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Editorial Commentary: Does Size Matter: Drill Holes in Subpectoral Biceps Tenodesis?
Summary
Proximal humerus fracture is a rare complication following subpectoral tenodesis (SPBT). While smaller screws may be feasible, further biomechanical studies are needed to assess fracture risk and construct strength.
Area of Science:
- Orthopedic surgery
- Shoulder arthroscopy
- Biceps tendon pathology
Background:
- Subpectoral tenodesis (SPBT) is a common procedure for long head of biceps tendon tears.
- Proximal humerus fracture is a rare but serious complication associated with SPBT.
- Current techniques utilize unicortical interference screws for tenodesis.
Discussion:
- The biceps tendon diameter may allow for smaller tenodesis screws in SPBT.
- Biomechanical strength of constructs using smaller interference screws requires investigation.
- The role of drill hole size in determining fracture risk needs further evaluation.
Key Insights:
- Technical feasibility of using smaller tenodesis screws exists.
- Biomechanical integrity of smaller screw constructs is uncertain.
- Drill hole size as a primary fracture risk factor is questionable.
Outlook:
- Further research is needed to validate the biomechanical strength of smaller interference screws.
- The established SPBT technique with unicortical interference screws remains reliable.
- Premature alteration of the SPBT technique is not recommended based on current evidence.
