series.
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Affiliation(s)
| | - Elyse J Berlinberg
- Midwest Orthopaedics at Rush, Chicago, IL, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daanish Khazi-Syed
- Midwest Orthopaedics at Rush, Chicago, IL, USA; The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Harsh H Patel
- Midwest Orthopaedics at Rush, Chicago, IL, USA; St. Joseph's Health, Paterson, NJ, USA
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Alt PS, Marx C, Braun S. All-suture anchor size and drill angle influence load to failure in a porcine model of subpectoral biceps tenodesis, a biomechanical study. BMC Musculoskelet Disord 2024; 25:408. [PMID: 38783272 PMCID: PMC11118723 DOI: 10.1186/s12891-024-07503-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Tenodesis of the long head of the biceps tendon is frequently performed in shoulder surgery, and all-suture anchors have become more popular as fixation methods. However, uncertainty still exists regarding the ultimate load to failure of all-suture anchors and the best insertion angle at a cortical humeral insertion point. PURPOSE The purpose of this study was to compare the biomechanical characteristics of three types of all-suture anchors frequently used for biceps tenodesis. In addition, the influence of two different insertion angles was observed in a porcine humeri model. METHODS The ultimate load to failure and failure mode of three types of all-suture anchors (1.6 FiberTak®, 1.9 FiberTak®, 2.6 FiberTak®, Arthrex®) applicable for subpectoral biceps tenodesis were evaluated at 90° and 45° insertion angles in 12 fresh-frozen porcine humeri. The anchors were inserted equally alternated in a randomized manner at three different insertion sites along the bicipital groove, and the suture tapes were knotted around a rod for pullout testing. In total, 36 anchors were evaluated in a universal testing machine (Zwick & Roell). RESULTS The 2.6 FiberTak® shows higher ultimate loads to failure with a 90° insertion angle (944.0 N ± 169.7 N; 537.0 N ± 308.8 N) compared to the 1.9 FiberTak® (677.8 N ± 57.7 N; 426.3 N ± 167.0 N, p-value: 0.0080) and 1.6 FiberTak® (733.0 N ± 67.6 N; 450.0 N ± 155.8 N, p-value: 0.0018). All anchor types show significantly higher ultimate loads to failure and smaller standard deviations at the 90° insertion angle than at the 45° insertion angle. The major failure mode was anchor pullout. Only the 2.6 FiberTak® anchors showed suture breakage as the major failure mode when placed with a 90° insertion angle. CONCLUSIONS All three all-suture anchors are suitable fixation methods for subpectoral biceps tenodesis. Regarding our data, we recommend 90° as the optimum insertion angle. CLINICAL RELEVANCE The influence of anchor size and insertion angle of an all-suture anchor should be known by the surgeon for optimizing ultimate loads to failure and for achieving a secure fixation.
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Affiliation(s)
- Prisca S Alt
- Department of Handsurgery, University Hospital Basel, Basel, Switzerland
| | - Christian Marx
- Research Unit for Orthopedic Sports Medicine and Injury Prevention, Medical Informatics and Technology, UMIT - Private University for Health Sciences, Hall in Tirol, 6060, Austria
| | - Sepp Braun
- Gelenkpunkt - Sports and Joint Surgery, Innsbruck, Austria.
- Research Unit for Orthopedic Sports Medicine and Injury Prevention, Medical Informatics and Technology, UMIT - Private University for Health Sciences, Hall in Tirol, 6060, Austria.
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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 2024:S1058-2746(24)00360-4. [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] [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.
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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.
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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.
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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
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Ideler N, De Mesel A, Vercruysse L, Declercq G, van Riet R, Verborgt O. Clinical and radiological outcome of all-suture anchors in shoulder and elbow surgery. Shoulder Elbow 2023; 15:544-553. [PMID: 37811390 PMCID: PMC10557925 DOI: 10.1177/17585732221127433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 10/10/2023]
Abstract
Background All-suture anchors (ASAs) are noted to cause various bone reactions when used in upper limb surgery but clinical implications are unknown. Methods 88 shoulders and 151 elbows with a mean follow-up of 47.1 ± 17.7 months were invited for follow-up including clinical examination, questionnaires and radiographs. The anchor drill holes were radiographically assessed. Results At final follow up, mean DASH was 12.9 ± 13.8 and mean VAS 2.2 ± 2.4 in the shoulder population. In the elbow group mean MEPS was 91.8 ± 12.7 and mean VAS 1.5 ± 1.9. Implant-specific complications were seen in 10 elbow cases but none in the shoulder group. The mean diameter of the 1.4 mm all-suture anchor drill hole was enlarged to 2.5 ± 1.4 mm in the shoulder group and to 2.9 ± 1.0 mm in the elbow group. 50% of the 1.4 mm anchor drill holes showed abnormal morphology but these morphologic changes did not correlate with clinical outcome, complications or reoperation rate. Discussion Satisfying clinical outcomes are found in upper limb surgery using ASAs. Various bone changes are seen after implantation of an ASA, but these are not clinically relevant. Long-term consecutive follow-up data is required.
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Affiliation(s)
- Nick Ideler
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
| | - Annelien De Mesel
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
| | - Loïc Vercruysse
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
| | - Geert Declercq
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
| | - Roger van Riet
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
- Department of Orthopedic Surgery and Traumatology, University Hospital Antwerp, Edegem, Belgium
| | - Olivier Verborgt
- Department of Orthopedic Surgery and Traumatology, AZ Monica, Antwerp, Belgium
- Department of Orthopedic Surgery and Traumatology, University Hospital Antwerp, Edegem, Belgium
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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.
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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
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Su T, Zhu YC, Du MZ, Jiang YF, Guo QW, Hu YL, Jiao C, Jiang D. Anatomic reconstruction using the autologous gracilis tendon achieved less sprain recurrence than the Broström-Gould procedure but delayed recovery in chronic lateral ankle instability. Knee Surg Sports Traumatol Arthrosc 2022; 30:4181-4188. [PMID: 35674772 DOI: 10.1007/s00167-022-07011-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/10/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To compare the return-to-activity and long-term clinical outcomes between anatomic lateral ligament reconstruction using the autologous gracilis tendon and modified Broström-Gould (MBG) procedure in chronic lateral ankle instability (CLAI). It was hypothesised that there was no difference between the two techniques. METHODS From 2013 to 2018, 30 CLAI patients with grade III joint instability confirmed by anterior drawer test underwent anatomic reconstruction of lateral ankle ligament with the autologous gracilis tendon (reconstruction group) in our institute. Another 30 patients undergoing MBG procedure (MBG group) were matched in a 1:1 ratio based on demographic parameters. The post-operative American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) pain score, Tegner activity score, Karlsson-Peterson score, surgical complications, return-to-activities and work were retrospectively evaluated and compared between the two groups. RESULTS All subjective scores significantly improved after the operation (all with p < 0.001) without difference between the two groups (all n.s.). The MBG group showed a significantly higher proportion of postoperative sprain recurrence than the reconstruction group (26.7% vs. 0, p = 0.002). The reconstruction group showed a significantly longer period to start walking with full weight-bearing (10.5 ± 6.9 vs. 7.0 ± 3.1 weeks, p = 0.015), jogging (17.1 ± 8.9 vs. 12.7 ± 6.9 weeks, p = 0.043) and return-to-work (13.5 ± 12.6 vs. 8.0 ± 4.7 weeks, p = 0.039) than the MBG group. CONCLUSIONS Both anatomic reconstruction using the autologous gracilis tendon and MBG procedure could equally achieved reliable long-term clinical outcomes and the tendon reconstruction showed a relatively lower incidence of postoperative sprain recurrence but delayed recovery to walking, jogging and return-to-work. The MBG procedure was still the first choice with rapid recovery but the tendon reconstruction was recommended for patients with higher strength demand. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tong Su
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Yi-Chuan Zhu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Ming-Ze Du
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Yan-Fang Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Qin-Wei Guo
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Yue-Lin Hu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China.
| | - Dong Jiang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, No.49 North Garden Road, Beijing, 100191, China.
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Waugh CA, Havenhand T, Jain N. Open Subpectoral Tenodesis for Isolated Traumatic Long Head of Biceps Tendon Rupture Provides Excellent Functional Outcomes in Active Male Patients. Cureus 2022; 14:e31553. [PMID: 36408311 PMCID: PMC9666244 DOI: 10.7759/cureus.31553] [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] [Accepted: 10/30/2022] [Indexed: 11/17/2022] Open
Abstract
Background: For many years the long head of biceps tendon (LHBT) rupture has been described and is commonly identified by weakness, cramping, and the so-called "Popeye" sign. Traditionally, this was treated non-operatively, likely reflecting patient factors and the technical difficulty in reattaching a degenerative and shortened tendon. In contrast, traumatic distal biceps rupture is now commonly repaired despite historically being managed non-operatively. The advent of a convenient and reproducible surgical technique led to an increase in the rate of fixation, thereby improving the cramping and weakness associated with non-operative treatment. Given recent surgical advances within this field, many techniques are now present for LHBT pathology. We describe results from a cohort of patients suffering traumatic LHBT rupture who sought a surgical solution to improve their symptoms. Methods: Over four years, 18 male patients underwent surgical intervention for isolated traumatic LHBT rupture. The technique used involved an open subpectoral tenodesis with fixation of the LHBT into the bicipital groove. Postoperative immobilization using a sling was recommended for six weeks prior to a progressive rehabilitation program. Patients were assessed with pre- and postoperative visual analog scores (VAS) for pain and American Shoulder and Elbow Society (ASES) scores. Results: The mean patient age at the time of surgery was 49 years (range: 26-65 years). The mean time to surgery was nine weeks (range: 2-24 weeks). All patients showed an improvement following surgery with a mean pre-op ASES score of 33 (range: 10-60) compared to a post-op score of 92.6 (range: 85-100). All patients were able to return to work and sport, with all but one returning to the same functional demand level of work. The mean pre-op pain VAS was 6.3 (out of 10) compared to 0.2 post-op. All patients had a requirement for analgesia pre-operatively and none had postoperatively. No surgical complications were observed. No correlation was observed between the time to surgery and the outcome. Discussion: LHBT rupture is often treated non-operatively as few studies within the literature describe the surgical technique and outcomes from surgical intervention. When treated non-operatively, patients complain of pain, cramping, and cosmetic deformity known as the "Popeye" sign. Following a traumatic rupture of the LHBT, we have demonstrated excellent outcomes using a standard approach and common fixation technique that has the potential to improve the functional outcome for symptomatic patients. Conclusion: Open subpectoral biceps tenodesis is associated with excellent outcomes in symptomatic patients following isolated LHBT rupture.
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Colantonio DF, Tucker CJ, Murphy TP, Mescher PK, Le AH, Putko RM, Holm ER, Weishar R, Vippa TK, Rudic TN, Chang ES. All-Suture Suspensory Button Has Similar Biomechanical Performance to Metal Suspensory Button for Onlay Subpectoral Biceps Tenodesis. Arthrosc Sports Med Rehabil 2022; 4:e2051-e2058. [PMID: 36579049 PMCID: PMC9791876 DOI: 10.1016/j.asmr.2022.09.004] [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: 05/30/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose To evaluate the maximal load at failure, cyclic displacement, and stiffness of onlay subpectoral biceps tenodesis (BT) with an intramedullary unicortical metal button (MB) versus a unicortical all-suture button (ASB). Methods Eighteen matched paired human cadaveric proximal humeri were randomly allocated for subpectoral BT with either ASB or MB using a high-strength suture. Specimens were tested on a servohydraulic mechanical testing apparatus under cyclic load for 1,000 cycles and then loaded to failure. The clamp was then adjusted to isolate the suture-anchor point interface and loaded to failure. Maximal load to failure, displacement, and stiffness were compared. Results There was no significant difference between groups in stiffness, displacement, or yield load. The maximal load to failure for the MB was greater than the ASB (347.6 ± 74.1N vs 266.5 ± 69.3N, P = .047). Eight specimens in each group failed by suture pull-through on the tendon. When the suture-anchor point interface was isolated, there was no significant difference in maximal load at failure (MB 586.5 ± 215.8N vs ASB 579.6 ± 255.9N, P = .957). Conclusions This study demonstrates that the MB and ASB have similar biomechanical performance when used in subpectoral BT. Although the MB showed statistically significant greater maximal load to failure, there was no difference between the MB and ASB when the suture-tendon interface was eliminated. Suture pull-through was the most common mode of failure for both implants, underscoring the importance of the suture-tendon interface. Clinical Relevance Fixation techniques for the treatment of long head of the biceps brachii tenodesis continue to evolve. The use of an all-suture suspensory button has advantages, but it is important to understand if this implant is a biomechanically suitable alternative to a metal suspensory button.
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Affiliation(s)
- Donald F. Colantonio
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland,Walter Reed National Military Medical Center, Bethesda, Maryland, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland,Address correspondence to Donald F. Colantonio, M.D., 8901 Rockville Pike, Building 19, Room 2101, Bethesda, MD 20889
| | - Christopher J. Tucker
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland,Walter Reed National Military Medical Center, Bethesda, Maryland, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Timothy P. Murphy
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland,Walter Reed National Military Medical Center, Bethesda, Maryland, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Patrick K. Mescher
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland,Walter Reed National Military Medical Center, Bethesda, Maryland, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Anthony H. Le
- Department of Defense–Veterans Affairs Extremity Trauma and Amputation Center of Excellence, USA
| | - Robert M. Putko
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland,Walter Reed National Military Medical Center, Bethesda, Maryland, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Erik R. Holm
- Walter Reed National Military Medical Center, Bethesda, Maryland, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Robert Weishar
- Walter Reed National Military Medical Center, Bethesda, Maryland, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Tarun K. Vippa
- Department of Orthopaedic Surgery, Inova Health System, Fairfax, Virginia, USA
| | - Theodore N. Rudic
- Department of Orthopaedic Surgery, Inova Health System, Fairfax, Virginia, USA
| | - Edward S. Chang
- Walter Reed National Military Medical Center, Bethesda, Maryland, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland,Department of Orthopaedic Surgery, Inova Health System, Fairfax, Virginia, USA
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10
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Degenhardt H, Pogorzelski J, Themessl A, Muench LN, Wechselberger J, Woertler K, Siebenlist S, Imhoff AB, Scheiderer B. Reliable Clinical and Sonographic Outcomes of Subpectoral Biceps Tenodesis Using an All-Suture Anchor Onlay Technique. Arthroscopy 2022; 38:729-734. [PMID: 34508820 DOI: 10.1016/j.arthro.2021.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 07/14/2021] [Accepted: 08/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical outcomes and structural integrity of primary subpectoral biceps tenodesis using an all-suture anchor onlay technique for long head of the biceps (LHB) tendon pathology. METHODS We conducted a retrospective case series with prospectively collected data of patients who underwent primary, isolated subpectoral biceps tenodesis with a single all-suture anchor onlay fixation between March 2017 and March 2019. Outcomes were recorded at a minimum follow-up of 12 months based on assessments of the American Shoulder and Elbow Surgeons (ASES) score, LHB score, and elbow flexion strength and supination strength measurements. The integrity of the tenodesis construct was evaluated using ultrasound. RESULTS Thirty-four patients were available for clinical and ultrasound examination at a mean follow-up of 18 ± 5 months. The mean ASES score significantly improved from 51.0 ± 14.2 points preoperatively to 89.8 ± 10.5 points postoperatively (P < .001). The minimal clinically important difference for the ASES score was 8.7 points, which was exceeded by 31 patients (91.2%). The mean postoperative LHB score was 92.2 ± 8.3 points. Regarding subcategories, an average of 47.2 ± 6.3 points was reached for "pain/cramps"; 26.4 ± 6.1 points, "cosmesis"; and 18.6 ± 2.6 points, "elbow flexion strength." Both elbow flexion strength and supination strength were similar compared with the nonoperated side (P = .169 and P = .210, respectively). In 32 patients, ultrasound examination showed an intact tenodesis construct, whereas 2 patients (5.9%) sustained failure of the all-suture anchor fixation requiring revision. CONCLUSIONS Primary subpectoral biceps tenodesis using an all-suture anchor onlay technique for pathology of the LHB tendon provides reliable clinical results and a relatively low failure rate (5.9%). LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Hannes Degenhardt
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Jonas Pogorzelski
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Alexander Themessl
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | | | - Klaus Woertler
- Department of Radiology, Technical University of Munich, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
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11
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Colantonio DF, Le AH, Keeling LE, Slaven SE, Vippa TK, Helgeson MD, Chang ES. Intramedullary Unicortical Button and All-Suture Anchors Provide Similar Maximum Strength for Onlay Distal Biceps Tendon Repair. Arthroscopy 2022; 38:287-294. [PMID: 34332050 DOI: 10.1016/j.arthro.2021.06.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/03/2021] [Accepted: 06/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the biomechanical profile of onlay distal biceps repair with an intramedullary unicortical button versus all-suture anchors under cyclic loading and maximal load to failure. METHODS Twenty paired fresh-frozen human cadaveric elbows were randomized to onlay distal biceps repair with either a single intramedullary button or with two 1.35-mm all-suture anchors. A 1.3-mm high tensile strength tape was used in a Krackow stitch to suture the tendons in both groups. Specimens and repair constructs were loaded for 3,000 cycles and then loaded to failure. Maximum load to failure, mode of failure, and construct elongation were recorded. RESULTS Mean (± standard deviation) maximum load to failure for the unicortical intramedullary button and all-suture anchor repairs were 503.23 ± 141.77 N and 537.33 ± 262.13 N (P = .696), respectively. Mean maximum displacement after 3,000 cycles (± standard deviation) was 4.17 ± 2.05 mm in the button group and 2.06 ± 1.05 mm in the suture anchor group (P = .014). Mode of failure in the button group was suture tape rupture in 7 specimens, failure at the tendon-suture interface in 2 specimens, and button pullout in 1 specimen. Anchor pullout was the mode of failure in all suture anchor specimens. There were no tendon ruptures or radial tuberosity fractures in either group. CONCLUSIONS This study demonstrates that onlay distal biceps repair with 2 all-suture anchors has similar maximum strength to repair with an intramedullary button and that both are viable options for fixation. CLINICAL RELEVANCE All-suture anchors and unicortical intramedullary button have similar maximum strength at time zero. Both constructs provide suitable fixation for onlay distal biceps repair.
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Affiliation(s)
- Donald F Colantonio
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A..
| | - Anthony H Le
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Laura E Keeling
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, U.S.A
| | - Sean E Slaven
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Tarun K Vippa
- Department of Orthopaedic Surgery, Inova Health System, Fairfax, Virginia, U.S.A
| | - Melvin D Helgeson
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Edward S Chang
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A.; Department of Orthopaedic Surgery, Inova Health System, Fairfax, Virginia, U.S.A
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12
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Otto A. Editorial Commentary: All-Suture Anchors Are Evidence-Based and Biomechanically Sound but Require Additional Clinical Outcomes Evaluation. Arthroscopy 2022; 38:295-296. [PMID: 35123710 DOI: 10.1016/j.arthro.2021.09.022] [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: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 02/02/2023]
Abstract
All-suture anchors (ASA) have gained great interest in our community, and multiple biomechanical studies have investigated their primary stability. Equal stability with similar load to failure has been observed for ASA in comparison to current standard implants. Although important biomechanical observations have been made, clinical outcomes are rare for ASA. Consequently, there is a lack of evidence for the clinical benefits of ASA.
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13
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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: 3] [Impact Index Per Article: 1.5] [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.
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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
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14
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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: 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: 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.
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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
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15
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Blaeser AM, Markus DH, Hurley ET, Gonzalez-Lomas G, Strauss EJ, Jazrawi LM. Current Controversies and Decision-Making in the Management of Biceps Pathologies. JBJS Rev 2021; 9:01874474-202112000-00008. [PMID: 34962898 DOI: 10.2106/jbjs.rvw.21.00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Biceps tendon pathologies include a spectrum of injuries that range from mild tendinosis to complete tendon rupture. » Tendinosis, the most common pathology, occurs more frequently with age and is likely related to chronic degeneration. On the other side of the spectrum of severity lies a rupture of the long head of the biceps tendon (LHBT), which may be accompanied by injury to the glenoid labrum. » Superior labral anterior-posterior (SLAP) tears are frequently associated with biceps pathology. Surgical management for injuries of the bicipital-labral complex includes biceps tenodesis or tenotomy and SLAP repair. A consensus as to which of these procedures is the optimal choice has not been reached, and management may ultimately depend on patient-specific characteristics. » Due to the relatively low incidence of distal biceps tendon rupture, agreement on the optimal management strategy has not been reached. Surgical repair, or reconstruction in the case of a chronic rupture, is often chosen. However, nonoperative management has also been utilized in older, less-active patients.
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Affiliation(s)
- Anna M Blaeser
- Department of Sports Medicine, New York University Langone Health, New York, NY
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16
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Increased Load to Failure in Biceps Tenodesis With All-Suture Suture Anchor Compared With Interference Screw: A Cadaveric Biomechanical Study. Arthroscopy 2021; 37:3016-3021. [PMID: 33895306 DOI: 10.1016/j.arthro.2021.03.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/01/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical characteristics of a single radially expanding all-suture anchor with an interference screw for open subpectoral long head of biceps tendon (LHBT) tenodesis. METHODS Eighteen fresh-frozen matched-pair human cadaveric humeri were used for this biomechanical study. The matched pair humeri were randomly assigned into 2 experimental biceps tenodesis groups: conventional interference screw (CIS) or all-suture suture anchor (ASSA). Open subpectoral LHBT tenodesis was then performed and biomechanical testing was performed using a servohydraulic test frame. A preload of 5 N was applied for 2 minutes before cyclic loading. Displacement was recorded at cycle 300 (D300) and cycle 500 (D500) and at ultimate failure. Data recorded included displacement, load to failure, displacement at failure. Paired t test was used for analysis. RESULTS Decreased displacement was observed for the CIS group at D300 (1.67 ± 0.57 mm vs 3.35 ± 2.24 mm; P = .04), D500 (2.00 ± 0.76 mm vs 3.87 ± 2.20 mm; P = .04), and at failure (5.17 ± 3.05 mm vs 10.76 ± 2.66 mm; P < .001). Load to failure was lower in CIS specimens (170 ± 24.5 N vs 217.8 ± 51.54 N; P = .02). Failure in each case was tendon pullout for all CIS specimens; in ASSA 6 specimens failed as the suture pulled through the tendon, 2 specimens failed by suture breakage. No difference in stiffness was observed between the 2 groups (CIS = 98.33 ± 22.98 N/m vs ASSA = 75.94 ± 44.83 N/m; P = .20). CONCLUSIONS Our study found that open subpectoral biceps tenodesis performed with an ASSA construct results in increased load to failure as compared with CIS. However, the CIS did demonstrate decreased displacement as compared to ASSA in this cadaveric biomechanical study. CLINICAL RELEVANCE ASSA and CIS at time zero provide fixation as indicated by the provider intraoperatively for LHBT tenodesis. ASSA, however, does remove less cortical bone than does CIS and therefore produces a smaller stress riser in the proximal humerus. Further testing as to the integrity of ASSA is warranted to determine the integrity of the tenodesis with cyclical loading.
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17
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All-Suture Anchors in Orthopaedic Surgery: Design, Rationale, Biomechanical Data, and Clinical Outcomes. J Am Acad Orthop Surg 2021; 29:e950-e960. [PMID: 34550098 DOI: 10.5435/jaaos-d-20-01224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 05/11/2021] [Indexed: 02/01/2023] Open
Abstract
All-suture anchors (ASAs) are a relatively new alternative to traditional suture anchors, comprised of sutures, suture tapes, or ribbons woven through a soft sleeve. These novel anchors are typically smaller than traditional anchors, allowing for more anchors to be used in the same amount of space or for use when bone stock is limited, for example, in revision settings. They can be inserted through curved guides to reach more challenging locations, and they have thus far had similar loads to failure during biomechanical testing as traditional anchors. However, these benefits must be weighed against new challenges. When using ASAs, care must be taken to fully deploy and seat the anchor against cortical bone for optimal fixation and to prevent gap formation. Furthermore, decortication, often performed to enhance the biologic environment for soft-tissue healing, may weaken the cortical bone on which ASA fixation depends on. The purpose of this article is to provide insight on the designs, advantages, and potential disadvantages associated with ASAs, as well as review the available biomechanical and clinical data.
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18
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Cabarcas BC, Beletsky A, Liu J, Gowd AK, Manderle BJ, Cohn M, Verma NN. Short-Term Clinical and Return-to-Work Outcomes After Arthroscopic Suprapectoral Onlay Biceps Tenodesis With a Single Suture Anchor. Arthrosc Sports Med Rehabil 2021; 3:e1065-e1076. [PMID: 34430886 PMCID: PMC8365203 DOI: 10.1016/j.asmr.2021.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/15/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To describe short-term outcomes of arthroscopic suprapectoral onlay biceps tenodesis using a single all-suture anchor with respect to validated outcome measures, return to work, objective strength and motion data, and biceps-specific testing. Methods This study describes a consecutive series of patients undergoing arthroscopic suprapectoral onlay biceps tenodesis performed by a single surgeon from January to December 2017. Patients were evaluated preoperatively and postoperatively with the American Shoulder and Elbow Surgeons questionnaire, visual analog scale, Single Assessment Numeric Evaluation, Veterans RAND 12-Item Health Survey, and 12-Item Short Form survey, and return-to-work survey. Postoperative strength, range of motion, and biceps-specific testing was also performed. Results This study included 50 patients (26 men and 24 women), with an average age (± standard deviation) of 50.1 ± 10.9 years and average final follow-up of 21.3 ± 8.5 months. Among employed patients, 32 (71.1%) returned to work at an average of 4.6 ± 2.3 months. Light-duty workers returned to work at a significantly greater rate (85.7% vs 33.3%, P = .016) and in less time (2.6 ± 2.0 months vs 6.8 ± 4.2 months) than heavy-duty workers. No differences were found between operative and nonoperative sides in the biceps apex distance (P = .636) or range of motion in elbow flexion and extension (P > .9 for both), supination (P = .192), or pronation (P = .343) postoperatively. Strength in elbow flexion (P = .002), as well as shoulder forward elevation (P < .001) and external rotation (P < .001), increased postoperatively. Significant patient-reported improvements were noted in the American Shoulder and Elbow Surgeons score, visual analog scale pain score, Single Assessment Numeric Evaluation score, Constant-Murley score, and Veterans RAND 12-Item Health Survey and 12-Item Short Form physical component scores (P ≤ .001 for all). A postoperative Popeye deformity developed in 5 patients (10%). Conclusions Arthroscopic suprapectoral onlay biceps tenodesis with a single all-suture anchor can provide overall excellent clinical outcomes regarding strength, motion, and validated patient-reported outcome questionnaires. Return to occupational activities may be less predictable and more prolonged for heavy laborers. A small number of patients may experience cosmetic deformity postoperatively. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Brandon C. Cabarcas
- University of South Florida Morsani College of Medicine, Tampa, Florida, U.S.A
- Address correspondence to Brandon C. Cabarcas, M.D., 5 Tampa General Cir, Ste 710, Tampa, FL 33606, U.S.A.
| | - Alexander Beletsky
- Division of Sport Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Joseph Liu
- Department of Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, California, U.S.A
| | - Anirudh K. Gowd
- Wake Forest University, Winston-Salem, North Carolina, U.S.A
| | - Brandon J. Manderle
- Division of Sport Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Matthew Cohn
- Division of Sport Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
| | - Nikhil N. Verma
- Division of Sport Medicine, Midwest Orthopaedics at Rush, Chicago, Illinois, U.S.A
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19
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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: 3.3] [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.
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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.
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20
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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.
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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
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21
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Meghpara MB, Schulz W, Buerba RA, Golan EJ, Vyas D. Clinical Outcomes of an All-Arthroscopic Biceps Tenodesis Using the Anterolateral Anchor During Concomitant Double-Row Rotator Cuff Repair. Orthop J Sports Med 2020; 8:2325967120959142. [PMID: 33102609 PMCID: PMC7551489 DOI: 10.1177/2325967120959142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/07/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Pathology of the long head of the biceps tendon frequently occurs
concomitantly with rotator cuff tears, necessitating a surgical treatment,
often in the form of a tenodesis procedure. Many techniques for a tenodesis
exist; however, they often require additional implants or a separate
incision. Purpose: To report an average of 2-year outcomes of an all-arthroscopic biceps
tenodesis employing the stay sutures from the anterolateral anchor during
concomitant double-row rotator cuff repair (RCR). Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected and retrospectively reviewed for all
patients who underwent an all-arthroscopic biceps tenodesis during
concomitant double-row RCR by the senior author between January 2014 and May
2018. Patients were included if they underwent this procedure and had
baseline preoperative patient-reported outcomes (PROs) with a minimum of 1
year of postoperative PROs for the American Shoulder and Elbow Surgeons
(ASES) score and visual analog scale (VAS) for pain score. Additionally,
patient data, surgical history, postoperative complications, and
satisfaction were reported. Results: Fifteen patients were eligible for the study. There were 12 (80%) men and 3
(20%) women with a mean age of 50.0 years (range, 35-64 years). The mean
follow-up time was 25.2 months (range, 13-63 months). Six of 15 (40%)
patients also had an arthroscopic subscapularis repair performed. ASES
shoulder scores improved from 37.1 preoperatively to 94.1 postoperatively
(P < .001), and VAS scores improved from 6.4
preoperatively to 0.5 postoperatively (P < .001). One
patient who underwent concomitant subscapularis repair reported continued
anterior groove pain. No patients experienced biceps cramping, developed a
deformity, or required a repeat operation at the final follow-up. Overall,
93.3% of the patients reported being highly satisfied with their
surgery. Conclusion: This study presents the clinical results of an all-arthroscopic technique for
concomitant double-row RCR and biceps tenodesis, which resulted in high
rates of patient satisfaction and significant improvement in reported
shoulder outcome and pain scores. Additionally, this technique offers the
potential benefits of avoiding a secondary incision, which may decrease
surgical morbidity while also decreasing cost by eliminating the need for an
extra, tenodesis-specific implant.
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Affiliation(s)
- Mitchell B Meghpara
- Austin Sports Medicine, Austin, Texas, USA.,University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - William Schulz
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rafael A Buerba
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Elan J Golan
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Northside Orthopedic Specialists, Snellville, Georgia, USA
| | - Dharmesh Vyas
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,UPMC Lemieux Sports Complex, Cranberry Township, Pennsylvania, USA
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22
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Otto A, Siebenlist S, Baldino JB, Murphy M, Muench LN, Mehl J, Obopilwe E, Cote MP, Imhoff AB, Mazzocca AD. All-suture anchor and unicortical button show comparable biomechanical properties for onlay subpectoral biceps tenodesis. JSES Int 2020; 4:833-837. [PMID: 33345223 PMCID: PMC7738569 DOI: 10.1016/j.jseint.2020.08.004] [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] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Hypothesis The purpose of this study was to biomechanically evaluate onlay subpectoral long head of the biceps (LHB) tenodesis with all-suture anchors and unicortical buttons in cadaveric specimens. Methods After evaluation of bone mineral density, 18 fresh-frozen, unpaired human cadaveric shoulders were randomly assigned to 2 groups: One group received an onlay subpectoral LHB tenodesis with 1 all-suture anchor, whereas the other group received a tenodesis with 1 unicortical button. The specimens were mounted in a servo-hydraulic material testing system. Tendons were initially loaded from 5 N to 100 N for 5000 cycles at 1 Hz. Displacement of the repair constructs was observed with optical tracking. After cyclic loading, each specimen was loaded to failure at a rate of 1 mm/s. Results The mean displacement after cyclic loading was 6.77 ± 3.15 mm in the all-suture anchor group and 8.41 ± 3.17 mm in the unicortical button group (P = not significant). The mean load to failure was 278.05 ± 38.77 N for all-suture anchor repairs and 291.36 ± 49.69 N for unicortical button repairs (P = not significant). The most common mode of failure in both groups was LHB tendon tearing. There were no significant differences between the 2 groups regarding specimen age (58.33 ± 4.37 years vs. 58.78 ± 5.33 years) and bone mineral density (0.50 ± 0.17 g/cm2 vs. 0.44 ± 0.19 g/cm2). Conclusion All-suture anchors and unicortical buttons are biomechanically equivalent in displacement and load-to-failure testing for LHB tenodesis. All-suture anchors can be considered a validated alternative for onlay subpectoral LHB tenodesis.
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Affiliation(s)
- Alexander Otto
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA.,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Joshua B Baldino
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Matthew Murphy
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julian Mehl
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
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23
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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: 0.3] [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.
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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.
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24
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Eguia FA, Ali I, Bansal A, McFarland EG, Srikumaran U. Minimal clinically important differences after subpectoral biceps tenodesis: definition and retrospective assessment of predictive factors. J Shoulder Elbow Surg 2020; 29:S41-S47. [PMID: 32643609 DOI: 10.1016/j.jse.2020.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Minimal clinically important differences (MCIDs) at 1 year after subpectoral biceps tenodesis are unknown for the American Shoulder and Elbow Surgeons (ASES) scale, Subjective Shoulder Value (SSV), and visual analog scale (VAS) for pain. Our objectives were to determine MCIDs for these measures at 1 year after biceps tenodesis and to identify preoperative factors that predict attainment of MCIDs. METHODS We included 52 patients who underwent arthroscopic débridement, decompression, and mini-open biceps tenodesis from 2016-2018. We analyzed age, sex, body mass index value, arm dominance, diagnosis, range of shoulder motion, and preoperative and 1-year postoperative ASES, SSV, and VAS scores. MCIDs were calculated using a distribution-based method of one-half the standard deviation. Preoperative thresholds predictive of MCIDs were calculated with univariate logistic regression. Multiple logistic regression was used to determine factors that predict MCIDs. Significance was set at a 2-tailed P value of <.05. RESULTS MCIDs for the ASES, SSV, and VAS were 13, 12, and 1.6 points, respectively. Preoperative ASES score <59 predicted MCID on the ASES (P = .03); VAS score >3 predicted MCID on the VAS (P < .01); external shoulder rotation >40° predicted MCID on the SSV (P = .02); and age >41 years predicted MCID on the VAS (P = .02). CONCLUSION At 1 year after débridement, decompression, and biceps tenodesis, MCIDs were 13, 12, and 1.6 points for the ASES, SSV, and VAS, respectively. Patients most likely to attain MCIDs were those aged >41 years, those with the most preoperative pain, and those with the poorest preoperative shoulder function.
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Affiliation(s)
- Francisco A Eguia
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Iman Ali
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Ankit Bansal
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Edward G McFarland
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
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25
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Ransom EF, Ficke B, Ponce BA, Meyer RD. Brachial Plexus Injuries Associated With Open Subpectoral Biceps Tenodesis: A Report of Two Cases. JBJS Case Connect 2020; 9:e0392. [PMID: 31584904 DOI: 10.2106/jbjs.cc.18.00392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report 2 cases of brachial plexus injury after open subpectoral biceps tenodesis. In 1 patient, the nerves likely sustained a stretch injury related to retractor use. In the other patient, multiple nerves were severed, and we hypothesize that they were caught in a drill bit. CONCLUSIONS To decrease the risk of nerve injury due to traction or inadvertent wrapping of nerves in the drill bit or tenodesis screw, we recommend careful retractor use and tendon fixation techniques that use a protective sleeve during both drilling and fixation.
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Affiliation(s)
- Erin F Ransom
- University of Alabama-Birmingham, Birmingham, Alabama
| | | | - Brent A Ponce
- University of Alabama-Birmingham, Birmingham, Alabama
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26
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Ergün S, Akgün U, Barber FA, Karahan M. The Clinical and Biomechanical Performance of All-Suture Anchors: A Systematic Review. Arthrosc Sports Med Rehabil 2020; 2:e263-e275. [PMID: 32548592 PMCID: PMC7283965 DOI: 10.1016/j.asmr.2020.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/18/2020] [Indexed: 11/27/2022] Open
Abstract
Purpose This systematic review aimed to clarify the relative strengths and weaknesses of the all-suture anchors (ASAs) in both clinical and experimental studies. Our hypothesis was that there would be similar clinical and experimental data for ASAs regarding the biomechanical properties, clinical outcomes and complication rates. Methods A systematic review of MEDLINE and Embase databases was performed. The inclusion criteria for clinical studies were both retrospective or prospective study design and minimum 1-year follow-up; for biomechanical studies, the inclusion criteria were performance on either cadaver and animal bones or synthetic surfaces. Studies were excluded if the studies were not in English or if they were review articles, commentaries, letters, case reports, or technical notes. The risk of bias assessment was done using the Methodological Index for Non-randomized Studies (MINORS) tool. Results We included 13 experimental and 3 clinical studies. The least displacement under cyclic loading was recorded with Q-Fix. Failure mode was mostly by suture breaking for the Q-Fix, whereas anchor pullout was the most common for the others. Cadaver humerus’ greater tuberosity seemed to be less durable for the ASAs. Tests on cadaver glenoid showed similar biomechanical properties when compared to a control anchor. Studies investigating clinical and radiologic findings were very few, and only 3 case series were included in this review. Clinical findings of patients treated with ASAs for instability and rotator cuff repair showed satisfactory results and little increase in the complication rate (retear or revision surgery because of loose anchor). Conclusions ASAs have similar or better biomechanical properties compared to regular anchors. Low-profile design seems to be an important advantage. Case series can not distinguish between the possible clinical benefits and/or risks. Clinical Relevance ASAs have similar biomechanical properties when compared with other types of anchors. Their strength and performance vary with anatomic location, which may influence clinical success.
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Affiliation(s)
- Selim Ergün
- Department of Orthopedics and Traumatology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Umut Akgün
- Department of Orthopedics and Traumatology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - F Alan Barber
- Plano Orthopedic and Sports Medicine Center, Plano, Texas, U.S.A
| | - Mustafa Karahan
- Department of Orthopedics and Traumatology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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27
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Abstract
Surgical management for biceps pathologies has advanced to provide stronger fixation and to be less invasive. The long head of the biceps tendon has been recognized as a common contributor to anterior shoulder pain and is often associated with other glenohumeral pathologies such as SLAP lesions, rotator cuff tears, and subacromial impingement. Both tenotomy and tenodesis have shown to be effective in ameliorating pain associated with the long head of the biceps tendon. However, decreased muscle function and cosmetic concerns are seen at higher rates after tenotomy compared with tenodesis. One option for the treatment of biceps tendon pathology includes mini-open subpectoral biceps tenodesis. Lower reoperation rates are observed after subpectoral biceps tenodesis than after suprapectoral biceps tenodesis, with thoughts that releasing the tendon from its sheath and the bicipital groove relieves the patient of most associated pain. The purpose of this Technical Note is to describe in detail our preferred operative technique for mini-open subpectoral biceps tenodesis using an onlay technique with all-suture anchor fixation.
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28
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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: 9] [Impact Index Per Article: 2.3] [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.
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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
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29
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Gifford A, Tauro T, Haunschild E, Okoroha K, Cole BJ. Mini-open Subpectoral Biceps Tenodesis Using All-Suture Anchor. Arthrosc Tech 2020; 9:e445-e451. [PMID: 32368463 PMCID: PMC7189024 DOI: 10.1016/j.eats.2019.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/19/2019] [Indexed: 02/03/2023] Open
Abstract
The proximal biceps tendon is a common source of shoulder pain and dysfunction. When patients continue to have pain after exhaustive nonoperative treatment, the long head of the biceps tendon can be effectively treated with a tenotomy or tenodesis. Although biceps tenotomy is a less complex and highly reliable treatment, there is the potential for suboptimal outcomes including muscle cramping, fatigue, cosmetic deformity, and supination weakness. Biceps tenodesis eliminates the source of shoulder pain while securing the tendon proximally. Currently, there are multiple techniques for performing a biceps tenodesis (arthroscopic, open suprapectoral, open subpectoral) and myriad fixation methods (bio-tenodesis screw, bone bridge, cortical button, all-suture anchor). Our article presents a technique for a mini-open subpectoral biceps tenodesis using an onlay technique with an all-suture anchor preloaded with needles. This technique allows efficient and proper tendon fixation while minimizing potential complications.
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Affiliation(s)
| | | | | | | | - Brian J. Cole
- Address correspondence to Brian J. Cole, M.D., M.B.A., Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W Harrison St, Ste 300, Chicago, IL 60612, U.S.A.
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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: 0.3] [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.
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Saltzman BM, Leroux TS, Cotter EJ, Basques B, Griffin J, Frank RM, Romeo AA, Verma NN. Trends in Open and Arthroscopic Long Head of Biceps Tenodesis. HSS J 2020; 16:2-8. [PMID: 32015734 PMCID: PMC6973858 DOI: 10.1007/s11420-018-9645-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND In young and active patients, long head of biceps (LHB) tenodesis has become a common procedure for managing LHB pathology, but it remains unclear whether it is performed in isolation or along with other shoulder procedures and whether open and arthroscopic techniques produce different complications. QUESTIONS/PURPOSES We sought to determine and compare open and arthroscopic LHB tenodesis in terms of (a) trends in overall use, (b) trends in use in isolation and in association with rotator cuff repair (RCR) and superior labral tear from anterior-to-posterior (SLAP) debridement/repair, and (c) the rates of post-operative complications. METHODS We performed a retrospective analysis of data from an insurance database to identify LHB tenodesis procedures performed from 2011 to 2014. The overall annual rates of open and arthroscopic LHB tenodesis were determined and then stratified according to concurrent RCR and SLAP repair/debridement. A multivariate logistic regression analysis that controlled for patient demographics (age, sex, comorbidity) was performed. RESULTS Overall, 8547 patients underwent LHB tenodesis, of which 43.5% were open and 56.5% were arthroscopic procedures. There was a significant increase in the utilization of LHB tenodesis from 2011 to 2014. In isolation, open LHB tenodesis was the more common technique overall and by year. Arthroscopic LHB tenodesis was the most common tenodesis technique performed in conjunction with RCR and SLAP repair/debridement. The overall complication rate was 2.9%; only wound dehiscence demonstrated a difference between techniques. CONCLUSIONS The rates of open and arthroscopic LHB tenodesis procedures increased significantly from 2011 to 2014, with open techniques more common when LHB tenodesis is performed in isolation and arthroscopic techniques more common when performed as a concomitant procedure. Our use of a population database did not allow us to evaluate biomechanical or cost-related phenomena, and future research should examine these and other relevant differences between these two LHB tenodesis techniques.
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Affiliation(s)
- Bryan M. Saltzman
- grid.240684.c0000 0001 0705 3621Midwest Orthopaedics, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612 USA
| | - Timothy S. Leroux
- grid.17063.330000 0001 2157 2938Department of Surgery, University of Toronto, Toronto, Canada
| | - Eric J. Cotter
- grid.14003.360000 0001 2167 3675Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, 1685 Highland Ave, Madison, WI 53705 USA
| | - Bryce Basques
- grid.240684.c0000 0001 0705 3621Midwest Orthopaedics, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612 USA
| | - Justin Griffin
- grid.489003.6Jordan-Young Institute, 5716 Cleveland Street #200, Virginia Beach, VA 23462 USA
| | - Rachel M. Frank
- grid.266185.e0000000121090824Department of Orthopaedic Surgery, University of Colorado School of Medicine, 2150 Stadium Drive, Boulder, CO 80309 USA
| | - Anthony A. Romeo
- Chief of Orthopedics - New York, Rothman Institute Orthopaedics, 176 3rd Ave, New York, NY 10003 USA
| | - Nikhil N. Verma
- grid.240684.c0000 0001 0705 3621Midwest Orthopaedics, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612 USA
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Tu J, Xu B, Guo R. Open subpectoral vs. arthroscopic proximal biceps tenodesis: A comparison study of clinical outcomes. Exp Ther Med 2019; 19:428-434. [PMID: 31853318 PMCID: PMC6909789 DOI: 10.3892/etm.2019.8232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/15/2019] [Indexed: 11/10/2022] Open
Abstract
The purpose of the present study was to compare the results of open subpectoral biceps tenodesis and arthroscopic proximal biceps tenodesis for treating long head of biceps (LHB) lesions. From January 2015 to June 2016, a total of 259 patients underwent LHB tenodesis surgery. Among them, 117 patients (60 females and 57 males) who met the inclusion and exclusion criteria were enrolled into the present study and were randomly divided into two groups, including an open subpectoral tenodesis group (OSPBT; n=62) and an arthroscopic proximal tenodesis group (ASPBT; n=55). All patients were followed up for at least 12 months. The demographic characteristics of each patient were recorded in detail. Moreover, clinical examinations of LHB lesions, such as shoulder range of motion (ROM), Visual Analog Scale (VAS) scores (0, no pain, to 10, most severe pain), American Shoulder and Elbow Surgeons (ASES) scores, and Constant-Murley shoulder outcome scores, were investigated prior to surgery, as well as 3, 6 and 12 months after surgery. Postoperative complications were also comprehensively investigated. There were no significant differences in sex, body mass index, dominant shoulder, duration of pain, injury type and operation time between the groups. The mean length of hospital stay in the ASPBT group was significantly lower than that of the OSPBT group (5.4±1.8 days vs. 9.3±2.9 days; P<0.05). The clinical outcomes, including shoulder ROMs, VAS scores, ASES scores and Constant-Murley shoulder outcome scores, were significantly improved after either OSPBT or ASPBT treatment. Specifically, the VAS score, incidence of postoperative stiffness and bicipital groove tenderness in the OSPBT group were significantly lower than those in the ASPBT group at 3 months post-surgery (P<0.05). Additionally, there were no significant difference in the improvement of other clinical outcomes and postoperative complications between the two groups. ASPBT and OSPBT were both effective and safe techniques for treating LHB lesions. However, tenderness of the bicipital groove was more common in the early stages of recovery post-surgery in the ASPBT group, which may be related to tendinitis of the LHB in the bicipital groove.
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Affiliation(s)
- Jun Tu
- Department of Sports Medicine and Arthroscopic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Bin Xu
- Department of Sports Medicine and Arthroscopic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P.R. China
| | - Ruipeng Guo
- Laboratory for Biomechanics and Biomaterials, Hanover Medical School, D-30627 Hannover, Germany
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Double on-lay fixation using all suture-type anchor for subpectoral biceps tenodesis has favorable functional outcomes and leads to less cosmetic deformities than single on-lay fixation. Knee Surg Sports Traumatol Arthrosc 2019; 27:4005-4013. [PMID: 31410527 DOI: 10.1007/s00167-019-05663-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE This study aimed to compare the clinical outcomes between single on-lay and double on-lay subpectoral biceps tenodesis (SPBT) using all-suture type anchor in patients with concomitant long head of the biceps tendon (LHBT) lesions and rotator cuff tears. METHODS The study included 130 patients who underwent SPBT using all-suture type anchor and arthroscopic rotator cuff repair. Single and double anchor on-lay fixations were performed in 69 patients (group A) and 61 patients (group B), respectively. In 16 patients of group A and 36 patients of group B, a metallic wire was embedded at tenodesis site and difference of wire location pre-and postoperatively was measured using simple radiography. RESULTS In both groups, the mean visual analogue scale (VAS) score during motion, the mean UCLA and constant scores significantly improved at the last follow-up (all p < 0.001). These scores were not significantly different between two groups. However, postoperatively, a significant difference was observed in the incidence of cosmetic deformity between two groups (p = 0.019). The cosmetic deformity was noted in 9 (13.0%) patients (Popeye deformity 7.2% and biceps softening 5.8%) in group A and 1 (1.6%) patient (Popeye deformity) in group B. In the subgroup analysis on biceps migration after the surgery, the mean migration distance of metal wire was 2.5 ± 3.0 mm in group A and 1.9 ± 2.6 mm in group B (n.s.). No patient had migration of > 10 mm. CONCLUSIONS SPBT using all-suture type anchor was a favorable treatment option for lesions of the LHBT with rotator cuff tear. The clinical relevance of this study is the finding that double on-lay fixation with all-suture type anchor would result less cosmetic deformity than the single on-lay fixation for those who need subpectoral biceps tenodesis. LEVEL OF EVIDENCE III.
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Cyclic and Load-to-Failure Properties of All-Suture Anchors in Human Cadaveric Shoulder Glenoid Bone. Arthroscopy 2019; 35:1954-1959.e4. [PMID: 30979619 DOI: 10.1016/j.arthro.2019.01.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 01/12/2019] [Accepted: 01/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the cyclic displacement and ultimate load to failure of 4 all-suture anchors in human cadaveric shoulder glenoid bone. METHODS Four all-suture anchors indicated for glenoid labral repair were tested in 14 matched pairs of human cadaveric fresh-frozen glenoids. Anchors were inserted at 4 different locations for a total of 112 tests (12-, 3-, 6-, and 9-o'clock positions for right glenoids). Cyclic loading (10 to 60 N at 1 Hz for 200 cycles) and single pull-to-failure testing (33 mm/s) were performed. A Kruskal-Wallis 1-way analysis of variance with the Dunn multiple-comparison post hoc test was used for statistical analysis. RESULTS One matched pair was excluded because of poor bone quality. Thus, 13 matched pairs were included in the study, and a total of 104 tests were performed. The Q-Fix anchors showed significantly less displacement after 100 cycles (mean ± standard deviation, 1.40 ± 0.97 mm; P < .001) and 200 cycles (1.53 ± 1.00 mm, P < .001) than all other anchors tested. The Q-Fix (191.3 ± 65.8 N), Suturefix (188.3 ± 61.4 N), and JuggerKnot (183.6 ± 63.5 N) anchors had significantly greater ultimate loads to failure than the Iconix anchors (143.5 ± 54.1 N) (P = .01, P = .012, and P = .021, respectively). Displacement greater than 5 mm occurred in 6 Iconix anchors (22.1%), 5 Suturefix anchors (19.2%), 4 JuggerKnot anchors (15.4%), and 0 Q-Fix anchors (0%). CONCLUSIONS The Q-Fix anchors showed less displacement with cyclic loading than the Iconix, JuggerKnot, and Suturefix anchors. The Iconix anchors had a lower ultimate load to failure than the Q-Fix, Suturefix, and JuggerKnot anchors. Only the Q-Fix group had no anchors displace greater than 5 mm with cyclic loading. CLINICAL RELEVANCE All-suture anchors vary in their deployment mechanism, which may alter their strength and performance. Operators must be aware of these anchors' propensity to displace while deploying them.
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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.
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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: 5.6] [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.
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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
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Lee JH, Itami Y, Hedayati B, Bitner B, McGarry MH, Lee TQ, Shin SJ. Biomechanical effects of position and angle of insertion for all-suture anchors in arthroscopic Bankart repair. Clin Biomech (Bristol, Avon) 2018; 60:45-50. [PMID: 30316165 DOI: 10.1016/j.clinbiomech.2018.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/19/2018] [Accepted: 10/01/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The biomechanical properties of all-suture anchor for labral repair depending on the insertion angle and location are lacking. The purpose of this study was to quantify the biomechanical fixation characteristics of the anchor position and insertion angle of all-suture anchors for arthroscopic Bankart repair. METHODS Twenty-four fresh frozen cadaveric glenoid were used. All-suture anchors with 1.5-mm diameter were randomly inserted at 2:30, 4:00, and 5:30 o'clock positions on the glenoid edge, with either 30°, 45° or 60° insertion angles to the mediolateral axis of the glenoid. Anchors were preloaded to 5 N and cyclically loaded from 5 N to 20 N for 10 cycles, followed by a load to failure test at 60 mm/min. Permanent, non-recoverable displacement was quantified at the end of the cyclic loading test to yield load. FINDINGS All-suture anchors implanted at the 2:30 o'clock position of the glenoid provided greater stiffness, yield load, and ultimate load than those inserted at the 4:00 and 5:30 o'clock positions, regardless of the insertion angle. Displacement at yield and ultimate load were similar among the positions and insertion angles (yield load, vs. 4:00, p = 0.01; vs. 5:30, p = 0.045; ultimate load, vs. 4:00, p < 0.01; vs. 5:30, p < 0.01). The insertion angles of 30°, 45° and 60° did not influence mechanical stability between the 4:00 and 5:30 o'clock positions. INTERPRETATION The insertion angle of all-suture anchors does not significantly affect the stability at antero-inferior quadrant of the glenoid.
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Affiliation(s)
- Jae-Hoo Lee
- Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Yasuo Itami
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Bobak Hedayati
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Benjamin Bitner
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopaedic Surgery, University of California, Irvine, CA, USA
| | - Sang-Jin Shin
- Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, College of Medicine, Seoul, Republic of Korea.
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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: 3.0] [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.
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Christian DR, Redondo ML, Cvetanovich GL, Beer AJ, Cole BJ. Mini-Open Subpectoral Biceps Tenodesis With an All-Suture Anchor. OPER TECHN SPORT MED 2018. [DOI: 10.1053/j.otsm.2018.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Werner BC. Editorial Commentary: How Can I Tenodese the Biceps Tendon of the Shoulder? Let Me Count the Ways. Arthroscopy 2018; 34:1762-1763. [PMID: 29804600 DOI: 10.1016/j.arthro.2018.01.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 01/31/2018] [Indexed: 02/02/2023]
Abstract
The debate regarding the management of long head of the biceps tendon pathology continues to evolve. Previous literature has compared tenotomy and tenodesis, tenodesis above or below the pectoralis major tendon, tenodesis to bony or soft tissue sites, and a host of fixation methods. Recent research compares biomechanical fixation between an all-suture anchor and interference screw for arthroscopic tenodesis. Although the methods have similar biomechanical properties, time-zero cadaveric data has inherent limitations, and importantly, there is a substantial cost differential between these and other implants that surgeons should also consider when choosing a tenodesis method.
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Ruder JA, Dickinson EY, Habet N, Peindl RD, D'Alessandro DF, Fleischli JE. Slight Reduction in the Insertion Depth for an All-Suture Anchor Decreases Cyclic Displacement in the Shoulder Glenoid. Arthroscopy 2018; 34:1384-1390. [PMID: 29456066 DOI: 10.1016/j.arthro.2017.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine if the depth of anchor insertion affects the biomechanical performance of a 1.5-mm all-suture anchor in glenoid bone. METHODS A 1.5-mm all-suture anchor was tested in 8 matched pairs of human cadaver fresh-frozen glenoids. Anchors were inserted at 6 different locations and tested at 3 different depths: 21 mm (preset drilling depth), 17 mm, and 13 mm. Cyclic loading and destructive testing was performed. Displacement after 100 and 200 cycles, along with ultimate failure strength, was determined. RESULTS After 100 and 200 cycles, anchors placed at 13 and 17 mm had undergone significantly less displacement than those at 21 mm (P < .05). No difference was observed in ultimate load to failure between anchors placed at 21 and 17 mm. However, the ultimate load to failure was significantly lower in anchors placed at 13 mm (P < .05). There were 5 clinical failures in anchors placed at 21 mm, one at 17 mm, and none at 13 mm. CONCLUSIONS The 1.5-mm all-suture anchor tested in this study has an optimal insertion depth of 17 mm, 4 mm shallower than the preset drill depth. At the optimal insertion depth of 17 mm, it underwent significantly less displacement after cyclic loading without a reduction in the ultimate load to failure. CLINICAL RELEVANCE Given the results of this study, the optimal insertion depth for this 1.5-mm all-suture anchor is 17 mm, 4 mm shallower than the preset drill depth.
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Affiliation(s)
- John A Ruder
- Department of Orthopaedic Surgery, Carolinas HealthCare System, Charlotte, North Carolina, U.S.A
| | | | - Nahir Habet
- Department of Orthopaedic Surgery, Carolinas HealthCare System, Charlotte, North Carolina, U.S.A
| | - Richard D Peindl
- Department of Orthopaedic Surgery, Carolinas HealthCare System, Charlotte, North Carolina, U.S.A
| | | | - James E Fleischli
- OrthoCarolina Sports Medicine Center, Charlotte, North Carolina, U.S.A..
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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: 1.5] [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.
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Amouyel T, Le Moulec YP, Tarissi N, Saffarini M, Courage O. Arthroscopic Biceps Tenodesis Using Interference Screw Fixation in the Bicipital Groove. Arthrosc Tech 2017; 6:e1953-e1957. [PMID: 29430396 PMCID: PMC5798995 DOI: 10.1016/j.eats.2017.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/12/2017] [Indexed: 02/03/2023] Open
Abstract
Arthroscopic repair of the long head of the biceps (LHB) is performed to treat various biceps pathologies yet the choice between tenotomy or tenodesis remains controversial. Although tenotomy is simpler and quicker, tenodesis results in fewer complications, and there are several techniques available using various fixation devices and sites. This Technical Note describes an all-arthroscopic, suprapectoral tenodesis technique using a bioresorbable interference screw, without motorized devices to create the humeral tunnel in the bicipital groove. The LHB tendon is detached from its glenoid insertion using an arthroscopic cutting instrument or electrocautery. Two portals are created 50 mm distal to the acromioclavicular joint and at 15 mm on either side of the bicipital groove. The arthroscope is introduced through the distal lateral portal till it makes contact with the humerus. The LHB is fastened within its groove using a grasper, reinforced, and then fixed in the humeral tunnel using an interference screw. The present technique is safe, simple, and reproducible. It requires 2 portals in addition to the standard posterior portal and the intra-articular working portal. It minimizes iatrogenic intra-articular damage and thereby limits possible complications. It also limits the intra-articular operative time compared with SLAP repairs.
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Affiliation(s)
- Thomas Amouyel
- Department of Orthopaedic Surgery, Hopital Privé de l’Estuaire (HASS), Le Havre, France,Address correspondence to Thomas Amouyel, M.D., Department of Orthopaedic Surgery, Hopital Privé de l’Estuaire (HASS), 505 rue Irène Juliot-Curie, Le Havre 76620, France.Department of Orthopaedic SurgeryHopital Privé de l’Estuaire (HASS)505 rue Irène Juliot-CurieLe Havre76620France
| | - Yves-Pierre Le Moulec
- Department of Orthopaedic Surgery, Hopital Privé de l’Estuaire (HASS), Le Havre, France
| | - Nicolas Tarissi
- Department of Orthopaedic Surgery, Hopital Privé de l’Estuaire (HASS), Le Havre, France
| | | | - Olivier Courage
- Department of Orthopaedic Surgery, Hopital Privé de l’Estuaire (HASS), Le Havre, France
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Kennedy NI, Godin JA, Ferrari MB, Sanchez G, Cinque ME, Hussain ZB, Provencher MT. Subpectoral Biceps Tenodesis: Interference Screw and Cortical Button Fixation. Arthrosc Tech 2017; 6:e1415-e1420. [PMID: 29354450 PMCID: PMC5622588 DOI: 10.1016/j.eats.2017.05.028] [Citation(s) in RCA: 9] [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: 03/31/2017] [Accepted: 05/30/2017] [Indexed: 02/03/2023] Open
Abstract
Bicep tendon pathology often arises from chronic overuse injuries, acute trauma, or degenerative changes in the glenohumeral joint. These injuries can cause significant shoulder pain, and can greatly limit range of motion and, in turn, activities of daily living. The diagnosis of biceps pathologies can be challenging, because patients often present with nonspecific symptoms. Some bicep tendon pathologies may be treated nonoperatively; however, biceps tendon subluxation and the presence of rotator cuff or SLAP lesions require surgical management. One of the options for the treatment of bicep tendon pathology includes miniopen subpectoral biceps tenodesis. The purpose of this Technical Note is to describe in detail our preferred operative technique for miniopen subpectoral biceps tenodesis with 2 different fixation methods.
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Affiliation(s)
| | | | | | - George Sanchez
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Mark E. Cinque
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Matthew T. Provencher
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A.,The Steadman Clinic, Vail, Colorado, U.S.A.,Address correspondence to Matthew T. Provencher, M.D., M.C., U.S.N.R., Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 1000, Vail, CO 81657, U.S.A.Steadman Philippon Research Institute181 West Meadow DriveSuite 1000VailCO81657U.S.A.
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Barber FA, Herbert MA. All-Suture Anchors: Biomechanical Analysis of Pullout Strength, Displacement, and Failure Mode. Arthroscopy 2017; 33:1113-1121. [PMID: 28017468 DOI: 10.1016/j.arthro.2016.09.031] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/20/2016] [Accepted: 09/26/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the biomechanical and design characteristics of all-suture anchors. METHODS All-suture anchors were tested in fresh porcine cortical bone and biphasic polyurethane foam blocks by cyclic loading (10-100 N for 200 cycles), followed by destructive testing parallel to the insertion axis at 12.5 mm/s. Endpoints included ultimate failure load, displacement at 100 and 200 cycles, stiffness, and failure mode. Anchors tested included JuggerKnot (1.4, 1.5, and 2.8), Iconix (1, 2, and 3), Y-knot (1.3, 1.8, and 2.8), Q-Fix (1.8 and 2.8), and Draw Tight (1.8 and 3.2). RESULTS The mean ultimate failure strength of the triple-loaded anchors (564 ± 42 N) was significantly greater than the mean ultimate failure strength of the double-loaded anchors (465 ± 33 N) (P = .017), and the double-loaded anchors were stronger than the single-loaded anchors (256 ± 35 N) (P < .0001). No difference was found between the results in porcine bone and biphasic polyurethane foam. None of these anchors demonstrated 5 mm or 10 mm of displacement during cyclic loading. The Y-Knot demonstrated greater displacement than the JuggerKnot and Q-Fix (P = .025) but not the Iconix and Draw Tight (P > .05). The most common failure mode varied and was suture breaking for the Q-Fix (97%), JuggerKnot (81%), and Iconix anchors (58%), anchor pullout with the Draw Tight (76%), whereas the Y-Knot was 50% suture breaking and 50% anchor pullout. CONCLUSIONS The ultimate failure load of an all-suture anchor is correlated directly with its number of sutures. With cyclic loading, the Y-Knot demonstrated greater displacement than the JuggerKnot and Q-Fix but not the Iconix and Draw Tight. JuggerKnot (81%) and Q-Fix (97%) anchors failed by suture breaking, whereas the Draw Tight anchor failed by anchor pullout (76%). CLINICAL RELEVANCE All-suture anchors vary in strength and performance, and these factors may influence clinical success. Biphasic polyurethane foam is a validated model for suture anchor testing.
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Affiliation(s)
- F Alan Barber
- Plano Orthopedic Sports Medicine and Spine Center, Plano, Texas, U.S.A
| | - Morley A Herbert
- Advanced Surgical Institutes, Medical City Dallas Hospital, Dallas, Texas, U.S.A
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