The biceps tenodesis technique that a surgeon chooses does not, apparently, affect biomechanical outcomes, according to a new systematic review.
Surprise! Fixation Technique Doesn’t Affect Tenodesis Outcomes
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Secondary#bicepstenodesis#fixationtechnique#interferencescrew
In the study, “A Systematic Review and Meta-analysis of Biceps Tenodesis Fixation Strengths: Fixation Type and Location Are Biomechanically Equivalent,” published in the December 2020 issue of the journal Arthroscopy, the researchers conducted a meta-analysis and systematic review to better understand the biomechanical outcomes of different fixation constructs.
Using a PROSPERO-registered systematic review, they analyzed the biomechanical outcomes of different tenodesis techniques in cadaveric models based on both type of fixation and location. Eighteen studies from PubMed, Embase and Cochrane databases were analyzed.
The biomechanical outcomes of interest were ultimate load to failure, stiffness and cyclic displacement. The researchers compared raw mean differences in data not only between fixation groups, but also between suprapectoral and subpectoral fixation location groups: interference screw vs. cortical button, suture anchor or all-soft tissue.
Overall, 347 cadaveric specimens were included in the analysis. Interference screw fixation showed greater mean stiffness by 8.0 N/mm (p = .013) compared to the other techniques, but didn’t show any significant differences when evaluated for ultimate load to failure and cyclic displacement (p = .28 and p = .18, respectively).
The researchers also didn’t observe any difference in construct strength 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).
The researchers wrote, “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).”
They added, ”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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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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