Biomechanical evaluation of four biceps tenodesis locations: A comparative study of ultimate failure load and tendon displacement.

INTRODUCTION/

OBJECTIVES

Biceps tenodesis is a widely accepted treatment for patients with long-head biceps tendinopathy, particularly in younger, high-demand individuals. Despite its efficacy, the biomechanically optimal location for biceps tenodesis remains a subject of ongoing debate. This biomechanical study aims to compare the ultimate failure load and tendon displacement across four distinct biceps tenodesis locations in fresh-frozen human humeri to determine the strongest and most stable fixation site.

METHODS

Fresh-frozen porcine tendons were fixed using interference screws at four biceps tenodesis sites (intra-articular, biceps groove, suprapectoral, and subpectoral) on six fresh-frozen human humeri. Each construct was subjected to cyclic loading (50 ​N-100 ​N for 5000 cycles), followed by continuous load increments until failure occurred. The ultimate failure load and tendon displacement were recorded. A linear mixed model was applied to account for the multilevel model testing.

RESULTS

The mean ultimate failure loads for each group were as follows: intra-articular, 261.2 ​± ​78 ​N; biceps groove, 305 ​± ​113 ​N; suprapectoral, 337 ​± ​64 ​N; and subpectoral, 274.3 ​± ​108 ​N. Statistical analysis demonstrated a significant difference between the intra-articular and suprapectoral groups (p value ​= ​0.03). No other pairwise comparisons in the subgroup analysis revealed significant differences.

CONCLUSIONS

The suprapectoral location demonstrated the highest ultimate failure load, with statistically significant differences compared with the intra-articular group (p value ​= ​0.03) but not with the biceps groove and subpectoral groups. However, the results are specific to the interference screw fixation technique.

LEVEL OF EVIDENCE: III.