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Proximal Biceps Tenodesis: An Anatomic Study and Comparison of the Accuracy of Arthroscopic and Open Techniques Using Interference Screws.

Kovack TJ, Idoine JD, Jacob PB - Orthop J Sports Med (2014)

Bottom Line: Males were found to have statistically longer TTL and LO-SBG measurements (111.6 vs 96.5 mm [P = .027] and 37.2 vs 30.0 mm [P = .009], respectively).In the native shoulder, the mean distances from the MTJ to the superior and inferior borders of the pectoralis major tendon were 23.8 and 31.7 mm, respectively.Based on study findings, a screw length of 15 to 18 mm may be needed.

View Article: PubMed Central - PubMed

Affiliation: Orthopedic Specialists of Central Ohio, Hilliard, Ohio, USA.

ABSTRACT

Purpose: To (1) better define the anatomy of the proximal shoulder in relation to the long head of the biceps tendon, (2) compare the length-tension relationship of the biceps tendon in the native shoulder with that after arthroscopic and open tenodesis techniques using interference screws, and (3) provide surgical recommendations for both procedures based on study findings.

Study design: Descriptive laboratory study.

Methods: Twenty fresh-frozen cadaveric shoulders were dissected for analysis. Initial anatomic measurements involving the proximal long head of the biceps tendon (BT) were made, which included: the labral origin to the superior bicipital groove (LO-SBG), the total tendon length (TTL), the musculotendinous junction (MTJ) to the inferior pectoralis major tendon border, the MTJ to the superior pectoralis major tendon border, and the biceps tendon diameter (BTD) at 2 different tenodesis locations. These same measurements were made again after completing a simulated suprapectoral arthroscopic and open subpectoral tenodesis, both with interference screw fixation. Statistical comparisons were then made between the native anatomy and that after tenodesis, with the goal of assessing the accuracy of re-establishing the normal length-tension relationship of the long head of the BT after simulated arthroscopic suprapectoral and open subpectoral tenodesis with tenodesis screws.

Results: For all cadavers, the mean TTL was 104.1 mm. For the arthroscopic suprapectoral technique, the mean LO-SBG was 33.6 mm, and the mean tendon resection length was 12.8 mm in males and 5.0 mm in females. The mean BTD was 6.35 mm at the arthroscopic suprapectoral tenodesis site and 5.75 mm at the open subpectoral tenodesis site. Males were found to have statistically longer TTL and LO-SBG measurements (111.6 vs 96.5 mm [P = .027] and 37.2 vs 30.0 mm [P = .009], respectively). In the native shoulder, the mean distances from the MTJ to the superior and inferior borders of the pectoralis major tendon were 23.8 and 31.7 mm, respectively. No statistically significant differences were found in the location of the MTJ after simulated arthroscopic or open tenodesis with tenodesis screws as compared with the native shoulder. Mean hole depth in the open subpectoralis tenodesis was 22.4 mm (males) and 18.6 mm (females), with a mean of 20.5 mm for both sexes.

Conclusion: This study better defines the anatomy of the proximal shoulder in relationship to the long head of the BT. Using our surgical techniques and recommendations, both arthroscopic and open tenodesis procedures adequately restored the native length-tension relationship of the long head of the biceps. Surgical recommendations are as follows: For arthroscopic suprapectoral tenodesis with tenodesis screws, the anatomic landmark of the SBG should be used. The tendon resection length should be approximately 1 cm in males and 5 mm in females when using a 25-mm tunnel. For subpectoral tenodesis, the site of tenodesis should be placed approximately 3 cm above the inferior border of the pectoralis major tendon in the bicipital groove; whipstitching and preserving approximately 2 cm of the biceps tendon above the MTJ is also recommended. The diameter of the screws in either location should be based on patient anatomy. However, this study shows the need for slightly longer screws for the subpectoral tenodesis, as the average hole depth was 20.5 mm. The system used in this study has 7 × 10-mm and 8 × 12-mm screws available. Based on study findings, a screw length of 15 to 18 mm may be needed.

No MeSH data available.


Location of measurement landmarks in relation to the long head of the biceps. (A) Labral origin (LO); (B) superior bicipital groove (SBG); (C) superior border of the pectoralis tendon (S); (D) musculotendinous junction (MTJ); and (E) inferior border of the pectoralis tendon (I).
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fig3-2325967114522198: Location of measurement landmarks in relation to the long head of the biceps. (A) Labral origin (LO); (B) superior bicipital groove (SBG); (C) superior border of the pectoralis tendon (S); (D) musculotendinous junction (MTJ); and (E) inferior border of the pectoralis tendon (I).

Mentions: Anatomic measurements gathered in the native shoulder were taken as described (Figure 3). Tagging sutures and pins were placed at specific locations along the biceps tendon to facilitate anatomic length measurements. Table 1 lists the measurements that were gathered in the native shoulder prior to any biceps tenotomy or tenodesis. All length measurements were made using a caliper and checked twice for accuracy. The total biceps tendon length (TTL) was measured from the labral origin to the musculotendinous junction (LO-MTJ). Next, the distance from the labral origin to the superior biceps groove (LO-SBG) was measured. This measurement was taken lateral to the articular margin of the humeral head at the superior aspect of the bicipital groove just before it transitions inferior and distal. Next, the superior and inferior borders of the pectoralis major tendon were identified. Measurements were then gathered from the biceps MTJ to the inferior (MTJ-I) and superior (MTJ-S) borders of the pectoralis tendon. This concluded all measurements that were gathered in the native shoulder.


Proximal Biceps Tenodesis: An Anatomic Study and Comparison of the Accuracy of Arthroscopic and Open Techniques Using Interference Screws.

Kovack TJ, Idoine JD, Jacob PB - Orthop J Sports Med (2014)

Location of measurement landmarks in relation to the long head of the biceps. (A) Labral origin (LO); (B) superior bicipital groove (SBG); (C) superior border of the pectoralis tendon (S); (D) musculotendinous junction (MTJ); and (E) inferior border of the pectoralis tendon (I).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4555622&req=5

fig3-2325967114522198: Location of measurement landmarks in relation to the long head of the biceps. (A) Labral origin (LO); (B) superior bicipital groove (SBG); (C) superior border of the pectoralis tendon (S); (D) musculotendinous junction (MTJ); and (E) inferior border of the pectoralis tendon (I).
Mentions: Anatomic measurements gathered in the native shoulder were taken as described (Figure 3). Tagging sutures and pins were placed at specific locations along the biceps tendon to facilitate anatomic length measurements. Table 1 lists the measurements that were gathered in the native shoulder prior to any biceps tenotomy or tenodesis. All length measurements were made using a caliper and checked twice for accuracy. The total biceps tendon length (TTL) was measured from the labral origin to the musculotendinous junction (LO-MTJ). Next, the distance from the labral origin to the superior biceps groove (LO-SBG) was measured. This measurement was taken lateral to the articular margin of the humeral head at the superior aspect of the bicipital groove just before it transitions inferior and distal. Next, the superior and inferior borders of the pectoralis major tendon were identified. Measurements were then gathered from the biceps MTJ to the inferior (MTJ-I) and superior (MTJ-S) borders of the pectoralis tendon. This concluded all measurements that were gathered in the native shoulder.

Bottom Line: Males were found to have statistically longer TTL and LO-SBG measurements (111.6 vs 96.5 mm [P = .027] and 37.2 vs 30.0 mm [P = .009], respectively).In the native shoulder, the mean distances from the MTJ to the superior and inferior borders of the pectoralis major tendon were 23.8 and 31.7 mm, respectively.Based on study findings, a screw length of 15 to 18 mm may be needed.

View Article: PubMed Central - PubMed

Affiliation: Orthopedic Specialists of Central Ohio, Hilliard, Ohio, USA.

ABSTRACT

Purpose: To (1) better define the anatomy of the proximal shoulder in relation to the long head of the biceps tendon, (2) compare the length-tension relationship of the biceps tendon in the native shoulder with that after arthroscopic and open tenodesis techniques using interference screws, and (3) provide surgical recommendations for both procedures based on study findings.

Study design: Descriptive laboratory study.

Methods: Twenty fresh-frozen cadaveric shoulders were dissected for analysis. Initial anatomic measurements involving the proximal long head of the biceps tendon (BT) were made, which included: the labral origin to the superior bicipital groove (LO-SBG), the total tendon length (TTL), the musculotendinous junction (MTJ) to the inferior pectoralis major tendon border, the MTJ to the superior pectoralis major tendon border, and the biceps tendon diameter (BTD) at 2 different tenodesis locations. These same measurements were made again after completing a simulated suprapectoral arthroscopic and open subpectoral tenodesis, both with interference screw fixation. Statistical comparisons were then made between the native anatomy and that after tenodesis, with the goal of assessing the accuracy of re-establishing the normal length-tension relationship of the long head of the BT after simulated arthroscopic suprapectoral and open subpectoral tenodesis with tenodesis screws.

Results: For all cadavers, the mean TTL was 104.1 mm. For the arthroscopic suprapectoral technique, the mean LO-SBG was 33.6 mm, and the mean tendon resection length was 12.8 mm in males and 5.0 mm in females. The mean BTD was 6.35 mm at the arthroscopic suprapectoral tenodesis site and 5.75 mm at the open subpectoral tenodesis site. Males were found to have statistically longer TTL and LO-SBG measurements (111.6 vs 96.5 mm [P = .027] and 37.2 vs 30.0 mm [P = .009], respectively). In the native shoulder, the mean distances from the MTJ to the superior and inferior borders of the pectoralis major tendon were 23.8 and 31.7 mm, respectively. No statistically significant differences were found in the location of the MTJ after simulated arthroscopic or open tenodesis with tenodesis screws as compared with the native shoulder. Mean hole depth in the open subpectoralis tenodesis was 22.4 mm (males) and 18.6 mm (females), with a mean of 20.5 mm for both sexes.

Conclusion: This study better defines the anatomy of the proximal shoulder in relationship to the long head of the BT. Using our surgical techniques and recommendations, both arthroscopic and open tenodesis procedures adequately restored the native length-tension relationship of the long head of the biceps. Surgical recommendations are as follows: For arthroscopic suprapectoral tenodesis with tenodesis screws, the anatomic landmark of the SBG should be used. The tendon resection length should be approximately 1 cm in males and 5 mm in females when using a 25-mm tunnel. For subpectoral tenodesis, the site of tenodesis should be placed approximately 3 cm above the inferior border of the pectoralis major tendon in the bicipital groove; whipstitching and preserving approximately 2 cm of the biceps tendon above the MTJ is also recommended. The diameter of the screws in either location should be based on patient anatomy. However, this study shows the need for slightly longer screws for the subpectoral tenodesis, as the average hole depth was 20.5 mm. The system used in this study has 7 × 10-mm and 8 × 12-mm screws available. Based on study findings, a screw length of 15 to 18 mm may be needed.

No MeSH data available.