Subpectoral biceps tenodesis with BicepsButton fixation in the young population: which technique works best?

BACKGROUND: Injuries of the long head of the biceps (LHB) tendon are a prevalent source of anterior shoulder pain and are commonly treated with tenodesis. Not only a stable fixation of the LHB but also anatomic restoration of the length-tension relationship plays a central role in providing satisfactory functional and cosmetic outcomes, especially in young patients. We report the clinical outcomes of 2 different subpectoral tenodesis techniques using unicortical button fixation. METHODS: Patients aged ≤ 50 years who were treated between April 2015 and January 2020 with 1 of the 2 following subpectoral tenodesis techniques were retrospectively selected and enrolled to undergo a follow-up examination at least 2 years after surgery: subpectoral in situ tenodesis followed by resection of the intra-articular portion leaving a residual tendon stump in the bicipital groove (group I) vs. tenotomy followed by resection of the stump and subpectoral tenodesis (group II). Patients who underwent concomitant rotator cuff repair, subsequent shoulder surgery, or contralateral biceps surgery were excluded. Clinical outcomes were evaluated using the LHB score and the Constant-Murley Score (CMS), as well as measurements of isometric elbow flexion and forearm supination strength. Sonographic evaluation included assessment of the integrity of the LHB and tenodesis, examination for signs of inflammation within the sulcus or around the tendon, and measurements of the distalization of the myotendinous junction of the LHB compared with the nonoperative side. RESULTS: A total of 34 patients comprising group I (24 men; mean age at time of surgery, 40.3 years; mean follow-up period, 57.2 months) and 24 patients comprising group II (19 men; mean age at time of surgery, 39.8 years; mean follow-up period, 51.9 months) were evaluated. The total CMS, as well as the scores for each CMS subcategory, did not reveal significant differences between the groups. The overall LHB score was on average 10 points higher in group I (mean, 94 points) than in group II (mean, 84 points) (P = .016). Regarding the LHB score subcategories, group I showed significantly better results for patient-dependent cosmesis (mean, 15 points in group I vs. 12 points in group II; P = .005) and examiner-dependent cosmesis (mean, 14 points in group I vs. 10 points in group II; P = .001). This finding was substantiated by a significantly higher distalization of the myotendinous junction in group II (mean, 3.0 cm in group I vs. 3.8 cm in group II; P = .030). CONCLUSION: This study shows that subpectoral in situ tenodesis of the LHB followed by arthroscopic resection of the intra-articular portion provides higher LHB scores and better cosmetic outcomes compared with proximal intra-articular tenotomy followed by subpectoral tenodesis.

Understanding the assembly of amphiphilic additives in bulk and dispersed non-lamellar lipid-based matrices: Phosphorylation, H-bonding and ionisation.

The aqueous channel size of lipidic cubic phases can be a limiting factor for certain applications. For this reason, additives have been used to exquisitely control their nanostructure. In this study, two families of primary phosphoesters have been designed, synthesised and utilised to determine the effect of the positioning of the guest additive at the interface of the host mesophase, and to contrast the effect of headgroup ionisation and protonation. A general methodology has been developed to produce primary phosphoesters, and a unique use of 31P NMR has been used in order to systematically investigate the influence of these additives on monoolein- and phytantriol-based bulk lipidic cubic phases and dispersed cubosomes. In general, di-phosphorylated additives exhibit a greater effect upon lipid packing than the mono- and tri-phosphorylated molecules due to their optimal positioning. In dispersion, the protonation state of the phosphate headgroups was manipulated by altering the pH, where shifts in pKa determined by 31P NMR were used as a fluorescent label-free method to identify the location and ionisation state of the phosphate additives. This study systematically evaluates the influence of the positioning of the additive, headgroup size and charge of phosphorylated lipids on the behaviour of lipidic mesophases.