Subpectoral Biceps Tenodesis Using Dynamic Endobutton Fixation in a Humeral Bone Tunnel With Interference Screw Augmentation

Abstract

Pathology of the proximal long head of the biceps can result from multiple etiologies and is often associated with persistent anterior shoulder pain and functional limitations. Biceps tenodesis presents a frequently used treatment option for pathology of the long head of the biceps tendon and can be performed both as by intraarticular or extra-articular technique. Postoperative rehabilitation is often prolonged and can be undesirable in the high-demand professional or athlete. The ability to accelerate postoperative mobilization is limited by the strength of the initial fixation and gap formation from loading of the tenodesed tendon. A new technique is described that uses a combined endobutton and interference screw fixation in a humeral bone tunnel to optimize the strength of initial tendon fixation and minimizes gap formation. In addition, a unique tensioning technique helps to optimize restoration of muscle length, myotension, and cosmesis of the proximal biceps. This novel technique provides a safe, minimally invasive fixation of the long head of the biceps and may help to accelerate return to demanding professional and athletic activities.

Improvement in long head of biceps function and lower rate of biceps deformities after subpectoral tenodesis with cortical button and interference screw vs. arthroscopic tenotomy: a 4-year follow-up

“…This does not reflect a higher force generation due to improved restoration of the optimal length-tension relationship of the LHB tendon as proposed by Mithoefer, but rather the effect of preselecting patients according to Hsu criteria. 21 , 38 In fact, also the nontreated arm displayed a significantly higher elbow flexion and forearm supination strength. As the strength ratio treated/nontreated arm did not show any significant difference between the groups, we conclude that both techniques do not impair the force generation of the biceps.…”

“…On preselected patients, tenodesis was performed according to the technique described by Mithoefer 38 : The arm was slightly abducted and externally rotated, a vertical 3 cm incision was made at the inferior border of the PMT. After blunt dissection, the bone bed was prepared for LHB tendon reinsertion.…”

“…Although the first tenodesis was described many decades ago, this technique gained popularity only recently, with exponential new techniques in the last decade. 4 , 20 , 24 , 25 , 36 , 38 Surgical fixation of the LHB tendon can be performed either open or arthroscopically, and the LHB tendon can be reinserted either intraarticular or extraarticular. 1 Extraarticular placement is usually done below the bicipital groove, and it is classified according to its relationship to the pectoralis major tendon (PMT): suprapectoral, which lies over the superior border of the PMT; or subpectoral, which lies below the inferior border of the PMT.…”

“…This combination leads to the restoration of the optimal length-tension relationship of the LHB tendon while providing a high pullout strength. 38 , 49 …”

Arthroscopic All-Inside Biceps Tenodesis: Technique and Outcomes

“…These procedures have included soft-tissue tenodesis techniques in which the LHB undergoes tenotomy and is then tied into the surrounding soft-tissue structures or undergoes tenodesis to the bone surface with suture anchors 1 , 7 , 8 or in which the LHB is secured into a bone socket with suture, a cortical button, or an interference screw 3 , 9, 10, 11. Biomechanically, no significant difference was noted in maximum load to failure among cortical button fixation, suture anchor fixation, and interference screw fixation 7 , 12, 13, 14. In addition, no statistically significant difference was noted in displacement of the tendon representative of tendon creep after cyclic loading 15 , 16 in any of the aforementioned techniques.…”