BMC musculoskeletal disorders · 2026
Effect of tendon-to-bone gap on adjustable- versus fixed-loop biceps tendon fixation.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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L Golovakha M, S Lisunov M, P Panchenko S
Аннотация
BACKGROUND: Distal biceps tendon ruptures significantly impair forearm flexion and supination strength, particularly in active individuals. Suspensory fixation using cortical button devices is a widely accepted surgical approach. Adjustable-loop techniques allow maximal tendon-to-bone apposition, while fixed-loop methods are simpler but may leave a gap. Biomechanical differences between these techniques specific to the distal biceps tendon remain poorly investigated, especially given the unique loading patterns of the elbow compared to other joints.
METHODS: Finite element analysis was performed using ANSYS software. Three-dimensional models of the radius and distal biceps tendon were constructed from computed tomography data. Three configurations were compared: Model 1 (adjustable-loop with dense tendon-to-bone contact, 0 mm gap), Model 2 (fixed-loop with 1.0 mm gap), and Model 3 (fixed-loop with 5.0 mm gap). Cortical bone, tendon, suture, and titanium button properties were assigned based on literature values. A 500 N tensile load was applied at the proximal tendon boundary simulating 90° elbow flexion. Stress, strain, and displacement distributions were analyzed in the fixation system and tendon.
RESULTS: Maximum tensile stresses in the fixation system were lowest in Model 1 (353 MPa) compared to Model 2 (407 MPa, + 15%) and Model 3 (423 MPa, + 20%). Tendon maximum stresses were similar across models (170-175 MPa), exceeding ultimate tendon strength only at isolated concentration nodes. Maximum strains in the fixation system followed the same pattern: 0.29 (Model 1), 0.33 (Model 2), 0.35 (Model 3). Maximum tendon displacements (d_t) were 5.4 mm (Model 1), 5.7 mm (Model 2), and 6.9 mm (Model 3), primarily due to suture elongation. The 90th percentile stresses (σ_P90) and strains (ε_P90) remained consistent across configurations. The superior biomechanical performance of the adjustable-loop technique primarily reflects its ability to achieve zero tendon-to-bone gap rather than the loop mechanism itself.
CONCLUSIONS: Suspensory fixation with zero tendon-to-bone gap (achieved by adjustable-loop technique) demonstrated superior biomechanical performance, exhibiting lower peak stresses, strains, and displacements in the fixation system compared to fixed-loop techniques with gaps. These findings suggest improved construct stability with zero-gap apposition. Further in vitro cyclic loading studies and clinical validation are required.
METHODS: Finite element analysis was performed using ANSYS software. Three-dimensional models of the radius and distal biceps tendon were constructed from computed tomography data. Three configurations were compared: Model 1 (adjustable-loop with dense tendon-to-bone contact, 0 mm gap), Model 2 (fixed-loop with 1.0 mm gap), and Model 3 (fixed-loop with 5.0 mm gap). Cortical bone, tendon, suture, and titanium button properties were assigned based on literature values. A 500 N tensile load was applied at the proximal tendon boundary simulating 90° elbow flexion. Stress, strain, and displacement distributions were analyzed in the fixation system and tendon.
RESULTS: Maximum tensile stresses in the fixation system were lowest in Model 1 (353 MPa) compared to Model 2 (407 MPa, + 15%) and Model 3 (423 MPa, + 20%). Tendon maximum stresses were similar across models (170-175 MPa), exceeding ultimate tendon strength only at isolated concentration nodes. Maximum strains in the fixation system followed the same pattern: 0.29 (Model 1), 0.33 (Model 2), 0.35 (Model 3). Maximum tendon displacements (d_t) were 5.4 mm (Model 1), 5.7 mm (Model 2), and 6.9 mm (Model 3), primarily due to suture elongation. The 90th percentile stresses (σ_P90) and strains (ε_P90) remained consistent across configurations. The superior biomechanical performance of the adjustable-loop technique primarily reflects its ability to achieve zero tendon-to-bone gap rather than the loop mechanism itself.
CONCLUSIONS: Suspensory fixation with zero tendon-to-bone gap (achieved by adjustable-loop technique) demonstrated superior biomechanical performance, exhibiting lower peak stresses, strains, and displacements in the fixation system compared to fixed-loop techniques with gaps. These findings suggest improved construct stability with zero-gap apposition. Further in vitro cyclic loading studies and clinical validation are required.