Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Am J Sports Med. 2020 Apr;48(5):1273-1280. doi: 10.1177/0363546519876107. Epub 2019 Oct 4.
Despite the increasing use of biceps tenodesis, there is a lack of consensus regarding optimal implant choice (suture anchor vs interference screw) and implant placement (suprapectoral vs subpectoral).
PURPOSE/HYPOTHESIS: The purpose was to determine the associations of procedural parameters with the biomechanical performance of biceps tenodesis constructs. The authors hypothesized that ultimate failure load (UFL) would not differ between sub- and suprapectoral repairs or between interference screw and suture anchor constructs and that the number of implants and number of sutures would be positively associated with construct strength.
Meta-analysis.
The authors conducted a systematic literature search for studies that measured the biomechanical performance of biceps tenodesis repairs in human cadaveric specimens. Two independent reviewers extracted data from studies that met the inclusion criteria. Meta-regression was then performed on the pooled data set. Outcome variables were UFL and mode of failure. Procedural parameters (fixation type, fixation site, implant diameter, and numbers of implants and sutures used) were included as covariates. Twenty-five biomechanical studies, representing 494 cadaveric specimens, met the inclusion criteria.
The use of interference screws (vs suture anchors) was associated with a mean 86 N-greater UFL (95% CI, 34-138 N; = .002). Each additional suture used to attach the tendon to the implant was associated with a mean 53 N-greater UFL (95% CI, 24-81 N; = .001). Multivariate analysis found no significant association between fixation site and UFL. Finally, the use of suture anchors and fewer number of sutures were both independently associated with lower odds of native tissue failure as opposed to implant pullout.
These findings suggest that fixation with interference screws, rather than suture anchors, and the use of more sutures are associated with greater biceps tenodesis strength, as well as higher odds of native tissue failure versus implant pullout. Although constructs with suture anchors show inferior UFL compared with those with interference screws, incorporation of additional sutures may increase the strength of suture anchor constructs. Supra- and subpectoral repairs provide equivalent biomechanical strength when controlling for potential confounders.
尽管肱二头肌肌腱固定术的应用越来越广泛，但在植入物选择（缝合锚钉与骨-腱界面螺钉）和植入物位置（肩前或肩后）方面尚未达成共识。
确定手术参数与肱二头肌肌腱固定术生物力学性能之间的关联。作者假设，肩前或肩后修复、骨-腱界面螺钉与缝合锚钉固定、植入物数量和缝线数量之间的最终失效负荷（ultimate failure load，UFL）均无差异，且构建体强度与植入物数量和缝线数量呈正相关。
荟萃分析。
作者对评估肱二头肌肌腱固定术在人体尸体标本中的生物力学性能的研究进行了系统的文献检索。两名独立的审查员从符合纳入标准的研究中提取数据。然后对汇总数据集进行了荟萃回归分析。结果变量为 UFL 和失效模式。纳入的手术参数（固定类型、固定部位、植入物直径以及使用的植入物和缝线数量）作为协变量。25 项生物力学研究，代表 494 个尸体标本，符合纳入标准。
使用骨-腱界面螺钉（与缝合锚钉相比）与 UFL 平均增加 86 N（95%CI，34-138 N； =.002）相关。将肌腱固定到植入物的每根附加缝线与 UFL 平均增加 53 N（95%CI，24-81 N； =.001）相关。多变量分析发现固定部位与 UFL 之间无显著关联。最后，使用缝合锚钉和较少数量的缝线与较低的原生组织失败几率（与植入物拔出相比）独立相关。
这些发现表明，与使用缝合锚钉相比，使用骨-腱界面螺钉以及使用更多缝线与更强的肱二头肌肌腱固定术强度以及更高的原生组织失败几率（与植入物拔出相比）相关。尽管缝合锚钉固定的构建体的 UFL 低于骨-腱界面螺钉固定的构建体，但增加额外的缝线可能会增加缝合锚钉固定的构建体的强度。在控制潜在混杂因素的情况下，肩前和肩后修复提供等效的生物力学强度。
