Abstract
Background
Acute distal biceps tendon ruptures are uncommon injuries that often affect young active males, typically resulting from an eccentric load on their dominant extremity. The purpose of this study was to compare pullout strength and tendon gapping in the tension slide technique (TST) versus a knotless fixation technique (KFT).
Methods
Two sets of experiments were performed using cadaveric elbow specimens. In the first experiment, eight elbows from different cadavers were tested to compare TST with a standard locking whipstitch with KFT, four elbows in each group, using a standard locking whipstitch. In the second experiment, 12 elbows were used to study the differences between TST with a standard locking whipstitch with KFT using suture tape reinforced whipstitch (RKFT), using the TST data from the first and second experiment. Each experiment evaluated gapping after cyclic loading and the second experiment also tested the construct to load to failure.
Results
Gapping for KFT with a standard locking whipstitch was 10.64 mm versus 2.69 mm for the TST after 1000 cycles (P = 0.016). A reinforced whipstitch significantly improved the failure to gap on the KFT with no significant difference in gapping when compared to TST after 3000 cycles (P = 0.36). The resultant gapping for TST and KST was 2.08 mm and 2.99 mm (P = 0.91), respectively. Load to failure for TST and KFT were 282 Nm and 328 Nm (P = 0.20), respectively.
Conclusion
Bone-tendon gap resistance of a KFT repair of a torn distal biceps tendon is limited by suture technique. Using a tape reinforced locking whipstitch, the repair is as strong as TST repair.
Levels of Evidence: Basic Science.
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Acknowledgements
The authors thank Arthrex for supplying the implants and sutures used in this study. We also thank the University of Illinois at Chicago for its support and for supplying cadavers and necessary lab equipment. The authors, their immediate family, and any research foundation with which they are affiliated did not receive any financial payment or other benefits from any commercial entity related to the subject of this article.
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Surgical implants and suture were provided by Arthrex using an approved Arthrex research grant. No financial awards or incentives were given to any of the authors.
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This article does not contain any studies with human participants or animals performed by any of the authors.
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Per institutional policy, IRB is not needed for cadaveric work.
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Savin, D.D., Piponov, H., Watson, J.N. et al. Biomechanical evaluation of distal biceps tendon repair using tension slide technique and knotless fixation technique. International Orthopaedics (SICOT) 41, 2565–2572 (2017). https://doi.org/10.1007/s00264-017-3559-2
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DOI: https://doi.org/10.1007/s00264-017-3559-2