Abstract
Background
Biomechanical analysis of biceps tenodesis procedures has historically focused on load to failure models. Minimal data exists for the analysis of biomechanical strain properties of the biceps tendon in a sub-failure, physiologic cadaver model.
Hypothesis
Tendon strain characteristics are different between bony and soft tissue tenodesis surgery, and the soft tissue tenodesis procedure reproduces a strain pattern more similar to the native biceps tendon.
Methods
Eight fresh frozen cadaver upper extremities were mounted onto a custom device that controls shoulder abduction and rotation. Strain on the tendon was measured using a differential variable reluctance transducer as the arm was moved through cycles of abduction and external rotation. Each arm was mounted once, and all 3 testing procedures were performed on each of the 8 specimens. Statistical analysis was completed using ANOVA, followed by multiple comparisons with Bonferroni correction.
Results
The bony tenodesis model placed higher strain on the biceps tendon than the soft tissue tenodesis (p = 0.025). Also, the bony tenodesis model increased the strain on the biceps tendon when compared to the native tendon (p = 0.031). In contrast, the soft tissue tenodesis did not significantly alter strain when compared to the native tendon (p = 0.089).
Conclusion
The soft tissue tenodesis procedure better maintained the native strain environment when compared to the bony tenodesis using an interference screw. Due to this closer approximation of native biceps tendon biomechanics, the soft tissue procedure may be more preferable clinically than the bony tenodesis.
Level of Evidence: 1, Controlled Laboratory Study.
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References
Hsu AR, Ghodadra NS, Provencher CDRMT, Lewis PB, Bach BR. Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results. J Shoulder Elbow Surg. 2011;20:326–32.
Slenker NR, Lawson K, Ciccotti MG, Dodson CC, Cohen SB. Biceps tenotomy versus tenodesis: clinical outcomes. J Arthrosc Relat Surg. 2012;28:576–82.
Kelly AM, Drakos MC, Fealy S, Taylor SA, O’Brien SJ. Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results. Am J Sports Med. 2005;33:208–13.
Mariani EM, Cofield RH, Askew LJ, Li GP, Chao EY. Rupture of the tendon of the long head of the biceps brachii. Surgical versus nonsurgical treatment. Clin Orthop Relat Res. 1988;228:233–9.
Boileau P, Krishnan SG, Coste JS, Walch G. Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation. Arthroscopy. 2002;18:1002–12.
Becker DA, Cofield RH. Tenodesis of the long head of the biceps brachii for chronic bicipital tendinitis. Long-term results. J Bone Joint Surg Am. 1989;71:376–81.
Post M, Benca P. Primary tendinitis of the long head of the biceps. Clin Orthop Relat Res. 1989;246:117–25.
Nord KD, Smith GB, Mauck BM. Arthroscopic biceps tenodesis using suture anchors through the subclavian portal. Arthroscopy. 2005;21:248–52.
Dines D, Warren RF, Inglis AE. Surgical treatment of lesions of the long head of the biceps. Clin Orthop Relat Res. 1982;164:165–71.
Elkousy HA, Fluhme DJ, O’Connor DP, Rodosky MW. Arthroscopic biceps tenodesis using the percutaneous, intra-articular trans-tendon technique: preliminary results. Orthopedics. 2005;28:1316–9.
Richards DP, Burkhart SS. A biomechanical analysis of two biceps tenodesis fixation techniques. Arthroscopy. 2005;21:861–6.
Golish SR, Caldwell PE 3rd, Miller MD, Singanamala N, Ranawat AS, Treme G, Pearson SE, Costic R, Sekiya JK. Interference screw versus suture anchor fixation for subpectoral tenodesis of the proximal biceps tendon: a cadaveric study. Arthroscopy. 2008;24:1103–8.
Kusma M, Dienst M, Eckert J, Steimer O, Kohn D. Tenodesis of the long head of biceps brachii: cyclic testing of five methods of fixation in a porcine model. J Shoulder Elbow Surg. 2008;17:967–73.
Lopez-Vidriero E, Costic RS, Fu FH, Rodosky MW. Biomechanical evaluation of 2 arthroscopic biceps tenodeses: double-anchor versus percutaneous intra-articular transtendon (PITT) techniques. Am J Sports Med. 2010;38:146–52.
Sekiya JK, Elkousy HA, Rodosky MW. Arthroscopic biceps tenodesis using the percutaneous intra-articular transtendon technique. Arthroscopy. 2003;19:1137–41.
Romeo AA, Mazzocca AD, Tauro JC. Arthroscopic biceps tenodesis. Arthroscopy. 2004;20:206–13.
Frost A, Zafar MS, Maffulli N. Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii. Am J Sports Med. 2009;37:828–33.
Jayamoorthy T, Field JR, Costi JJ, Martin DK, Stanley RM, Hearn TC. Biceps tenodesis: a biomechanical study of fixation methods. J Shoulder Elbow Surg. 2004;13:160–4.
Ozalay M, Akpinar S, Karaeminogullari O, Balcik C, Tasci A, Tandogan RN, Gecit R. Mechanical strength of four different biceps tenodesis techniques. Arthroscopy. 2005;21:992–8.
Mazzocca AD, Bicos J, Santangelo S, Romeo AA, Arciero RA. The biomechanical evaluation of four fixation techniques for proximal biceps tenodesis. Arthroscopy. 2005;21:1296–306.
Acknowledgments
Arthrex, Inc. provided the cadaver arms through a donation to the Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine. No financial remuneration to the authors, or any member of their family,was received related to the subject of the article.
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Levin, S.D., Wellman, D.S., Liu, C. et al. Biomechanical strain characteristics of soft tissue biceps tenodesis and bony tenodesis. J Orthop Sci 18, 699–704 (2013). https://doi.org/10.1007/s00776-013-0429-7
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DOI: https://doi.org/10.1007/s00776-013-0429-7