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Related Experiment Video

Updated: May 5, 2026

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All Suture Biceps Tenodesis Has Greater Biomechanical Strength Than Metal Button Fixation.

Matthew J Kinnard1, Jeremy D Tran1, Steven D Voinier1,2,3

  • 1Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.

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|January 8, 2025
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Summary

The all-suture Caspari-Weber (CW) technique for biceps tenodesis demonstrated superior maximal load to failure compared to the metal button (MB) method. Both techniques showed similar stiffness and displacement, offering surgeons a robust, potentially lower-cost option.

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Area of Science:

  • Orthopedic Surgery
  • Biomechanical Testing
  • Shoulder Arthroscopy

Background:

  • Subpectoral biceps tenodesis is a common procedure for managing biceps tendon pathology.
  • Fixation techniques, including metal buttons and all-suture anchors, vary in biomechanical properties.
  • Understanding the mechanical differences is crucial for surgical decision-making.

Purpose of the Study:

  • To compare the biomechanical properties of the all-suture Caspari-Weber (CW) technique versus the intramedullary unicortical metal button (MB) for subpectoral biceps tenodesis.
  • Specifically evaluating maximal load to failure, cyclic displacement, stiffness, and failure modes.

Main Methods:

  • A matched-pair cadaveric study using 16 proximal humeri.
  • Specimens underwent subpectoral biceps tenodesis using either the CW or MB technique.
  • Cyclic loading for 1,000 cycles followed by load-to-failure testing on a servohydraulic apparatus.

Main Results:

  • No significant differences were found in construct stiffness or displacement between the CW and MB groups.
  • The CW technique exhibited a significantly greater maximal load to failure (588.36 ± 149.06 N) compared to the MB technique (375.83 ± 131.4 N, P = .014).
  • Failure modes were not detailed but were compared between groups.

Conclusions:

  • The all-suture CW technique provides superior load-to-failure strength over the unicortical MB technique for subpectoral biceps tenodesis.
  • Both fixation methods offer comparable construct displacement and stiffness.
  • The CW technique presents a mechanically robust and potentially more cost-effective option for open subpectoral biceps tenodesis.