Does Biceps Tenotomy or Tenodesis Have Better Results After Surgery? A Systematic Review and Meta-analysis.

BACKGROUND: Although tenotomy and tenodesis are frequently used for long head of the biceps tendon lesions, controversies remain as to which technique is superior regarding pain, functionality, complications, and cosmetic appearance. QUESTIONS/PURPOSES: (1) For long head of biceps tendon lesions, does tenotomy or tenodesis result in greater improvements in VAS score for pain? (2) Which approach has superior results when evaluating function outcome (Constant) scores? (3) Does tenotomy or tenodesis have fewer complications? (4) Does tenotomy or tenodesis result in better cosmesis (Popeye sign)? METHODS: A systematic review was performed in the Cochrane Library, Embase, PubMed, and Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS) using the keywords "long head of the biceps tendon," "biceps tenodesis," and "tenotomy." We completed the search in June 2020. The inclusion criteria were randomized controlled trials and quasirandomized controlled trials that investigated tenodesis and tenotomy with no language restriction and evaluation of adult patients who presented with a long head of the biceps tendon lesion, associated with other lesions or not, without previous shoulder surgeries and who had no response to nonoperative treatment. The initial search yielded 239 studies, 40 of which were duplicates. We assessed the titles and abstracts of 199 articles and excluded all studies that were not randomized controlled trials (literature reviews) or that compared different techniques. We assessed the full text of 14 articles and excluded the ones that were protocols and cohort studies. We evaluated the risk of bias using the Cochrane Collaboration tool. We included eight studies in this systematic review and meta-analysis, with a total of 615 participants, 306 of whom were treated with tenotomy and 309 with tenodesis. The median duration of follow-up was 2 years. Overall, the included studies had a low risk of bias. The complications evaluated were adhesive capsulitis, biceps brachii tear, cramps, and a subsequent second surgical procedure. We used a random model in this meta-analysis so that we could generalize the results beyond the included studies. In this study, we only reported differences between the groups if they were both statistically valid and larger than the minimum clinically important difference (MCID). RESULTS: Comparing tenotomy and tenodesis, we observed no difference between the groups regarding pain in the long term (mean difference 0.25 [95% confidence interval -0.29 to 0.80]; p = 0.36). There was no difference in Constant score in the long-term (mean difference -1.45 [95% CI -2.96 to 0.06]; p = 0.06). There were no differences when evaluating for major complications (odds ratio 1.37 [95% CI 0.29 to 6.56]; p = 0.70). There were not enough papers evaluating adhesive capsulitis, cramping, and risk of revision surgery. Popeye sign was more frequent in the tenotomy group than in the tenodesis group (OR 4.70 [95% CI 2.71 to 8.17]; p < 0.001). CONCLUSION: This systematic review demonstrated that tenotomy and tenodesis offer satisfactory treatment for long head of the biceps tendon lesions. In terms of pain improvement and Constant score, there was no difference between the techniques, but patients undergoing tenotomy have worse cosmetic results. Therefore, surgeons should choose the technique based on their skills and the patient's expectations of surgery, such as cosmesis and time to recovery. More studies are needed to evaluate complications such as adhesive capsulitis and cramping, as well as to compare duration of surgery and recovery time for each technique. LEVEL OF EVIDENCE: Level I, therapeutic study.

Biceps tenotomy versus tenodesis for lesions of the long head of the biceps tendon: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Biceps tenotomy and biceps tenodesis are 2 most common surgical procedures for long head of the biceps tendon (LHBT) pathology, but debate still exists regarding the choice of treatment. This meta-analysis was conducted to compare clinical results between tenotomy and tenodesis for the treatment of lesions of LHBT. It was hypothesized that there is no difference in outcomes of tenotomy and tenodesis for lesions of LHBT. METHODS: A comprehensive search of literature published between 1980 and April 2020 was performed using MEDLINE, EMBASE, Web of Science, and the Cochrane Library databases. Randomized controlled trials (RCTs) comparing tenotomy and tenodesis for LHBT lesions were included. The primary outcomes were Constant score and Popeye deformity. The secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) for pain, muscle strength, cramping pain, and operative time. For primary outcomes, trial sequential analysis (TSA) was conducted to reduce the risk of random errors and the GRADE (grading of recommendations, assessment, development, and evaluations) approach was used to assess the quality of the body of evidence. RESULTS: A total of 9 RCTs were included. In pooled analysis, statistical significance was observed in the Constant score (mean difference [MD], 1.59; 95% confidence interval [CI] 0.04-3.14; P = .04), Popeye deformity (risk ratio [RR], 0.33; 95% CI, 0.22-0.49; P < .00001) and operative time (MD, 9.94; 95% CI 8.39-11.50; P < .00001). However, there were no significant differences between the tenodesis and tenotomy in ASES score (P = .71), VAS for pain (P = .79), cumulative elbow flexion strength (P = .85), cumulative elbow supination strength (P = .23), and cramping pain (P = .61) TSA revealed that the results for Constant score was inconclusive. CONCLUSION: For the treatment of LHBT lesions, with the exception of constant score, there was no significant benefit of tenodesis over tenotomy. Although tenotomy is affected by a higher risk of Popeye sign, it is more timesaving.

Comparative clinical outcomes of anterolateral ligament reconstruction versus lateral extra-articular tenodesis in combination with anterior cruciate ligament reconstruction: systematic review and meta-analysis.

BACKGROUND: Anterolateral augmentation procedures can be divided into traditional lateral extra-articular tenodesis (LET) and modern anterolateral ligament (ALL) reconstruction. Nevertheless, no studies have compared the clinical results between LET and ALL reconstruction, when combined with intra-articular ACL reconstruction. This study was therefore designed to compare the clinical results, including the anterior translation, rotational laxity, and patient-reported outcomes, in a group of patients who underwent ACL reconstruction combined with LET or ALL reconstruction. METHODS: All studies systematically searched until March 2018 without any language restriction that reported the results of a lateral extra-articular stabilization procedure using either LET or ALL reconstruction methods combined with ACL reconstruction were evaluated. Two reviewers independently recorded data from each study, including the sample size, improvement in Lysholm score, and the number of patients with each grade of knee laxity using Lachman and pivot shift tests. RESULTS: The pooled results of ten studies showed that the postoperative proportion of knees with grade 2 or 3 on the Lachman test was significantly higher following LET compared with ALL reconstruction in combination with ACL reconstruction (10.8%, 95% confidence interval [CI]: 6.6-17.1% vs. 1.5%, 95% CI 0.5-4.5%; p = 0.001). However, the pooled results of 12 studies showed that the proportion of knees that belonged to grade 2 or 3 on the pivot shift test, indicating poor rotational stability, was similar between these two techniques (4.9%, 95% CI 2.0-11.5% vs. 2.3%, 95% CI 1.1-4.5%; p = 0.101). The pooled improvements in Lysholm scores in these two groups were also similar (32.3, 95% CI 26.8-37.9 vs. 25.7, 95% CI 16.7-34.7, p = 0.218). CONCLUSION: LET could lead to worse anterior instability than with ALL reconstruction when these two approaches were combined with single-bundle ACL reconstruction. However, rotational stability and patient-reported outcomes were similar between the techniques.

Chronic Scapholunate Interosseous Ligament Disruption: A Systematic Review and Meta-Analysis of Surgical Treatments.

Background: Although many techniques have been described, there is no clear optimal surgical treatment for chronic scapholunate interosseous ligament (SLIL) disruption. Methods: We identified 255 articles reporting outcomes of SLIL reconstruction. Of these, 40 studies (978 wrists) met eligibility requirements and reported sufficient data on radiographic outcomes to be included in the study. The mean and standard deviation of preoperative and follow-up assessments including scapholunate gap (SLG) and scapholunate angle (SLA) were used to calculate pooled standardized mean differences (SMD) with 95% confidence intervals (CIs). For other radiographic or clinical outcomes, there were not enough reported data to calculate a pooled effect size, and pooled nonstandardized comparisons were made. Results: The SMD between preoperative and postoperative SLA in tenodesis reconstruction was 0.7 (CI, 0.29 to 1.11, P = .001) and 0.04 (CI, -0.27 to 0.38, P = .8) for capsulodesis reconstruction. For SLG, tenodesis demonstrated an SMD of 1.1 (CI, 0.6 to 1.55, P < .001) compared with 0.1 (CI, -0.36 to 0.59, P = .6) for capsulodesis reconstruction. Tenodesis had a significant improvement compared with capsulodesis in SLA (P = .01) and SLG (P = .005). Tenodesis also showed improvement in grip strength and Disabilities of the Arm, Shoulder and Hand scores. Conclusions: Comparing preoperative and postoperative radiographic measurements, tenodesis reconstruction demonstrated significantly improved SLG and SLA relative to capsulodesis. Interpreted in the context of the limitations, existing data demonstrates some benefit of tenodesis reconstruction.

A meta-analysis comparing tenotomy or tenodesis for lesions of the long head of the biceps tendon with concomitant reparable rotator cuff tears.

BACKGROUND: The best treatment for lesions of the long head of the biceps tendon (LHBT) with concomitant reparable rotator cuff tears is still controversial. The purpose of the meta-analysis was to compare clinical outcomes of biceps tenotomy and tenodesis for LHBT lesions. METHODS: A literature retrieval was conducted in MEDLINE, Embase, and Cochrane Library from 1979 to March 2018. Comparative studies (level of evidence I or II) comparing tenotomy and tenodesis for LHBT lesions with concomitant reparable rotator cuff tears were included. Risk of bias for all included studies was assessed using the Cochrane Collaboration's risk of bias tool. Clinical outcomes compared were Popeye sign, Constant score, VAS pain score, cramping pain, elbow flexion and forearm supination strength, and re-tear of the rotator cuff. RESULTS: Two randomized controlled trials (RCTs) and five prospective cohort studies (PCS) with 288 biceps tenotomy patients and 303 biceps tenodesis patients were included in this review. Tenotomy resulted in significantly greater rates of Popeye sign (RR, 2.70 [95% CI, 1.80 to 4.04]; P < 0.01) and a less favorable Constant score (MD, - 1.09 [95% CI, - 1.90 to - 0.28]; P < 0.01) compared to tenodesis. No significant heterogeneity was found between the two groups across all parameters except forearm supination strength. CONCLUSIONS: The current evidence indicates that biceps tenodesis for LHBT lesions with concomitant reparable rotator cuff tears results in decreased rate of Popeye sign and improved Constant score compared to biceps tenotomy. TRIAL REGISTRATION: PROSPERO, CRD42018105504. Registered on 13 August 2018.

Outcome after Combined Lateral Extra-articular Tenodesis and Anterior Cruciate Ligament Revision in Professional Soccer Players.

We report the functional outcome after combined anterior cruciate ligament (ACL) reconstruction and lateral extra-articular tenodesis (LET) for ACL re-rupture and high-grade pivot shift in professional soccer players. For this retrospective review, the medical records of 24 professional soccer players were analyzed. The mean age at surgery was 23.8 ± 4.2 years and the mean follow-up was 42.2 ± 16.9 months. Pre- and postoperative assessment included the KT-1000 Lachman test, pivot shift test, International Knee Documentation Committee (IKDC) subjective knee evaluation, Tegner activity scale (TAS), and Lysholm score. The rate of return to sports and the level of play at final follow-up were recorded. ACL revision was performed with an autologous bone-patellar tendon-bone autograft or a hamstring graft. LET was performed using an extra-articular MacIntosh procedure as modified by Arnold-Coker. Anterior-posterior laxity was significantly reduced at the final clinical assessment (p < 0.0001): 22 patients (91.7%) had a negative pivot shift and 2 (8.3%) had residual glide (+), with significant improvement (p < 0.0001). The mean subjective IKDC and Lysholm score improved from 69.5 ± 11.1 (range: 56-90) to 88.4 ± 8.9 (range: 62.1-100) and from 58.1 ± 11.7 (range: 33-72) to 97.4 ± 3.2 (range: 88-100), respectively, with significant improvement (p < 0.0001) over preoperative values. The overall failure rate was 8.3%. There were no differences between mean preinjury and final TAS scores (p > 0.05). The rate of return to sports at the same level was 91.7% and the mean time to return to sports was 9.2 ± 2.2 months. Mid-term functional outcome after combined extra-articular reconstruction and ACL revision surgery was satisfactory, with a reduction in residual postoperative rotatory instability and degree of pivot shift.

Biceps Tenodesis and Intra-articular Decompression for Treatment of Superior Labral Tear from Anterior to Posterior and Associated Paralabral Cyst in Active Duty Military.

Background: To examine the outcomes of combined biceps tenodesis and indirect, intra-articular arthroscopic paralabral cyst decompression for the treatment of active duty military patients with superior labral from anterior to posterior tears and associated paralabral cysts. Methods: Retrospective chart review of all active duty patients at our institution from 2011 to 2014 with superior labral from anterior to posterior tears and associated paralabral cysts at the spinoglenoid notch treated with biceps tenodesis and indirect arthroscopic cyst decompression. Patient charts were examined for pre- and post-operative parameters including strength, range of motion, visual analog scale pain score, American Shoulder and Elbow Surgeon Score, and Single Assessment Numeric Evaluation Score. Results: Seven patients met study criteria. All patients presented with chronic shoulder pain and decreased external rotation strength, and three patients had clinically apparent muscular atrophy. Pre- and post-operative assessment showed external rotation strength increased from a median of 4 (range 4-4) to 5 (range 4-5; p-value = 0.014), Single Assessment Numeric Evaluation increased from a median of 50 (range 0-70) to 75 (range 30-95; p-value = 0.031), American Shoulder and Elbow Surgeon increased from a median of 46.0 (range 32.0-58.0) to 66.5 (range 58.0-98.0; p-value = 0.068), and visual analog scale pain score decreased from a median of 3 (range 1-8) to 0 (range 0-5; p-value = 0.017). Median follow-up was 66 wk (range 36-138 wk). The change was statistically significant (p <0.05) for external rotation strength, Single Assessment Numeric Evaluation, and VAS reduction. Post-operatively, all patients returned to full duty at a median of 20 wk (range 12-36 wk). Conclusion: The use of biceps tenodesis in conjunction with indirect, intra-articular arthroscopic paralabral cyst decompression is an effective technique in an active patient population with superior labral from anterior to posterior tear with associated paralabral cyst.

Graft fixation influences revision risk after ACL reconstruction with hamstring tendon autografts.

Background and purpose - A large number of fixation methods of hamstring tendon autograft (HT) are available for anterior cruciate ligament reconstruction (ACLR). Some studies report an association between fixation method and the risk of revision ACLR. We compared the risk of revision of various femoral and tibial fixation methods used for HT in Scandinavia 2004-2011. Materials and methods - A register-based study of 38,666 patients undergoing primary ACLRs with HT, with 1,042 revision ACLRs. The overall median follow-up time was 2.8 (0-8) years. Fixation devices used in a small number of patients were grouped according to design and the point of fixation. Results - The most common fixation methods were Endobutton (36%) and Rigidfix (31%) in the femur; and interference screw (48%) and Intrafix (34%) in the tibia. In a multivariable Cox regression model, the transfemoral fixations Rigidfix and Transfix had a lower risk of revision (HR 0.7 [95% CI 0.6-0.8] and 0.7 [CI 0.6-0.9] respectively) compared with Endobutton. In the tibia the retro interference screw had a higher risk of revision (HR 1.9 [CI 1.3-2.9]) compared with an interference screw. Interpretation - The choice of graft fixation influences the risk of revision after primary ACLR with hamstring tendon autograft.

Incidence and Return to Play After Biceps Tenodesis in Professional Baseball Players.

PURPOSE: To determine return to play (RTP) rates after biceps tenodesis (BT) in professional baseball players. METHODS: Major League Baseball has maintained a prospective database containing all major and minor league baseball players who have undergone shoulder surgery since 2010. All players who had undergone BT were included. Minimum follow-up was 24 months, and thus we included data from 2010 to 2013. Using this database we determined the incidence, demographics, prior surgery history, concomitant procedures, RTP rates, and time to RTP. RESULTS: Between 2010 and 2013, 17 professional baseball players underwent BT. Seventy-one percent of the 17 were pitchers, and 29% of the 17 were in the major league. Forty-seven percent of the 17 had a history of a prior shoulder surgery and 47% of the 17 underwent concomitant labral repair. For all players, RTP after BT was 35%, whereas RTP after BT without a concomitant reconstructive procedure was 44% in 10 ± 6 months, and 25% for those who underwent both BT and a concomitant reconstructive procedure (P = .620). All players who RTP were able to return to at least 20 games at their preoperative level of play. Return to professional play was 80% among position players and 17% among pitchers (P = .028). For those pitchers who RTP, performance was not statistically changed. CONCLUSIONS: Professional baseball players who undergo BT have a 35% rate of return to their prior level of play. Whereas pitchers have only a 17% rate of RTP, position players have an 80% rate of RTP. Of those who returned, all returned to their prior level of play. The pitchers who returned had no significant change in performance statistics. LEVEL OF EVIDENCE: Level IV, therapeutic study, a case series.

Open subpectoral biceps tenodesis in patients over 65 does not result in an increased rate of complications.

BACKGROUND: Long head biceps tendon pathology is a common cause of anterior shoulder pain and is often associated with other shoulder conditions, such as rotator cuff tears and osteoarthritis. It is well accepted that older patients are at increased risk for major and minor peri- and postoperative complications. The purpose of this study is to investigate patients over 65 years old who underwent subpectoral biceps tenodesis and compare the complication rates of this group to those of patients younger than 65 years old. The hypothesis is, that there would be no difference in complication rates and that clinical outcome scores for patients over 65 were satisfying and showed improvements over time. METHODS: There were 337 patients who underwent open subpectoral biceps tenodesis, between January 2005 and June 2015, 23 were identified as being over the age of 65 with a minimum follow up of 12 months. All patients over the age of 65 were evaluated pre- and postoperatively using Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), Constant-Murley (CM) and Single Assessment Numeric Evaluation (SANE). Intraoperative and postoperative adverse events (fracture, infection, wound opening, rupture/failure and neurovascular injuries) related to the tenodesis procedure and to the surgery itself were collected from all 337 patients in a routine postoperative follow-up. RESULTS: The under 65 group (range 27-64 years) at an average follow up (FU) of 30 months (range 12-91 months) showed a 5.4% (17 out of 314) post-operative complication rate related to the subpectoral tenodesis, whereas the group over 65 (range 65-77 years) at an average follow up of 33 months (range 12-79 months) showed an 8.7% (2 out of 23) complication rate. CONCLUSION: This study demonstrates that in patients over the age of 65, biceps tenodesis is a successful procedure when performed for biceps tendinopathy and concomitantly with other surgical procedures of the shoulder, and does not result in an increased rate of complications when compared to a group of patients under the age of 65.

Tobacco use is associated with increased rates of infection and revision surgery after primary superior labrum anterior and posterior repair.

BACKGROUND: Although the general health consequences of tobacco use have been well defined, the effects of perioperative tobacco use on arthroscopic shoulder procedures remain largely unknown. The purpose of this study is to use a national database to investigate the relationship between tobacco use and rates of superior labrum anterior and posterior (SLAP) repair failure and postoperative infection after primary SLAP repair compared with matched controls. METHODS: A national private-payer insurance database was queried for patients who underwent arthroscopic primary SLAP from 2005-2012. These patients were divided into tobacco use and non-tobacco use cohorts using International Classification of Diseases, Ninth Revision coding. The non-tobacco use patients were then matched to the patients with coded tobacco use. Both cohorts were assessed for postoperative infection within 90 days and subsequent ipsilateral revision SLAP repair or biceps tenodesis within up to 7 years postoperatively. RESULTS: The incidences of revision SLAP repair or revision to a biceps tenodesis (P = .023) and postoperative infection (P = .034) were significantly higher in patients who used tobacco versus matched controls. CONCLUSIONS: SLAP repair in patients who use tobacco is associated with significantly increased rates of postoperative infection and revision SLAP repair or conversion to a biceps tenodesis.

Trends associated with distal biceps tendon repair in the United States, 2007 to 2011.

BACKGROUND: Current studies investigating surgical treatment of distal biceps tendon tears largely consist of small, retrospective case series. The purpose of this study was to investigate the current patient demographics, surgical trends, and postoperative complication rates associated with operative treatment of distal biceps tendon tears using a large database of privately insured, non-Medicare patients. METHODS: Patients who underwent surgical intervention for distal biceps tendon tears from 2007 to 2011 were identified using the PearlDiver database. Demographic and surgical data as well as postoperative complications were reviewed. Statistical analysis was performed using linear regression analysis and χ(2) tests, with statistical significance set at P < .05. RESULTS: A total of 1443 patients underwent surgical treatment for distal biceps tendon tears. Men and patients aged 40 to 59 years accounted for 98% and 72% of the cohort, respectively. Regarding surgical technique, reinsertion to the radial tuberosity was preferred (95%) over tenodesis to the brachialis (5%) (P < .01). In total, revision surgery for tendon rerupture occurred in 5.4% of treated patients. The incidence of revision surgery for rerupture in acute and chronic distal biceps tears was 5.1% and 7.0%, respectively (P = .36). Postoperative infection and peripheral nerve injury rates were 1.1% and 0.6%, respectively. CONCLUSION: Surgeons strongly preferred anatomic reinsertion to the radial tuberosity for treatment, regardless of the chronicity of the injury. Postoperative complication rates were similar to those found in prior studies, although the true rate of rerupture may be higher than previously thought.

SLAP Lesions: Trends in Treatment.

PURPOSE: To determine the trends in SLAP repairs over time, including patient age, and percentage of SLAP repairs versus other common shoulder arthroscopic procedures. METHODS: The records of 4 sports or shoulder/elbow fellowship trained orthopaedic surgeons were used to identify the total number of common shoulder arthroscopic cases performed between 2004 and 2014 using current procedural terminology codes (CPT): 29822, 29823, 29826, 29827, 29806, 29807, 29825, and 29828. The number of SLAP repairs (CPT code 29807) as a combined or isolated procedure were recorded, and the classification of SLAP type was undertaken using operative reports. Patient age was recorded. Linear regression was used to determine statistical significance. RESULTS: There were 9,765 patients who underwent arthroscopic shoulder procedures using the defined CPT codes between 2004 and 2014 by our 4 orthopaedic surgeons. Of these, 619 underwent a SLAP repair (6.3%); average age 31.2 ± 11.9. The age of patients undergoing SLAP repair significantly decreased over time (P < .001, R(2) = 0.794). Most SLAP repairs were performed on type II SLAP tears (P = .015, R(2) = 0.503). The percentage of SLAP repairs compared with the total number of shoulder arthroscopic surgeries and total number of patients who underwent SLAP repair significantly decreased over time (P < .001, R(2) = 0.832 and P = .002, R(2) = 0.674, respectively). Conversely, the number and percentage of biceps tenodeses are increasing over time (P = .0024 and P = .0099, respectively). CONCLUSIONS: Over the past 10 years, the total number of biceps tenodeses has increased, whereas the number and relative percentage of SLAP repairs within our practice have decreased. The average age of patients undergoing SLAP repair is decreasing, and most SLAP repairs are performed for type II SLAP tears. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Demographic trends in arthroscopic and open biceps tenodesis across the United States.

BACKGROUND: The purpose of this study was to evaluate trends in procedures and to report on demographic data of patients undergoing arthroscopic vs. open biceps tenodesis. METHODS: A retrospective review of a commercially available database (PearlDiver) was conducted to identify cases of arthroscopic and open biceps tenodesis performed between 2007 and 2011 with concurrent diagnoses of commonly associated shoulder disorders. Each record provided the patient's age, gender, and region within the United States, and statistical significance was determined with respect to each of these demographics. RESULTS: There were 9011 patients who underwent arthroscopic biceps tenodesis and 11,678 patients who underwent open biceps tenodesis between 2007 and 2011. The number of biceps tenodesis cases increased from 2007 to 2011 (2047 to 5832; P = .015). Both arthroscopic and open biceps tenodesis procedures were performed most commonly in the 30- to 59-year-old age group (76.3% and 76.1%; P < .00001). Men underwent arthroscopic or open biceps tenodesis more commonly than women did (66.1% and 71.9%; P < .00001). Rates of both open and arthroscopic biceps tenodesis varied significantly among the Midwest, South, Northeast, and West regions (P = .009; P = .007); 49.8% of arthroscopic and 44.6% of open biceps tenodesis cases were associated with rotator cuff tears, whereas 14.4% of arthroscopic and 16.2% of open cases were associated with biceps tendon disorders. CONCLUSION: Both arthroscopic and open biceps tenodesis cases increased annually from 2007 to 2011. The majority of biceps tenodesis cases were performed in men aged 30 to 59 years, and the South had the highest overall number of cases. Further studies are required to evaluate the efficacy of these procedures with and without concomitant pathologic processes.

Whip stitch versus grasping suture for tendon autograft.

PURPOSE: During tendon autograft harvest, either a grasping suture or traditional whip stitch can be used to grasp tendon prior to definitive bone fixation. Their grip strength has not, to our knowledge, been compared. This article compares a needle-free suture technique to a standard whip stitch by testing grip strength in vitro. METHODS: Twelve uniform ovine flexor tendons were prepared; six tendons with a standard, non-locking whip stitch and six tendons with a grasping suture. All the samples were tested to failure in uniaxial tension in a materials testing machine. Load/displacement curves were generated, and qualitatively assessed and peak loads were compared. RESULTS: There were no significant differences between the groups in tendon length or diameter. Modes of failure between the groups, as characterised by the load/displacement curves, were quite distinct. Peak load to failure was lower in the utility suture group (mean peak load at failure 121.28 N) than the whip stitch group (mean peak load to failure 188.82 N). All failures in the utility suture group occurred when the suture snapped. CONCLUSIONS: The grasping suture described here is weaker than a standard whip stitch but may be sufficiently strong to harvest and handle tendon autograft. A standard whip stitch remains the choice for definitive graft fixation.

[Operative and follow-up treatment of rotator cuff tears--the current situation]. / Operative Therapie und Nachbehandlung der Rotatorenmanschettenruptur--Aktueller Stand.

AIM: The aim of this study was to evaluate the current situation of rotator cuff repair and follow-up treatment in German hospitals. METHODS: An evaluated survey, enquiring about the year 2006, was sent to all 777 German orthopaedic and/or trauma surgery departments. The hospitals were chosen using the official index of hospitals from the German Federal Statistical Office. RESULTS: 44 % of the surveys were sent back, whereby 40 % were of use. Within the 309 departments, 26 % of the total number of 59,957 shoulder operations were rotator cuff repairs. Mini-open was the operation method in 49 %, open in 29 % and arthroscopic in 22 % of cases. Regarding the operational methods, there were differences between the departments and level of care. The arthroscopic technique was used sometimes in 48 % of the departments, whereas 52 % never used it. Specialised shoulder departments employed the total arthroscopic procedure more often. A set follow-up treatment occurred in 79 % of departments. CONCLUSION: Rotator cuff repair is mainly carried out using the mini-open method, which is nowadays regarded as gold standard.