Background:

Despite the increasing use of biceps tenodesis, there is a lack of consensus regarding optimal implant choice (suture anchor vs interference screw) and implant placement (suprapectoral vs subpectoral).

Purpose/Hypothesis:

The purpose was to determine the associations of procedural parameters with the biomechanical performance of biceps tenodesis constructs. The authors hypothesized that ultimate failure load (UFL) would not differ between sub- and suprapectoral repairs or between interference screw and suture anchor constructs and that the number of implants and number of sutures would be positively associated with construct strength.

Study Design:

Meta-analysis.

Methods:

The authors conducted a systematic literature search for studies that measured the biomechanical performance of biceps tenodesis repairs in human cadaveric specimens. Two independent reviewers extracted data from studies that met the inclusion criteria. Meta-regression was then performed on the pooled data set. Outcome variables were UFL and mode of failure. Procedural parameters (fixation type, fixation site, implant diameter, and numbers of implants and sutures used) were included as covariates. Twenty-five biomechanical studies, representing 494 cadaveric specimens, met the inclusion criteria.

Results:

The use of interference screws (vs suture anchors) was associated with a mean 86 N–greater UFL (95% CI, 34-138 N; P = .002). Each additional suture used to attach the tendon to the implant was associated with a mean 53 N–greater UFL (95% CI, 24-81 N; P = .001). Multivariate analysis found no significant association between fixation site and UFL. Finally, the use of suture anchors and fewer number of sutures were both independently associated with lower odds of native tissue failure as opposed to implant pullout.

Conclusion:

These findings suggest that fixation with interference screws, rather than suture anchors, and the use of more sutures are associated with greater biceps tenodesis strength, as well as higher odds of native tissue failure versus implant pullout. Although constructs with suture anchors show inferior UFL compared with those with interference screws, incorporation of additional sutures may increase the strength of suture anchor constructs. Supra- and subpectoral repairs provide equivalent biomechanical strength when controlling for potential confounders.

中文翻译：

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植入物的选择和手术方法是否与二头肌腱形成相关联的强度？系统评价和元回归。

背景：

尽管肱二头肌腱固定术的使用越来越多，但关于最佳植入物选择（缝合锚钉与干涉螺钉）和植入物放置（上al与下胸膜）仍缺乏共识。

目的/假设：

目的是确定程序参数与二头肌腱固定构造的生物力学性能之间的关联。作者假设最终修复载荷（UFL）在亚修复和修复修复之间或干扰螺钉和缝合锚钉结构之间不会有所不同，并且植入物的数量和缝合线的数量与构建强度呈正相关。

学习规划：

荟萃分析。

方法：

作者进行了系统的文献搜索，以研究可测量人体尸体标本中二头肌腱固定修复的生物力学性能的研究。两名独立评论者从符合纳入标准的研究中提取了数据。然后对合并的数据集执行元回归。结果变量是UFL和失败模式。程序参数（固定类型，固定部位，植入物直径以及使用的植入物和缝合线的数量）作为协变量包括在内。代表494个尸体标本的二十五个生物力学研究符合纳入标准。

结果：

使用干涉螺钉（相对于缝线锚钉）与平均86 N–更大的UFL（95％CI，34-138 N；P = .002）相关。用于将肌腱附着到植入物上的每条额外缝合线均与平均53 N–更大的UFL相关（95％CI，24-81 N；P = .001）。多变量分析发现固定位点与UFL之间无显着关联。最后，与种植体拔除相反，使用缝合线锚钉和较少数量的缝合线都与较低的天然组织衰竭几率独立相关。

结论：

这些发现表明，用干涉螺钉而不是缝合线锚钉进行固定，以及使用更多的缝合线与更大的二头肌腱索强度有关，并且与种植体拔除相比，自然组织衰竭的几率也更高。尽管具有缝合锚钉的构造物与具有干扰螺钉的构造物相比，UFL较差，但是并入其他缝合线可能会增加缝合锚钉构造物的强度。当控制潜在的混杂因素时，上，下胸膜修复可提供同等的生物力学强度。