title: Suprapectoral biceps tenodesis: a biomechanical comparison of a new "soft anchor" tenodesis technique versus interference screw biceps tendon fixation.
abstract: BACKGROUND
  The interference screw technique is commonly used in tenodesis of the long head of the biceps for its well-documented robust fixation strength. Some complications may occur after tenodesis with interference screw such as persistent pain, bone fracture and cyst formation. A new technique using a small "soft anchor" has been proposed to avoid the risk of occurrence of the above-mentioned complications associated with the use of the interference screw. However, the proposed technique must provide adequate fixation strength. This study investigated the mechanical performance of the new technique and compared it with interference screw fixation.
  
  
  METHODS
  Fourteen human humeri and proximal biceps were tested after tenodesis using the two techniques. The fixation constructs were cycled 500 times between 20N and 100N at 1Hz to simulate some level of post-operative physical activity. Then, a tensile test to failure was performed to determine the strength of the two tenodesis constructs.
  
  
  RESULTS
  The ultimate strength was 238N (SD 96N) and 172N (SD 58N) for the "soft anchor" and the interference screw, respectively (P=0.14). In two out of seven repetitions in both groups, failure occurred at low load level due to inaccuracies in performing tenodesis. Considering these cases as outliers, the strength values increased up to 290N (SD 40N) and 202N (SD 32N) for the "soft anchor" and the interference screw, respectively (P=0.02).
  
  
  CONCLUSIONS
  The "soft anchor" technique provides a fixation strength comparable with the interference screw, but without using a screw. It could be considered as an alternative for suprapectoral biceps tenodesis.
authors.affiliation: Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy. Electronic address: baleani@tecno.ior.it.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Baleani
authors.affiliation: Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Dunia
authors.initials: D
authors.lastname: Francesconi
authors.affiliation: Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Zani
authors.affiliation: Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Giannini
authors.affiliation: Southern California Orthopedic Institute, Van Nuys, CA, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Snyder
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000601:surgery; D001696:Biomechanical Phenomena; D001863:Bone Screws; D002102:Cadaver; D006801:Humans; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D053441:Suture Anchors; D053656:Tenodesis / Q000379:methods*
keywords: Biceps tenodesis; Biomechanics; Fixation stiffness; Fixation strength; Mode of failure