title: Biomechanical comparison of arthroscopically performable techniques for suprapectoral biceps tenodesis.
abstract: OBJECTIVE
  The aim of this study was to biomechanically compare the cyclic and ultimate failure load (UFL) of 4 widely used techniques for arthroscopically performable suprapectoral tenodesis of the long head of the biceps tendon (LHB).
  
  
  METHODS
  We used 28 fresh-frozen human cadaveric specimens (mean age, 65 years [range, 43 to 78 years; SD, 6.7 years]; 43% male specimens) to investigate 4 different techniques for LHB tenodesis. All techniques were performed in an open manner, with localization at the entrance of the bicipital groove. Two suture anchor techniques (Healix [DePuy Mitek, Raynham, MA], 5.5 mm, with modified lasso-loop stitch; BioSwiveLock [Arthrex, Naples, FL], 5.5 mm, with interlocking Krackow stitch) and two techniques using tenodesis screws (Bio-Tenodesis screw [Arthrex], 8 × 23 mm; Biceptor [Smith & Nephew, Andover, MA], 8 × 25 mm) were investigated. Under a 10-N preload, an axial cyclic load with 100 cycles, 1-Hz frequency, and 50-N maximum load was applied. UFL was evaluated with an axial traction of 0.2 mm/s. LHB displacement during testing was measured by 3-dimensional photogrammetry.
  
  
  RESULTS
  All techniques had a mean displacement of less than 3 mm after cyclic loading. The highest UFL was measured with the Bio-Tenodesis screw (mean, 218.3 N; range, 134.0 to 313.0 N; SD, 59.7 N) and the lowest with the BioSwiveLock (mean, 111.2 N; range, 60.0 to 156.8 N; SD, 32.3 N). The Healix had the second highest UFL (mean, 187.1 N; range, 144.7 to 245.0 N; SD, 35.5 N), followed by the Biceptor (mean, 173.9 N; range, 147.0 to 209.3 N; SD, 27.2 N). There was no significant difference between the Healix, Bio-Tenodesis screw, and Biceptor (P > .05), but the Healix and Bio-Tenodesis screw had a significantly higher UFL than the BioSwiveLock (P < .01). The failure mode was either suture cutout or failure at the anchor-suture-bone interface or of the tendon itself and was generally dependent on technique.
  
  
  CONCLUSIONS
  All techniques resisted cyclic testing without a higher grade of displacement, and all devices except the BioSwiveLock had a satisfactory UFL whereas different failure mechanisms were present. The modified lasso-loop stitch provides sufficient tendon fixation and is equivalent to interference screws.
  
  
  CONCLUSIONS
  The lasso-loop suture anchor technique is an appropriate alternative for suprapectoral LHB tenodesis compared with tenodesis screw techniques.
authors.affiliation: Department of Orthopaedics, University Hospital of Düsseldorf, Düsseldorf, Germany. th.patzer@web.de
authors.forename: Thilo
authors.initials: T
authors.lastname: Patzer
authors.forename: Jan M
authors.initials: JM
authors.lastname: Rundic
authors.forename: Evgenij
authors.initials: E
authors.lastname: Bobrowitsch
authors.forename: Gavin D
authors.initials: GD
authors.lastname: Olender
authors.forename: Christof
authors.initials: C
authors.lastname: Hurschler
authors.forename: Markus D
authors.initials: MD
authors.lastname: Schofer
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy; D001696:Biomechanical Phenomena; D001863:Bone Screws; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010780:Photogrammetry; D012421:Rupture / Q000601:surgery; D012782:Shoulder / Q000502:physiology* / Q000601:surgery*; D053441:Suture Anchors; D013708:Tendon Injuries / Q000601:surgery*; D013710:Tendons / Q000502:physiology* / Q000601:surgery*; D053656:Tenodesis / Q000295:instrumentation / Q000379:methods*; D016474:Weight-Bearing