Biomechanical evaluation of a unicortical button versus interference screw for subpectoral biceps tenodesis

The purpose of this study was to evaluate and compare the biomechanical properties of a unicortical button with an interference screw used for subpectoral biceps tenodesis. We also describe the anatomic dangers of bicortical button use in the subpectoral location.

Twenty-eight fresh-frozen human cadaveric shoulders with a mean age of 52 years were studied. The specimens were randomly divided into 4 experimental biceps tenodesis groups (n = 7): unicortical button, interference screw, bicortical suspensory button, and bicortical suspensory with interference screw (Arthrex, Naples, FL). Each tenodesis specimen was mounted on a mechanical testing machine, preloaded for 2 minutes at 5 N, cycled from 5 to 70 N for 500 cycles (1 Hz), and loaded to failure (1 mm/s). We determined the mode of failure and computed the ultimate load to failure, yield load, pullout stiffness, and displacement at peak load. Calculations of the distance between the axillary and radial nerves with respect to the bicortical buttons were also calculated in 6 specimens.

There was no statistically significant difference (P > .05) among groups in terms of age, ultimate load to failure, pullout stiffness, or displacement at peak load. Suture-tendon interface failure was the most commonly observed mode of failure. The axillary nerve was on average 7.8 mm from the bicortical button; however, in 6 specimens the nerve was less than 3 mm away.

The use of a unicortical button for subpectoral biceps tenodesis provides biomechanical properties similar to the use of an interference screw. In addition, the use of a bicortical button in this area of the proximal humerus puts the axillary nerve at risk.

Using a unicortical button subpectoral biceps method may provide a surgeon with a safe and technically easy and reproducible technique while providing similar biomechanical properties to a known standard implant.