Biomechanical Analysis of Subpectoral Biceps Tenodesis

Authors:

Simon A. Euler, MD, Sean D. Smith, MSc, Brady T. Williams, BS, Grant J. Dornan, MSc, Peter J. Millett, MD, MSc, and Coen A. Wijdicks, PhD

Abstract:

Open subpectoral biceps tenodesis is one of the most common shoulder procedures and is performed in response to injury of the long head of the biceps tendon (LHB) or surrounding soft tissue. Excellent results and very low complication rates have been reported for biceps tenodesis with interference screws. Although the hole is drilled through an open approach, overlying soft tissue often prevents direct visualization of the bicipital groove and the drill placement if the medial and lateral borders of the humeral cortices are not fully exposed. This may lead to eccentric malpositioning of the screw and potential iatrogenic breaching of the humeral cortex. Biomechanically, cortical defects caused by screws or drill holes have been shown to significantly reduce bone strength when compared with an intact control.

Recently, Rios and Dein reported cases of proximal humeral fractures at the site of the tenodesis, presumably due to weakening of the cortex. Although only described in case reports so far, instances of proximal humeral fracture after biceps tenodesis or other procedures, which create significant holes, keyholes, or troughs in the humeral shaft, have been reported. Most of the fractures were associated with a malpositioned screw or drill hole. The most frequent mechanism of injury for proximal humeral fractures is direct compression load in abduction, typically described as a fall onto the outstretched hand. However, strength reduction of the humeral diaphysis after biceps tenodesis has never been quantified. Furthermore, the biomechanical consequences of concentric and malpositioned (eccentric) biceps tenodesis in response to compressive forces with the arm abducted, similar to a fall on the outstretched hand, have yet to be investigated.

The purpose of this study was to determine whether malpositioned (laterally eccentric) tenodesis screw placement affects humerus strength compared with central placement. We hypothesized that (1) laterally eccentric tenodesis screw placement would cause significant strength reduction compared with intact humeri and (2) concentric placement would not cause significant reduction in the strength of the humerus compared with the intact controls.

For the complete study: Biomechanical Analysis of Subpectoral Biceps Tenodesis

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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