Purpose
The purpose of this meta-analysis and systematic review was to critically evaluate
the biomechanical outcomes of different fixation constructs for a variety of biceps
tenodesis techniques in cadaveric models based on both type of fixation and location.
Methods
A PROSPERO-registered systematic review (CCRD42018109243) of the current literature
was conducted with the terms “long head of biceps” AND “tenodesis” AND “biomechanics”
and numerous variations thereof in the PubMed, Embase, and Cochrane databases, yielding
1,460 abstracts. After screening by eligibility criteria, 18 full-text articles were
included. The individual biomechanical factors evaluated included ultimate load to
failure (in newtons), stiffness (in newtons per millimeter), and cyclic displacement
(in millimeters). After reviewing the included literature, we performed a quality
analysis of the studies (Quality Appraisal for Cadaveric Studies scale score) and
a meta-analysis comparing raw mean differences in data between the suprapectoral and
subpectoral fixation location groups, as well as between the fixation construct groups.
Results
Among the 18 included studies, 347 cadaveric specimens were evaluated for ultimate
load to failure, stiffness, and cyclic displacement when comparing both location (suprapectoral
vs subpectoral) and tenodesis fixation type (interference screw vs cortical button,
suture anchor, or all–soft-tissue techniques). Interference screw fixation showed
significantly greater mean stiffness by 8.0 N/mm (P = .013) compared with the other grouped techniques but did not show significant differences
when evaluated for ultimate load to failure and cyclic displacement (P = .28 and P = .18, respectively). Additionally, no difference in construct strength was seen
when comparing the fixation strength of suprapectoral versus subpectoral techniques
for stiffness, ultimate load to failure, and cyclic loading (P = .47, P = .053, and P = .13, respectively).
Conclusions
In this meta-analysis, no significant biomechanical differences were found when the
results were stratified by specific surgical technique (interference screw vs other
tenodesis techniques) and location (suprapectoral vs subpectoral biceps tenodesis).
Clinical Relevance
As a result of this study, when biomechanically evaluating specific tenodesis constructs,
the individual clinician has the liberty of choosing the fixation technique based
on his or her preference and knowledge of shortcomings of each type of fixation construct.
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Article info
Publication history
Published online: June 30, 2020
Accepted:
May 27,
2020
Received:
December 10,
2019
Footnotes
The authors report the following potential conflicts of interest or sources of funding: T.J.D. receives educational payments from Smith & Nephew, outside the submitted work. M.T.P. receives royalties, consulting fees, and hospitality support from Arthrex, outside the submitted work; is a consultant for Joint Research Foundation and SLACK, outside the submitted work; receives honorarium from Arthrosurface, outside the submitted work; is an editorial or governing board member of Arthroscopy, Knee, Orthopedics, and SLACK; and is a board or committee member of the Arthroscopy Association of North America, American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, San Diego Shoulder Institute, and Society of Military Orthopaedic Surgeons. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2020 by the Arthroscopy Association of North America
