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Purpose: The purpose of this study was to biomechanically evaluate a new technique of intramedullary cortical button fixation for subpectoral biceps tenodesis and to compare it with the interference screw technique. Methods: We compared intramedullary unicortical button fixation (BicepsButton; Arthrex, Naples, FL) with interference screw fixation (Bio-Tenodesis screw; Arthrex) for subpectoral biceps tenodesis using 10 pairs of human cadaveric shoulders and ovine superficial digital flexor tendons. After computed tomography analysis, the specimens were mounted in a testing machine. Cyclic loading was performed (preload, 5 N; 5 to 70 N at 1.5 Hz for 500 cycles), recording the displacement of the tendon. Load to failure and stiffness were subsequently evaluated with a load-to-failure test (1 mm/s). Results: Cyclic loading showed a displacement of 11.3 ± 2.8 mm for intramedullary cortical button fixation and 9 ± 1.7 mm for interference screw fixation (P = .112). All specimens within the cortical button group passed the cyclic loading test, whereas 3 of 10 specimens within the interference screw group failed by tendon slippage at the screw-tendon-bone interface after a mean of 252 cycles (P = .221). Load-to-failure testing showed a mean load to failure of 218.8 ± 40 N and stiffness of 27.2 ± 7.2 N/mm for the intramedullary cortical button technique. For the interference screw, the mean load to failure was 212.1 ± 28.3 N (P = .625) and stiffness was 40.4 ± 13 N/mm (P = .056). Conclusions: We could not find any major differences in load to failure when comparing the tested techniques for subpectoral biceps tenodesis. Intramedullary cortical button fixation showed no failure during cyclic testing. However, we found a 30% failure rate (3 of 10) for the interference screw fixation. Clinical Relevance: Intramedullary cortical button fixation provides an alternative technique for subpectoral biceps tenodesis with comparable and, during cyclic loading, even superior biomechanical properties to interference screw fixation. [Copyright &y& Elsevier]

Abstract: Lesions of the long head biceps tendon (LHB) are frequent causes of shoulder pain and disability. Biceps tenotomy and tenodesis have gained widespread acceptance as effective procedures to manage both isolated LHB pathology and combined lesions of the rotator cuff and biceps-labral complex. The function of the LHB tendon and its role in glenohumeral kinematics presently remain only partially understood because of the difficulty of cadaveric and in vivo biomechanical studies. The purpose of this article is to offer an up-to-date review of the anatomy and biomechanical properties of the LHB and to provide an evidence-based approach to current treatment strategies for LHB disorders. [Copyright &y& Elsevier]

Abstract: This is a review of joint-preservation techniques for the shoulder. Whereas the management of diffuse articular cartilage loss in the glenohumeral joints of elderly and less active patients by total shoulder arthroplasty is well accepted, significant controversy persists in selecting and refining successful operative techniques to repair symptomatic glenohumeral cartilage lesions in the shoulders of young, active patients. The principal causes of focal and diffuse articular cartilage damage in the glenohumeral joint, including previous surgery, trauma, acute or recurrent dislocation, osteonecrosis, infection, chondrolysis, osteochondritis dissecans, inflammatory arthritides, rotator cuff arthropathy, and osteoarthritis, are discussed. Focal cartilage lesions of the glenohumeral joint are often difficult to diagnose and require a refined and focused physical examination as well as carefully selected imaging studies. This review offers a concise guide to surgical decision making and up-to-date summaries of the current techniques available to treat both focal chondral defects and more massive structural osteochondral defects. These techniques include microfracture, osteoarticular transplantation (OATS [Osteochondral Autograft Transfer System]; Arthrex, Naples, FL), autologous chondrocyte implantation, bulk allograft reconstruction, and biologic resurfacing. As new approaches to glenohumeral cartilage repair and shoulder joint preservation evolve, there continues to be a heightened need for collaborative research and well-designed outcomes analysis to facilitate successful patient care. [Copyright &y& Elsevier]