Arthroscopic Biceps Tenodesis Outcomes: A Comparison of Inlay and Onlay Techniques

2020 ◽  
Vol 48 (12) ◽  
pp. 3051-3056
Author(s):  
Georges Haidamous ◽  
Matthew P. Noyes ◽  
Patrick J. Denard
Keyword(s):  
Functional Outcome ◽  
Revision Surgery ◽  
Suture Anchor ◽  
Elbow Flexion ◽  
Interference Screw ◽  
Biceps Tenodesis ◽  
Onlay Technique ◽  
Flexion Strength ◽  
Knotless Suture Anchor ◽  
Popeye Deformity

Background: Arthroscopic biceps tenodesis (ABT) high in the groove can be achieved using an inlay or an onlay technique. However, there is little information comparing outcomes between the 2. Purpose: To compare postoperative healing and functional outcomes of ABT high in the groove performed using either an onlay or an inlay technique. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was performed on patients undergoing ABT at the articular margin (high in the groove) at a single center over a 2-year period. An inlay technique using an interference screw was performed during the first year, followed by an onlay technique using a knotless suture anchor during the second. Tendon healing, elbow flexion strength, functional outcome, and complications were evaluated at a postoperative minimum of 1 year. Results: A total of 37 patients with inlay and 53 with onlay ABTs were available for follow-up. There was no difference in range of motion, functional outcome scores, or elbow flexion strength between the groups. A postoperative popeye deformity was noted in 27% of patients in the inlay group as compared with 9.4% of the onlay group ( P = .028). Four patients (10.8%) in the inlay group required revision surgery (2 of which were biceps tenodesis related) as compared with 0% in the onlay group ( P = .015). Conclusion: An onlay technique using a knotless suture anchor for ABT at the top of the articular margin is an acceptable alternative to an inlay technique using an interference screw. The onlay technique was associated with lower rates of postoperative popeye deformity and revision surgery as compared with the inlay technique.

Biomechanical Evaluation of Open Suture Anchor Fixation Versus Interference Screw for Biceps Tenodesis

Orthopedics ◽  
2011 ◽  
Author(s):  
Derek F. Papp ◽  
Nathan W. Skelley ◽  
Edward G. Sutter ◽  
Jong Hun Ji ◽  
Carl H. Wierks ◽  
...  
Keyword(s):  
Suture Anchor ◽  
Interference Screw ◽  
Biceps Tenodesis ◽  
Biomechanical Evaluation ◽  
Suture Anchor Fixation ◽  
Anchor Fixation

A Prospective Randomized Study Comparing the Interference Screw and Suture Anchor Techniques for Biceps Tenodesis

2016 ◽  
Vol 45 (2) ◽  
pp. 440-448 ◽  
Author(s):  
Ji Soon Park ◽  
Sae Hoon Kim ◽  
Ho Jin Jung ◽  
Ye Hyun Lee ◽  
Joo Han Oh
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Functional Outcomes ◽  
Suture Anchor ◽  
Interference Screw ◽  
Arthroscopic Rotator Cuff Repair ◽  
Biceps Tenodesis ◽  
Work Level ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Background: Several methods are used to perform biceps tenodesis in patients with superior labrum-biceps complex (SLBC) lesions accompanied by a rotator cuff tear. However, limited clinical data are available regarding the best technique in terms of clinical and anatomic outcomes. Purpose: To compare the clinical and anatomic outcomes of the interference screw (IS) and suture anchor (SA) fixation techniques for biceps tenodesis performed along with arthroscopic rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 80 patients who underwent arthroscopic rotator cuff repair with SLBC lesions were prospectively enrolled and randomly divided according to the tenodesis method: the IS and SA groups. Functional outcomes were evaluated with the visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Constant score, Korean Shoulder Score (KSS), and long head of the biceps (LHB) score at least 2 years after surgery. The anatomic status of tenodesis was estimated using magnetic resonance imaging or ultrasonography, and the anatomic failure of tenodesis was determined when the biceps tendon was not traced in the intertubercular groove directly from the insertion site of the IS or SA. Results: Thirty-three patients in the IS group and 34 in the SA group were monitored for more than 2 years. All postoperative functional scores improved significantly compared with the preoperative scores (all P < .001) and were not significantly different between the groups, including the LHB score (all P > .05). Nine anatomic failures of tenodesis were observed: 7 in the IS group and 2 in the SA group ( P = .083). In a multivariate analysis using logistic regression, IS fixation ( P = .003) and a higher (ie, more physically demanding) work level ( P = .022) were factors associated with the anatomic failure of tenodesis significantly. In patients with tenodesis failure, the LHB score ( P = .049) and the degree of Popeye deformity by the patient and examiner ( P = .004 and .018, respectively) were statistically different compared with patients with intact tenodeses. Conclusion: Care must be taken while performing biceps tenodesis in patients with a higher work level; IS fixation appears to pose a higher risk in terms of the anatomic failure of tenodesis than SA fixation, although functional outcomes were not different.

scholarly journals Biceps Brachii Alterations Following the Latarjet Procedure: A Prospective Multicenter Study

2021 ◽  
Vol 10 (23) ◽  
pp. 5487
Author(s):  
Lucca Lacheta ◽  
Marco-Christopher Rupp ◽  
Andrea Achtnich ◽  
Sepp Braun ◽  
Mark Tauber ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Case Series ◽  
Elbow Flexion ◽  
Upper Extremities ◽  
Latarjet Procedure ◽  
Flexion Strength ◽  
Supination Strength ◽  
Popeye Deformity ◽  
Mini Open

Purpose: To prospectively investigate the postoperative forearm supination and elbow flexion strength of both upper extremities and popeye deformity in patients who underwent a mini-open Latarjet procedure for anterior shoulder instability. Methods: Patients who underwent a mini-open Latarjet procedure at two specialized shoulder centers were prospectively evaluated preoperatively (T0) and at least 6 months (T1) after surgery. Subjects were tested for elbow flexion and forearm supination strength of both upper extremities using an isometric dynamometer and customized torque dynamometer. Clinical outcome was assessed by the Constant Score (CS), American Shoulder and Elbow Score (ASES) and Simple Shoulder test (SST). Popeye deformity was defined as a distalization of the greatest circumference of the biceps muscle belly towards the lateral epicondyle of the elbow. Results: A total of 20 patients with a mean age of 27 ± 6 years were included in the study. At a mean follow-up of 10 ± 3 months, the elbow flexion strength was restored to the preoperative state (p = 0.240). Forearm supination strength significantly decreased at final follow-up, to 88 % in the surgical arm (p = 0.015) vs. 90 % in the non-surgical arm (p = 0.023). There was no statistical difference when comparing both arms concerning elbow flexion strength (p = 0.510) and forearm supination strength (p = 0.495). No significant popeye deformity was observed in both arms (p = 0.111 vs. p = 0.508). Clinical outcome scores improved significantly from 73 ± 18 to 82 ± 13 (p = 0.014) for CS and 76 ± 22 to 89 ± 12 (p = 0.008) for ASES score preoperatively to final follow-up. No difference in the SST was documented (p = 0.10). Conclusion: The Latarjet procedure showed to preserve elbow flexion strength and provided comparable forearm supination strength compared to the uninjured arm with reliable clinical outcome in this study population. However, a decrease of forearm supination strength in both arms was persistent at a mean of 10 months postoperatively. No popeye deformity was noted in the postoperative examinations. Level of evidence: Case series, Level III.

Are Implant Choice and Surgical Approach Associated With Biceps Tenodesis Construct Strength? A Systematic Review and Meta-regression

2019 ◽  
Vol 48 (5) ◽  
pp. 1273-1280 ◽  
Author(s):  
Hiroshi F. Aida ◽  
Brendan Y. Shi ◽  
Eric G. Huish ◽  
Edward G. McFarland ◽  
Uma Srikumaran
Keyword(s):  
Suture Anchor ◽  
Meta Analysis ◽  
Interference Screw ◽  
Suture Anchors ◽  
Biceps Tenodesis ◽  
Inclusion Criteria ◽  
Data Set ◽  
Interference Screws ◽  
Native Tissue ◽  
Meta Regression

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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