Las anclas de sutura muestran mayor resistencia que los tornillos de interferencia para la tenodesis del bíceps

Rodrigo de Marinis; Julio J. Contreras; Daniel Paccot; Felipe Palma; Pablo Besa; Felipe Toro; Rodrigo Guzmán; René Pozo

doi:10.1055/s-0044-1787735

Revista Chilena de Ortopedia y Traumatología, Table of Contents

CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2024; 65(02): e58-e64
DOI: 10.1055/s-0044-1787735

Artículo Original | Original Article

Suture Anchors Display Higher Resistance than Interference Screws for Biceps Tenodesis

Article in several languages: español | English

Rodrigo de Marinis

¹Unidad de Hombro y Codo, Departamento de Ortopedia y Traumatología, Facultad de Medicina, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

,

Julio J. Contreras

¹Unidad de Hombro y Codo, Departamento de Ortopedia y Traumatología, Facultad de Medicina, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

,

Daniel Paccot

²Unidad de Hombro y Codo, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile

,

Felipe Palma

³Laboratorio LIBFE, Escuela de Kinesiología, Universidad de los Andes, Santiago, Chile

,

Pablo Besa

¹Unidad de Hombro y Codo, Departamento de Ortopedia y Traumatología, Facultad de Medicina, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

,

Felipe Toro

²Unidad de Hombro y Codo, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile

,

Rodrigo Guzmán

³Laboratorio LIBFE, Escuela de Kinesiología, Universidad de los Andes, Santiago, Chile

,

René Pozo

²Unidad de Hombro y Codo, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile

› Author Affiliations

Abstract

Objective To assess four different fixation techniques for biceps tenodesis.

Materials and Methods A total of 32 fresh frozen sheep shoulders were randomly divided into 4equal groups according to each tenodesis technique: Biotenodesis screw (BTS), SwiveLock tenodesis screw (SLS) (Arthrex, Inc., Naples, FL, United States), triple lasso-loop (TLL), and double lasso-loop (DLL). All tenodesis were performed suprapectorally at the bicipital groove. For interference screws (ISs), no additional knots were added after fixation. All specimens were tested for ultimate load to failure (ULF), and the yield point (YP) was calculated. The mode of failure was recorded for each specimen. The statistical analysis was performed using a Kruskal-Wallis test and the Dunn post-hoc test. Significance was set at p < 0.05.

Results The ULF recorded for each experimental group was as follows: BTS group = 126.2 (range: 94.8–161.1) N; SLS group = 95.8 (range: 75.9–130) N; DLL group = 208.4 (range: 195.3–219.5) N; and TLL group = 261.4 (range: 194.9–306.5) N. The mode of failure for all specimens in the IS groups was tendon pullout from fixation, while specimens in the suture anchor (SA) groups mostly failed by tendon rupture. Both SA techniques showed a significantly higher ULF and YP when compared with each IS technique (p < 0.01). There were no significant differences in terms of the ULF or YP achieved between the use of DLL and of TLL.

Conclusion In the present animal cadaveric testing model, SA techniques demonstrated a higher ULF when compared with knotless IS techniques. Specifically, within the SA techniques, the mechanical resistance to axial load of the DLL was found to be comparable that of the TLL.

Level of Evidence Basic science study.

Keywords

biceps - tenodesis - suture anchor - interference screw

Full Text

References

Referencias
1 Lansdown DA, Bernardoni ED, Verma NN. Surgical technique for arthroscopic onlay suprapectoral biceps tenodesis with an all-suture anchor. JSES Open Access 2018; 2 (01) 69-73
2 Provencher MT, LeClere LE, Romeo AA. Subpectoral biceps tenodesis. Sports Med Arthrosc Rev 2008; 16 (03) 170-176
3 Ahrens PM, Boileau P. The long head of biceps and associated tendinopathy. J Bone Joint Surg Br 2007; 89 (08) 1001-1009
4 Delle Rose G, Borroni M, Silvestro A. et al. The long head of biceps as a source of pain in active population: tenotomy or tenodesis? A comparison of 2 case series with isolated lesions. Musculoskelet Surg 2012; 96 (Suppl. 01) S47-S52
5 Hsu AR, Ghodadra NS, Provencher MT, Lewis PB, Bach BR. Biceps tenotomy versus tenodesis: a review of clinical outcomes and biomechanical results. J Shoulder Elbow Surg 2011; 20 (02) 326-332
6 Slenker NR, Lawson K, Ciccotti MG, Dodson CC, Cohen SB. Biceps tenotomy versus tenodesis: clinical outcomes. Arthroscopy 2012; 28 (04) 576-582
7 Shang X, Chen J, Chen S. A meta-analysis comparing tenotomy and tenodesis for treating rotator cuff tears combined with long head of the biceps tendon lesions. Nordez A, editor. PLoS One. 2017; Oct 9; 12 (10) e0185788
8 Virk MS, Nicholson GP. Complications of Proximal Biceps Tenotomy and Tenodesis. Clin Sports Med 2016; 35 (01) 181-188
9 Gurnani N, van Deurzen DFP, Janmaat VT, van den Bekerom MPJ. Tenotomy or tenodesis for pathology of the long head of the biceps brachii: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2016; 24 (12) 3765-3771
10 Papp DF, Skelley NW, Sutter EG. et al. Biomechanical evaluation of open suture anchor fixation versus interference screw for biceps tenodesis. Orthopedics 2011; 34 (07) e275-e278
11 Park JS, Kim SH, Jung HJ, Lee YH, Oh JH. A Prospective Randomized Study Comparing the Interference Screw and Suture Anchor Techniques for Biceps Tenodesis. Am J Sports Med 2017; 45 (02) 440-448
12 Patzer T, Rundic JM, Bobrowitsch E, Olender GD, Hurschler C, Schofer MD. Biomechanical comparison of arthroscopically performable techniques for suprapectoral biceps tenodesis. Arthroscopy 2011; 27 (08) 1036-1047
13 Patzer T, Santo G, Olender GD, Wellmann M, Hurschler C, Schofer MD. Suprapectoral or subpectoral position for biceps tenodesis: biomechanical comparison of four different techniques in both positions. J Shoulder Elbow Surg 2012; 21 (01) 116-125
14 Tashjian RZ, Henninger HB. Biomechanical evaluation of subpectoral biceps tenodesis: dual suture anchor versus interference screw fixation. J Shoulder Elbow Surg 2013; 22 (10) 1408-1412
15 Su WR, Budoff JE, Chiang CH, Lee CJ, Lin CL. Biomechanical study comparing biceps wedge tenodesis with other proximal long head of the biceps tenodesis techniques. Arthroscopy 2013; 29 (09) 1498-1505
16 Gigi R, Dolkart O, Sharfman ZT. et al. Biomechanical evaluation of two arthroscopic techniques for biceps tenodesis: triple loop suture versus simple suture. J Shoulder Elbow Surg 2017; 26 (01) 165-169
17 Lafosse L, Van Raebroeckx A, Brzoska R. A new technique to improve tissue grip: “the lasso-loop stitch”. Arthroscopy 2006; 22 (11) 1246.e1-1246.e3
18 Bois AJ, Roulet S, Le Dû C, Neyton L, Godenèche A. The “Double Lasso-Loop” Technique Used for Arthroscopic Proximal Biceps Tenodesis. Arthrosc Tech 2019; 8 (03) e291-e300
19 Boileau P, Krishnan SG, Coste JS, Walch G. Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation. Arthroscopy 2002; 18 (09) 1002-1012
20 Valenti P, Benedetto I, Maqdes A, Lima S, Moraiti C. “Relaxed” biceps proximal tenodesis: an arthroscopic technique with decreased residual tendon tension. Arthrosc Tech 2014; 3 (05) e639-e641
21 Richards DP, Burkhart SS. A biomechanical analysis of two biceps tenodesis fixation techniques. Arthroscopy 2005; 21 (07) 861-866
22 Ramos CH, Coelho JCU. Biomechanical evaluation of the long head of the biceps brachii tendon fixed by three techniques: a sheep model. Rev Bras Ortop 2016; 52 (01) 52-60
23 Ozalay M, Akpinar S, Karaeminogullari O. et al. Mechanical strength of four different biceps tenodesis techniques. Arthroscopy 2005; 21 (08) 992-998
24 Kilicoglu O, Koyuncu O, Demirhan M. et al. Time-dependent changes in failure loads of 3 biceps tenodesis techniques: in vivo study in a sheep model. Am J Sports Med 2005; 33 (10) 1536-1544
25 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 (02) 160-164
26 Shi D, Wang D, Wang C, Liu A. A novel, inexpensive and easy to use tendon clamp for in vitro biomechanical testing. Med Eng Phys 2012; 34 (04) 516-520
27 Golish SR, Caldwell III PE, Miller MD. et al. Interference screw versus suture anchor fixation for subpectoral tenodesis of the proximal biceps tendon: a cadaveric study. Arthroscopy 2008; 24 (10) 1103-1108
28 Mazzocca AD, Bicos J, Santangelo S, Romeo AA, Arciero RA. The biomechanical evaluation of four fixation techniques for proximal biceps tenodesis. Arthroscopy 2005; 21 (11) 1296-1306
29 Romeo AA, Mazzocca AD, Tauro JC. Arthroscopic biceps tenodesis. Arthroscopy 2004; 20 (02) 206-213