Suprapectoral Biceps Tenodesis Using a Novel Interconnected Anchors Technique- A Cadaveric Biomechanical Study

Abstract

The long head of biceps tendon (LHBT) has been regarded as a source of anterior shoulder pain since one hundred years ago however the treatment of the LHBT lesion remains controversial The surgery is indicated in symptomatic patient who have LHB tendon pathology labral lesions and failed to conservative treatment Two most common procedures involve LHBT tenodesis or tenotomy both techniques are well-established and have their own proponents Although tenotomy served as a simple and quick surgery In younger and active population several studies have shown the preference for tenodesis regarding the cosmetic concern and better muscle strength A variety of implants have been described for the tenodesis including the interference screw single or dual suture anchors suspensory device and other implant free techniques In majority of studies interference screw was shown to have biomechanical superiority compared with the other methods However the risk of iatrogenic humeral fracture has been reported Alternatively some surgeon advocated tenodesis technique with suture anchor to prevent such complication In a biomechanical study the author demonstrated only one suture anchor may not provide adequate strength for tendon fixation As a result the method utilizing dual suture anchor fixation has been proposed to increase the fixation strength The purpose of this study is to introduce a novel tenodesis technique using two knotless anchors in interconnected fashion the construct was compared with two traditional fixations in biomechanical perspective The study was conducted with 24 cadaveric shoulder the result demonstrated that the IKA exhibited 38 9 ± 7 7 N/mm in stiffness and 288 3 ± 47 6 N in ultimate failure load IS exhibited 26 6 ± 6 3 N/mm in stiffness and 227 0 ± 52 4 N in ultimate failure load DKA exhibited 14 4 ± 3 1 N/mm in stiffness and 167 0 ± 19 3 N in ultimate failure load The both values in IKA were significantly greater than that in IS and DKA group In regard of the displacement after the cyclic test there was no statistical difference between the three groups The most commonly observed failure mode was biceps tendon rupture in IS group (7/8) suture slippage in DKA group(6/8) and tendon split by suture in IKA group (8/8) Based on the result the interconnected knotless anchor could offer an alternative in suprapectoral tenodesis

Date of Award	2020
Original language	English
Supervisor	Ming-Long Yeh (Supervisor)