A Systematic Review and Meta-analysis of Biceps Tenodesis Fixation Strengths: Fixation Type and Location Are Biomechanically Equivalent - Matthew Provencher, MD | Orthopedic Knee & Shoulder Surgeon

Authors:

Travis J Dekker, Liam A Peebles, Fletcher R Preuss, Brandon T Goldenberg, Grant J Dornan, Matthew T Provencher

Abstract:

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.

For the complete study: A Systematic Review and Meta-analysis of Biceps Tenodesis Fixation Strengths: Fixation Type and Location Are Biomechanically Equivalent

Matthew Provencher, MD

Average rating:

64 reviews

Gene reiling

Jul 21, 2023

by Gene reiling on Matthew Provencher, MD

Success

If you are planning to see Dr Provencher ,do not hesitate ,do it. In 2018 Dr Provencher replaced my LCL. I had no complications and very little pain. I did my physical therapy as prescribed. I was able to ski 30 plus days the winter of 2019-2020. Before seeing dr Provencher I had spent a years time trying to solve my problem locally. I saw a pain specialist, orthopedic urgent care and a orthopedic surgeon. All had access to an mri done locally. It was also read by local radiologist. Pain dr gave injections as did orthopedic urgent care. No relief from pain. Orthopedic surgeon told me about arthritis, meniscus needing cleaning up and general deterioration from age. Told me to take ibuprofen for pain. At that time I reached out to Steadman Clinic. By luck of the draw I was assigned Dr Provencher. I took with me the mri that had been done locally and viewed by 3 local Drs and 1 PA. It took Dr Provencher less than a minute to tell me my problem was my LCL after viewing my mri. He told me my options . I selected surgery as I wanted to continue an active life style. It was a complete success!!

THEODORE Wirecki

by THEODORE Wirecki on Matthew Provencher, MD

My reverse shoulder replacement

I had my reverse shoulder replacement with Dr.Provencher four months ago. Took an hour, home an hour later. No pain with the meds cocktail, ice machine, and lidocaine pump. My recovery was incredible quick and effortless, no pain and good range of motion. Dr.Provencher is really the best surgeon, and a genuine and kind human being. If you are able to have Dr. Provencher do your shoulder you would be a fool to go anywhere else. The Steadman Clinic is state of the art, extremely efficient, using tranexamic acid intravenously right before surgery to minimize bleeding and many other sophisticated strategies not available in community hospitals. The process and the outcome way exceeded my expectations. If you would like more detail about the experience email me or call on my cell, 3036182303.
Ted Wirecki MD

Alvin Hrubes

Feb 1, 2023

by Alvin Hrubes on Matthew Provencher, MD

My shoulder was ruined in a car accident. I am 82 years old and Dr. Provencher did more than I had ever hoped for. He did a reverse shoulder and at 2 weeks the range of motion exceeded what I had before replacement. He is my hero! Thank you, Dr. Provencher!!

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