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. 2020 Sep 21;4(4):833-837.
doi: 10.1016/j.jseint.2020.08.004. eCollection 2020 Dec.

All-suture anchor and unicortical button show comparable biomechanical properties for onlay subpectoral biceps tenodesis

Alexander Otto  1   2   3 , Sebastian Siebenlist  2 , Joshua B Baldino  1 , Matthew Murphy  1 , Lukas N Muench  2 , Julian Mehl  2 , Elifho Obopilwe  1 , Mark P Cote  1 , Andreas B Imhoff  2 , Augustus D Mazzocca  1
Affiliations

All-suture anchor and unicortical button show comparable biomechanical properties for onlay subpectoral biceps tenodesis

Alexander Otto et al. JSES Int. .

Abstract

Hypothesis: The purpose of this study was to biomechanically evaluate onlay subpectoral long head of the biceps (LHB) tenodesis with all-suture anchors and unicortical buttons in cadaveric specimens.

Methods: After evaluation of bone mineral density, 18 fresh-frozen, unpaired human cadaveric shoulders were randomly assigned to 2 groups: One group received an onlay subpectoral LHB tenodesis with 1 all-suture anchor, whereas the other group received a tenodesis with 1 unicortical button. The specimens were mounted in a servo-hydraulic material testing system. Tendons were initially loaded from 5 N to 100 N for 5000 cycles at 1 Hz. Displacement of the repair constructs was observed with optical tracking. After cyclic loading, each specimen was loaded to failure at a rate of 1 mm/s.

Results: The mean displacement after cyclic loading was 6.77 ± 3.15 mm in the all-suture anchor group and 8.41 ± 3.17 mm in the unicortical button group (P = not significant). The mean load to failure was 278.05 ± 38.77 N for all-suture anchor repairs and 291.36 ± 49.69 N for unicortical button repairs (P = not significant). The most common mode of failure in both groups was LHB tendon tearing. There were no significant differences between the 2 groups regarding specimen age (58.33 ± 4.37 years vs. 58.78 ± 5.33 years) and bone mineral density (0.50 ± 0.17 g/cm2 vs. 0.44 ± 0.19 g/cm2).

Conclusion: All-suture anchors and unicortical buttons are biomechanically equivalent in displacement and load-to-failure testing for LHB tenodesis. All-suture anchors can be considered a validated alternative for onlay subpectoral LHB tenodesis.

Keywords: All-suture anchor; LHB; LHB tenodesis; long head of the biceps tendon; subpectoral tenodesis; unicortical biceps button.

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Figures

Figure 1
Figure 1
After engaging the all-suture anchor against the inner cortex (A), a modified Krackow locking suture was applied on the long head of the biceps (LHB) tendon (B). (C) The LHB tendon was reattached while the free suture limb was tied to the remaining suture limb.
Figure 2
Figure 2
(A) Krackow locking sutures of the long head of the biceps (LHB) tendon were inserted into a biceps button, which was engaged with the inner humeral cortex. (B) The tendon was reattached by alternating pull on each suture limb and was fixed by tying the suture limbs.
Figure 3
Figure 3
(A) The specimen was securely mounted for testing in an axial direction. (B) Optical tracking was performed with 2 markers. MTS, material testing system; LHB, long head of biceps.
Figure 4
Figure 4
Displacement after cyclic loading (A) and load to failure (B) for all-suture anchor and unicortical button repair techniques. Data are presented as means and standard deviations (error bars).
See this image and copyright information in PMC

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