Biomechanical properties of suprapectoral biceps tenodesis: double knotless screw fixation is superior to single knotless screw fixation
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The purpose of this study is to biomechanically evaluate a new technique of double knotless screw fixation for suprapectoral biceps tenodesis and compare the results with that of the single knotless screw fixation as well as the interference screw fixation.
24 fresh-frozen human cadaveric shoulders with a mean age of 68.3 ± 9 years were studied. The specimens were randomly divided into three experimental biceps tenodesis groups (n = 8): single knotless screw, double knotless screw and interference screw. Each tenodesis specimen was mounted on a mechanical testing machine, preloaded for 2 min at 5 N, tested with cyclic loading from 5 to 70 N for 500 load cycles and subjected to an axial load to failure test (1 mm/s). The ultimate failure load, stiffness, cyclic displacement and mode of failure were evaluated.
The interference screw fixation had the highest ultimate failure load (215.8 ± 43.1 N) and stiffness (25.7 ± 5.2 N/mm) which were significantly higher than the corresponding results for the single and double knotless screw groups (P = 0.0029). The double knotless screw group had the second highest ultimate failure load (162.8 ± 13.8 N) and stiffness (15.1 ± 4.1 N/mm) which were significantly higher than the corresponding results for the single knotless screw technique (P = 0.0002). The most common mode of failure was suture slippage for both the double (7/8) and single knotless screw (6/8) groups while biceps tendon tearing occurred most often for the interference screw group (6/8).
In this biomechanical study, the double knotless screw fixation was found to have a significantly greater ultimate failure load and stiffness than the single knotless screw fixation but lower values than the interference screw fixation.
KeywordsKnotless screw Double knotless screw Winding suture Suprapectoral biceps tenodesis Interference screw
There is no funding source.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article was granted an exemption from the institutional review board (IRB) in a medical center.
- 2.Jacxsens M, Granger EK, Tashjian RZ (2018) 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 138(1):63–72. https://doi.org/10.1007/s00402-017-2810-z CrossRefPubMedGoogle Scholar
- 4.Wu PT, Jou IM, Yang CC, Lin CJ, Yang CY, Su FC, Su WR (2014) The severity of the long head biceps tendinopathy in patients with chronic rotator cuff tears: macroscopic versus microscopic results. J Shoulder Elbow Surg 23(8):1099–1106. https://doi.org/10.1016/j.jse.2013.11.013 CrossRefPubMedGoogle Scholar
- 6.Lee HJ, Jeong JY, Kim CK, Kim YS (2016) Surgical treatment of lesions of the long head of the biceps brachii tendon with rotator cuff tear: a prospective randomized clinical trial comparing the clinical results of tenotomy and tenodesis. J Shoulder Elbow Surg 25(7):1107–1114. https://doi.org/10.1016/j.jse.2016.02.006 CrossRefPubMedGoogle Scholar
- 7.Gurnani N, van Deurzen DF, Janmaat VT, van den Bekerom MP (2016) Tenotomy or tenodesis for pathology of the long head of the biceps brachii: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 24(12):3765–3771. https://doi.org/10.1007/s00167-015-3640-6 CrossRefPubMedGoogle Scholar
- 9.De Carli A, Vadala A, Zanzotto E, Zampar G, Vetrano M, Iorio R, Ferretti A (2012) Reparable rotator cuff tears with concomitant long-head biceps lesions: tenotomy or tenotomy/tenodesis? Knee Surg Sports Traumatol Arthrosc 20(12):2553–2558. https://doi.org/10.1007/s00167-012-1918-5 CrossRefPubMedGoogle Scholar
- 18.Golish SR, Caldwell PE 3rd, Miller MD, Singanamala N, Ranawat AS, Treme G, Pearson SE, Costic R, Sekiya JK (2008) Interference screw versus suture anchor fixation for subpectoral tenodesis of the proximal biceps tendon: a cadaveric study. Arthroscopy 24(10):1103–1108. https://doi.org/10.1016/j.arthro.2008.05.005 CrossRefPubMedGoogle Scholar
- 21.Patzer T, Santo G, Olender GD, Wellmann M, Hurschler C, Schofer MD (2012) Suprapectoral or subpectoral position for biceps tenodesis: biomechanical comparison of four different techniques in both positions. J Shoulder Elbow Surg 21(1):116–125. https://doi.org/10.1016/j.jse.2011.01.022 CrossRefPubMedGoogle Scholar
- 25.Slabaugh MA, Frank RM, Van Thiel GS, Bell RM, Wang VM, Trenhaile S, Provencher MT, Romeo AA, Verma NN (2011) Biceps tenodesis with interference screw fixation: a biomechanical comparison of screw length and diameter. Arthroscopy 27(2):161–166. https://doi.org/10.1016/j.arthro.2010.07.004 CrossRefPubMedGoogle Scholar
- 26.El-Azab H, Buchmann S, Beitzel K, Waldt S, Imhoff AB (2010) Clinical and structural evaluation of arthroscopic double-row suture-bridge rotator cuff repair: early results of a novel technique. Knee Surg Sports Traumatol Arthrosc 18(12):1730–1737. https://doi.org/10.1007/s00167-010-1257-3 CrossRefPubMedGoogle Scholar
- 29.Vaishnav S, Millett PJ (2010) Arthroscopic rotator cuff repair: scientific rationale, surgical technique, and early clinical and functional results of a knotless self-reinforcing double-row rotator cuff repair system. J Shoulder Elbow Surg 19(2 Suppl):83–90. https://doi.org/10.1016/j.jse.2009.12.012 CrossRefPubMedGoogle Scholar
- 31.Lorbach O, Trennheuser C, Kohn D, Anagnostakos K (2016) The biomechanical performance of a new forked knotless biceps tenodesis compared to a knotless and suture anchor tenodesis. Knee Surg Sports Traumatol Arthrosc 24(7):2174–2180. https://doi.org/10.1007/s00167-014-3365-y CrossRefPubMedGoogle Scholar