Publication: Arthroscopy: The Journal of Arthroscopic and Related Surgery

Date: May 2015

Authors: Kaback LA, Gowda AL, Paller D, Green A, Blaine T

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The purpose of this study was to evaluate the initial fixation strength of 3 techniques of arthroscopic tenodesis of the long head of the biceps (LHB).


Eighteen human cadaveric shoulders were randomly assigned to one of 3 simulated arthroscopic biceps tenodesis techniques-simple suture (SS), Krakow stitch (KS), or lasso loop (LL)-combined with a knotless fixation implant (3.5-mm Piton Anchor; Tornier, Minneapolis, MN). Biomechanical parameters were evaluated by cyclic loading and load to failure.


The mean failure load (P = .007) was 158.3 ± 32.2 N, 109.8 ± 41.1 N, and 46.6 ± 3.8 N for the KS, SS, and LL techniques, respectively. Mean stiffness was greater (statistically significant) in the KS (21.4 ± 3.0 N/mm) and SS (20.7 ± 7.9 N/mm) treatment groups compared with the LL group (4.5 ± 1.5 N/mm) (P = .011).


Biceps tenodesis performed with a more secure tendon suturing technique, such as the Krakow technique, provides superior ultimate and fatigue strength and thus may be more secure in clinical application and yield better clinical results. The mechanical properties of the LL technique were especially poor in comparison.


Although more complex suturing techniques for arthroscopic biceps tenodesis can be technically challenging, more secure tendon fixation may improve clinical outcomes.

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