No significant difference seen in biceps tenodesis fixation approaches

Interference screws and suture anchors both shown to be reliable for subpectoral tenodesis.

Issue: August 2006

Subpectoral biceps tenodesis reliably relieves anterior shoulder pain and improves function, with no major differences seen clinically or statistically between tendon fixation with either interference screws or suture anchors.

In a review of 88 consecutive patients who received open subpectoral tenodesis with either inference screw fixation or suture anchor fixation, Reuben Gobezie, MD, said at the American Orthopaedic Society for Sports Medicine (AOSSM) 2006 Annual Meeting that the long head of the biceps tendon is often a significant pain source. Using a subpectoral tenodesis technique offers several advantages.

"These [advantages] include technical simplicity, healing of a tendon in a distal location free from synovium and residual tendon disease, and it has an excellent cosmesis," said Gobezie, an orthopedic surgeon in the division of shoulder and elbow surgery at Case Western Reserve University, Cleveland. Gobezie completed this study with his colleagues, Jon J.P.Warner, MD, and Peter J. Millett, MD, while he was part of the Harvard Shoulder Service.

Simple is better

Gobezie said he and his colleagues knew going into the study that, "Whatever your method of fixation, it has to be simple, it has to be quick, it has to have good fixation strength, and it has to maintain a length-tension relationship for the biceps tendon."

All patients were tenodesed in the inferior aspect of the bicipital groove at the lower edge of the pectoralis major tendon.

The study cohorts included 34 patients who underwent interference screw fixation and 54 who received the suture anchors. Most patients presented with a biceps tendon tear; other indications included instability or tenosynovitis.

Outcomes assessment

Postsurgical follow-ups averaged 13 months. Outcomes were assessed using the Visual Analog Scale (VAS), the American Shoulder and Elbow Surgeons Self Assessment (ASES), reported tenderness of the bicipital groove, rupture, cosmesis, and the appearance of a "Popeye" deformity and complication. Researchers assessed outcomes clinically and over the telephone.

Gobezie reported no significant differences between the groups in the outcomes parameters. He noted that there was a trend toward slightly less tenderness at the tenodesis screw site.

The median VAS scores for both groups went from 9 preoperatively to 1 postoperatively. Average ASES scores preoperatively were 30 for the interference screw group and 28 for those receiving suture anchors. Postoperatively, the ASES scores improved to 70 and 76, respectively.

Five patients reported persistent bicipital groove tenderness, and there were no Popeye deformities, cosmesis problems or infections among the entire group, he reported.

"Although many biomechanical studies showed that the tenodesis screw was superior in terms of fixation, it didn't seem to be clinically relevant in this short-term study," he said.

For more information:
Gobezie R, Sanders BS, Warner JJP, Millett PJ. Interference screw vs. suture anchor fixation for open subpectoral biceps tenodesis: Does it matter? Presented at the American Orthopaedic Society for Sports Medicine 2006 Annual Meeting. June 29-July 2, 2006. Hershey, Pa.