Tension Slide Technique Research Articles

A Novel Spiked Washer and Screw Technique Provides a Biomechanically Superior Posterolateral Corner and Arcuate Fracture Repair.

Posterolateral corner and arcuate fractures can cause significant disruption to the stability and kinematics of the knee. This study aimed to determine the biomechanical performance of a novel spiked washer (SW) and intramedullary screw technique compared with a tension slide technique (TST) for the repair of arcuate fractures. Sixteen matched fresh-frozen cadaver knees underwent repair. Each specimen underwent transection of the posterolateral corner and lateral capsule along with a proximal fibula osteotomy to simulate an arcuate fracture. Eight specimens underwent repair with a SW technique and 8 underwent repair with a TST. Each specimen underwent cyclic loading followed by load to failure. Gap formation, ultimate load to failure, energy to failure, and stiffness were assessed. The SW technique had significantly less gap formation and higher load to failure. Furthermore, the SW technique had significantly higher stiffness and energy to failure. A SW and screw technique provided a significantly stronger construct with less gap formation when compared with a TST. [Orthopedics. 2024;47(5):e277-e281.].

Two Intramedullary and 1 Extramedullary Cortical Button, With or Without Interference Screw, Show Biomechanical Properties Superior to Native Tendon in Repair of the Distal Biceps Tendon: A Systematic Review and Network Meta-analysis of Biomechanical Performance

The aim of this study was to use a systematic review and network meta-analysis (NMA) to compare the failure strength, maximum strength, stiffness, and displacement of available constructs for distal biceps repair. An NMA was conducted to determine the performance of 2 all-suture suture anchors (2x ASA), 2 intramedullary cortical buttons (2x IM CB), 2 suture anchors (2x SA), extramedullary cortical buttons (EM CB), extramedullary cortical button plus interference screw (EM CB+IFS), interference screw (IFS), single intramedullary cortical button (IM CB), single suture anchor (SA), trans-osseous suture (TOS), tension slide technique (TST), and tension slide technique plus suture tape (TST+ST). Analysis consisted of arm-based network meta-analysis under Bayesian random-effects model with Markov Chain Monte Carlo (MCMC) sampling. Biomechanical outcomes were summarized as treatment effects and their corresponding 95% confidence intervals (CI). Rank probabilities were calculated and used to generate each treatment's surface under the cumulative ranking (SUCRA) curve. Biomechanical properties were compared to native tendon. Displacement >10mm was defined as clinical failure. Twenty-one studies were included. For failure strength, no construct outperformed the native tendon but 2x SA, IFS, SA, and TOS demonstrated poorer failure strength. For the maximum load to failure, EM CB+IFS outperformed the native tendon. Compared to native tendon, EM CB+IFS, EM CB, and 2xIM CB were stiffer, while 2x SA and IFS were less stiff. No construct demonstrated >10 mm of displacement, but constructs with displacement above the mean (3.5 mm) included 2x ASA, 2xIM CB, and TOS. The fixation constructs that consistently demonstrated comparable or better biomechanical properties (failure strength, maximum strength, stiffness) to native tendon in distal biceps tendon repair were the extramedullary cortical button with or without interference screw and two intramedullary cortical buttons. No construct demonstrated displacement beyond standard definitions for clinical failure. This network meta-analysis of biomechanical studies suggest that extramedullary cortical button and two intramedullary cortical buttons may be the most stable construct for distal biceps repair fixation, with equivalent or better biomechanical properties compared to native tendon.

Poster 186: Repair of the Distal Biceps Tendon: A Systematic Review & Network Meta-Analysis of Biomechanical Performance

Objectives:Rupture of the distal biceps is common and demonstrates excellent short- and long-term clinical outcomes following surgical repair. Prior studies have individually evaluated the biomechanical construct strength of multiple fixation devices, but none has comprehensively evaluated constructs in a head-to-head comparison. We sought to compare the failure strength, maximum strength, stiffness and displacement of available constructs for distal biceps repair.Methods:A network meta-analysis was conducted to determine the relative performance of 2 all-suture suture anchors, 2 intramedullary cortical buttons, 2 suture anchors, extramedullary cortical buttons, extramedullary cortical button plus interference screw, interference screw, single intramedullary cortical button, single suture anchor, trans-osseous suture, tension slide technique and tension slide technique plus suture tape. Analysis consisted of arm-based network meta-analysis under Bayesian random-effects model with Markov Chain Monte Carlo (MCMC) sampling. Geometry of the network was represented visually via a network plot with nodes representing treatments and edges representing direct comparative evidence. Biomechanical outcomes of fixation techniques were summarized as treatment effects and their corresponding 95% confidence intervals (CI). Rank probabilities were calculated and used to generate each treatment’s surface under the cumulative ranking (SUCRA) curve.Results:A total of 21 studies were included in the network meta-analysis. For failure strength, the two intramedullary cortical buttons ranked highest (92.73%). For maximum strength, the extramedullary cortical button alone (86.96%) and extramedullary button plus interference screw (83.40%) ranked highest. The two intramedullary cortical buttons ranked highest in stiffness (98.75%), followed by the extramedullary cortical button with interference screw (88.75%) and extramedullary cortical button (75.00%). Finally, with respect to demonstrating the least displacement after loading, the two suture anchors (89.43%) ranked highest, followed by tension slide technique with suture tape (73.14%) and extramedullary cortical button (72.71%).Conclusions:The fixation constructs that demonstrated the greatest overall biomechanical performance in distal biceps tendon repair were the extramedullary cortical button and two intramedullary cortical buttons. Two suture anchors demonstrated the least displacement after loading.Figure 1.Cochrane risk of bias summary of included studies.Figure 2.Evidence networks for outcomes of failure strength (A), maximum strength (B), stiffness (C), and displacement (D). The thickness of each line connecting two nodes is proportional to how often these two interventions were compared, while the size of each node is proportional to the respective patient sample size.Figure 3.Forest plot displaying the effect difference of each intervention on (A) failure strength, (B) maximum strength, (c) stiffness, and (D) displacement.

One-year minimum follow-up results following distal biceps tendon repair using tension slide technique

One-year minimum follow-up results following distal biceps tendon repair using tension slide technique

One-year minimum follow-up results following distal biceps tendon repair using tension slide technique

Background Tears of the distal biceps tendon are unusual and most often result from an injury or lifting a heavy object. These tears are usually complete and the muscle is separated from the bone and retracted back, causing weakness in supination and mid-prone elbow flexion. We present our results of patients undergoing repairs of these tears using the tension slide technique through a single longitudinal anterior incision who were followed up for a minimum of 1 year. Patients and methods A total of 17 patients with acute distal biceps tendon rupture were treated surgically by two surgeons, at two independent centers, using the tension slide technique (Arthrex) between 2017 and 2019. Patients were evaluated retrospectively at a minimum of 1-year follow-up using the patient-reported outcomes Quick Disabilities of the Arm, Shoulder, and Hand (DASH), Oxford elbow score (OES) and EQ-5D-5L. Results The average age at the time of injury was 49 years. All patients were right-hand dominant. Eleven injuries were on the right and remaining on the left side. All patients were males, and there was no documented history of anabolic steroid use. The average time to surgery, following injury, was 6 weeks. The mean postoperative DASH score was 4.4, the average OES was 49.17, and mean European quality of life five dimension (EQ5D) Vas was 84. The elbow range of motion (ROM) was comparable to the healthy contralateral side. There were no reported major complications, although we did have two (11%) minor complications: one case with delayed wound healing and the second patient with a delayed infection, treated with oral antibiotics for 14 days. Conclusions The utilization of the tension slide technique for repair of acute distal tendon biceps rupture using Endobutton and interference screw is safe. The complications were minor, and the function was excellent as reflected with OES and DASH scores.

Single Biotenodesis Screw vs Biotenodesis Screw with Cortical Button Tension Slide Technique for Flexor Hallucis Longus Transfer: A Biomechanical Analysis

Category:Ankle; Hindfoot; Sports; OtherIntroduction/Purpose:Restoration of functional plantarflexion of the ankle joint following chronic Achilles injury is achieved through transfer of the flexor hallucis longus (FHL) tendon. Fixation of the FHL tendon transfer with a cortical button tension slide technique is an advancement that has not been measured against traditional methods. The purpose of this study is to evaluate the biomechanical differences between a single biotenodesis screw versus biotenodesis screw with cortical button tension slide technique for the fixation of FHL transfer. The authors hypothesize a biomechanical advantage for the tension slide technique compared to the biotenodesis screw alone for fixation of the flexor hallucis longus in chronic Achilles pathology.Methods:12 pairs (n=24) of fresh-frozen cadaveric tibia-to-toe samples (6 male, 6 female) were utilized to assess the biomechanics of FHL tendon transfer fixation. All specimens underwent bone density analysis. Each pair of cadaveric samples were randomized to receive either the biotenodesis screw or the tension slide technique. FHL tendon transfer was performed via standard technique using a 6.25x15mm biotenodesis screw with the foot in 20 degrees plantarflexion. A 2.6x12mm cortical button was inserted and FHL tendon was introduced with a tension-slide technique. Biomechanical loading was applied between 20N and 60N at a rate of 1Hz for 100 cycles. Post-cyclic load to failure occurred at 1.25mm/sec. Cyclic displacement, structural stiffness, and ultimate load were derived from resultant load-displacement curves. Student t-tests were used to evaluate significant effects between both FHL tendon transfer techniques. Linear regression analysis was performed to assess interactions between bone density and strength of FHL tendon transfer.Results:Average tendon diameter of the 24 FHL samples was 5.44+-0.46 mm. Average bone density for all 24 calcaneus samples was determined to be 1.06+-0.08 g/cm2. Loading data was normalized with respect to bone density and tendon diameter to account for inherent anatomical differences between cadaveric specimens. The addition of a cortical button for FHL transfer to the calcaneus did not significantly affect cyclic displacement (0.78+-0.52mm vs 0.87+-0.80mm) or structural stiffness (162.11+- 43.34N/mm vs. 167.57+-49.19N/mm). Addition of the cortical button to the FHL tendon transfer construct resulted in a 34% significant increase in ultimate load (343.72+-68.93 N) compared to biotenodesis screw alone (255.62+-77.17 N) (p=0.0002). Linear regression analyses did not reveal any significant interactions between bone density and FHL tendon transfer technique.Conclusion:Enhanced strength can be achieved for Achilles pathology repaired with FHL tendon transfer utilizing a biotenodesis screw and cortical button tension slide technique demonstrated by a statistically significant 34% increase in ultimate load, subsequent to cyclic loading. Cortical buttons in the setting of FHL tendon transfer to the calcaneus offers an additional level of support in the case of extreme tendon transfer failure.

Single Incision Modified Tension Slide Technique in Distal Biceps Repair: Improved Load to Failure While Reducing Surgical Pitfalls.

Historically, distal biceps tendon repair through the tension slide technique (TST) using a cortical button has yielded the strongest published repair measured by observed gap formation in both cyclic and maximal load to failure. The modified tension slide technique (MTST) was developed in order to provide the surgeon with a technically simpler and biomechanically more effective way to reduce gap formation and consistently seat/bottom-out the tendon within the bone tunnel through a more direct line of pull. In order to compare the biomechanics of the MTST to the TST, we used 24 matched bovine extensor tendons, and conducted maximal load to failure and cyclical load to failure testing using an Instron 5566 machine. The mean maximal load to failure for the MTST was 444 N versus 229 N for the TST ( P <0.004) while no gap formation was observed in either group after cyclic load testing. These findings indicate that the MTST has a statistically significant increased load to gap formation of ∼2-fold in comparison to TST. In the MTST both limbs of suture are passed back through the tendon, before button implantation, eliminating the "operating in a hole" effect required in the TST, and making for a simpler surgical procedure.

Biomechanical Analysis of Single Interference Screw vs Interference Screw With Cortical Button for Flexor Hallucis Longus Transfer.

Background:Flexor hallucis longus tendon transfer (FHL) with a cortical button tension slide is an innovative addition that has not been measured against traditional methods.Methods:12 pairs (n=24) of fresh-frozen cadaveric tibia-to-toe samples were used and randomized to receive one of the operative FHL techniques. Specimens underwent bone density analysis. Biomechanical loading was applied between 20 and 60 N at 1 Hz for 100 cycles. Post–cyclic load to failure occurred at 1.25 mm/s. Cyclic displacement, structural stiffness, and ultimate load were derived from load-displacement curves. Student t tests evaluated significant effects between both FHL techniques. Linear regression analysis assessed interactions between bone density and strength of FHL technique.Results:Average tendon diameter was 5.44±0.46 mm. Average bone density was 1.06±0.08 g/cm2. Addition of a cortical button to FHL transfer did not significantly affect cyclic displacement (0.78±0.52 mm vs 0.87±0.80 mm) or structural stiffness (162.11±43.34 N/mm vs 167.57±49.19 N/mm). Cortical button addition to FHL transfer resulted in significantly increased ultimate load (343.72±68.93 N) compared with interference screw alone (255.62±77.17 N) (P = .0002). Linear regression analyses did not reveal any significant interactions between bone density and FHL tendon transfer technique.Conclusion:Enhanced strength can be achieved with FHL tendon transfer to calcaneus using an interference screw and cortical button tension slide technique as compared to an interference screw alone. Cortical buttons in the setting of FHL tendon transfer to the calcaneus offers an additional level of support.Clinical Relevance:Operative cases presenting with poor bone quality due to osteoporosis or osteopenia could benefit from cortical button fixation during FHL transfer. Clinical studies are needed to determine if the increased construct stability conferred from the additional use of a flip button results in fewer FHL transfer failures or better clinical outcomes.Level of Evidence:Level V, Controlled Laboratory Study.

Acute distal biceps tendon rupture: retrospective analysis of two different approaches and fixation techniques

PurposeThe aim of our study is to compare the modified double incision (DI) with bone tunnel reinsertion with the single-incision (SI) double tension slide technique in terms of clinical and functional outcomes and complication rates.MethodsA retrospective comparative analysis was performed on 65 patients treated for total distal biceps tendon rupture. The surgical technique adopted for each patient was based on the preference of two experienced elbow surgeons. The DASH and MAYO questionnaires, functional outcome and ROM were recorded in all subjects.ResultsOf 65 patients, we collected data of a cohort of 54 distal biceps tendon ruptures that satisfied inclusion criteria. Twenty-five were treated by modified DI and 29 SI techniques. The recovery of the complete ROM in terms of flexion/extension and prono-supination occurred in the 79.6% of the patients, without statistical significant difference between the adopted technique. We reported a complication rate of 12% and 20.7% for DI and SI techniques, respectively, without statistical correlation (P = 0.84). The average DASH score was similar for DI and SI techniques without significant differences (P = 0,848). The Mayo score results were excellent in the majority of the patients. No significant difference in MAYO results was reported comparing the surgical techniques (P = 1).ConclusionBoth techniques provide a reliable and strong repair with an optimal recovery of ROM returning to preinjury activity with substantially overlapping timelines.

Latissimus Dorsi Tendon Reconstruction at the Myotendinous Junction With Acellular Dermal Allograft

Background: Limited available data have shown latissimus dorsi tendon reconstruction to be an effective treatment for tendon tears in specific subpopulations of elite overhead throwing athletes. Indications: Primary indication for latissimus dorsi tendon reconstruction is a symptomatic, full-thickness humeral avulsion with or without a concomitant teres major tendon tear. Surgical candidates are typically young, high-demand, elite or professional overhead throwing athletes. In this case, the patient is a 29-year-old male former minor league pitcher and current pitching coach with a full-thickness avulsion of the latissimus dorsi tendon. Technique Description: The patient was positioned left lateral decubitus with a dynamic limb positioner maintaining the arm in 90° abduction and maximal internal rotation. This technique used a single posterior axillary incision, which was performed and dissected down to the ruptured latissimus dorsi tendon. We circumferentially applied an acellular dermal allograft to augment the reconstruction at the myotendinous junction. Subsequently, the construct was prepared for transfer with a Krackow suture technique. Suture buttons were used to secure the reconstructed latissimus dorsi tendon to the anatomic footprint on the proximal humerus with a tension slide technique. Results: One case series showed return to the previous level of competition for all baseball pitchers who underwent a latissimus dorsi reconstruction with excellent improvement in visual analog scale pain, American Shoulder and Elbow Surgeons, and Kerlan-Jobe Orthopaedic Clinic scores. Another larger study demonstrated equal return to play rates for professional baseball pitchers with a latissimus dorsi tear treated either nonoperatively or operatively. However, those treated operatively had no decline in performance, whereas the nonoperative cohort saw decline in some statistics. Conclusion: Latissimus dorsi tendon reconstruction using an acellular dermal allograft at the myotendinous junction is a viable treatment option for elite overhead throwing athletes with full-thickness tendon avulsions. It allows for full return to play, particularly if the patient has failed nonoperative management.

Retrospective Study of the Distal Biceps Tendon Repair Using “All-suture” Soft Anchors

Introduction: Distal biceps repair is commonly performed using various fixation devices, each having its advantages and drawbacks. All-suture soft anchor (ASSA) is a recent device mitigating some of the issues associated with previous devices. Materials and Methods: This retrospective study including 20 patients (21 ruptures) aims to evaluate the safety and functionality of ASSA by modified tension-slide technique. All operations were performed through a single-incision anterior approach using two 2.9 mm anchors. All but 1 were men with a mean age of 50.5 years. The mean duration from injury to surgery was 14 days. Results: At a mean follow-up of 11.8 months, compared with contralateral extremity, 18 (86%) of 21 regained full biceps strength with 5/5 flexion-supination power, while 3 displayed 4/5 power. All, except 1, returned to the previous level of function at an average of 24 weeks. As per the modified Mayo Elbow Performance Index, 18 (86%) achieved excellent and 3 (14%) had good results. Complications included lateral antebrachial cutaneous nerve palsy in 12 (resolved in 10), superficial radial nerve palsy in 1 (resolved), and heterotopic ossification in 1. No device-related complications or reruptures were noted. Conclusion: Primary repair of distal biceps tendon ruptures through the use of the ASSA is a viable option, which in conjunction with the proposed modification of tension-slide suture fixation technique yields clinically objective and functional results. Level of Evidence: Level IV—therapeutic.

Double Tension Slide Technique as a Novel Repair for Distal Biceps Tendon Tear: A Biomechanical Evaluation.

BackgroundA comparative biomechanical analysis of two distal biceps tendon repair techniques was performed: a single suture tension slide technique (TST) and two suture double tension slide (DTS) technique.MethodologyTen matched pairs of fresh frozen human cadaveric elbows (20 elbows) were randomly separated into two cohorts for distal biceps tendon repair. One cohort underwent the TST, and the other underwent the DTS technique. The tendon was preconditioned with cyclic loading from 0° to 90° at 0.5 Hz for 3,600 cycles with a 50 N load. The specimens were then loaded to failure at a rate of 1 mm/s. The difference in the load to failure between the groups was analyzed using the Student’s t test. The mode of failure was compared between groups using the chi-square test. All p-values were reported with significance set at p < 0.05.ResultsOverall, 77.8% of the included matched pairs demonstrated greater load to failure in the DTS group. The mean load to failure in the DTS group was 383.3 ± 149.3 N compared to 275.8 ± 98.1 N in the TST group (p = 0.13). The DTS specimens failed at the tendon (5/9), suture (3/9), and bone (1/9). The TST specimens failed at the tendon (4/9) and suture (5/9) only. There was no significant difference in failure type between groups (p = 0.76).ConclusionsDTS demonstrates a similar to greater load to failure compared to TST with a trend towards statistical significance. The redundancy provided by the second suture has an inherent advantage without compromising the biomechanical testing.

Combined Suspensory and Aperture Fixation of Posterior Tibialis Tendon Anterior Transfer for Dropfoot

Category:Other; TraumaIntroduction/Purpose:Anterior transfer of the tibialis posterior tendon (TPT) can restore ankle dorsiflexion in patients with foot drop. A limitation of this procedure is the need for postoperative ankle immobilisation. We present the results of a novel dual method of TPT docking which infers immediate stability, allowing early weightbearing.Methods:8 patients underwent 9 tendon transfers,age range of 28-52 years. 3 patients had dropfoot from common peroneal nerve injury, 6 cases were part of a complex cavovarus or spastic equinovarus correction. The TPT is passed to the dorsum of the foot through the interosseous membrane. The docking site is prepared with a bicortical pilot hole followed by unicortical overreaming. The TPT is whipstitched and an Arthrex biceps button is threaded to the sutures. The button is passed bicortical and flipped using a tension slide technique give stable suspensory fixation. Additional stability is conferred by overpassing an Arthrex biotenodesis screw giving aperture fixation. Patients are immobilised in a boot and allowed to weightbear immediately.Results:Follow up was 6 months. There was difficulty in docking of suspensory fixation in two of the early cases. These patients had aperture fixation and were immobilised non weightbearing in a cast for 6 weeks. With technical modifications, all subsequent patients had dual fixation. At 6 months there were no radiological or clinical failures of fixation. Patients without other underlying issues were able to mobilise splint free at 6 months. All patients were satisfied with their procedure.Conclusion:Aperture fixation with an interference screw has become the gold standard for TPT transfer, however, patients still need a prolonged period of immobilisation. Combined suspensory and aperture fixation is technically straightforward and seems to give more initial stability allowing early weightbearing. Further prospective studies and biomechanical studies are needed to validate this technique.

Functional outcomes of ulnar collateral ligament reconstruction with a novel double suspensory fixation

Ulnar collateral ligament reconstruction (UCLR) has allowed the return of overhead athletes to throwing sports. We describe a new double suspensory (DS) technique using a single tunnel in the ulna and humerus, achieving fixation with adjustable loop buttons. Inclusion criteria included skeletally mature baseball players with clinical and magnetic resonance imaging diagnosis of UCL insufficiency who failed a trial of structured nonoperative treatment. A total of 36 baseball players underwent DS UCLR, between 2011 and 2017, by 1 surgeon with minimum 2-year follow-up. The graft was fixated with an adjustable button loop on the humeral side and a tension slide technique with a button on the ulnar side. Pre- and postoperative Kerlan-Jobe Orthopaedic Clinicand Single Assessment Numerical Evaluationand postoperative Conway scores were obtained. The mean age was 19.8 ± 4.6 years (range, 14-35 years). All were male. Mean years played before surgery was 14.3 ± 4.6 years (range, 8-28 years). There were 32 (89%) pitchers and 4 (11%) position players. There were 13 (36%) high school, 20 (55%) college, 2 (6%) minor league, and 1 (3%) adult league athletes. The mean follow-up was 55.3 ± 23.7 months (range, 26-97 months). There was significant improvement in Kerlan-Jobe Orthopaedic Clinic (33.2 ± 19.9 to 89.7 ± 15.1, P < .0001) and Single Assessment Numerical Evaluation (20.7 ± 16.7 to 93.6 ± 11.9, P < .0001) scores. Using Conway scoring, 25 (69%) had excellent, 5 (14%) good, 3 (8%) fair, and 3 (8%) poor scores. Mean return to play was 9 ± 1.5 months (range, 6-16 months). Only 1 (3%) athlete required a revision surgery and ultimately returned to play and 1 (3%) hardware removal. None developed ulnar nerve symptoms. DS fixation for UCLR in baseball players can lead to excellent clinical results and early return to play.

Comminuted Fibular Head Fractures With Posterolateral Knee Instability: A Novel Repair Technique Using a Tension-Slide Device.

Comminuted proximal fibula fractures or arcuate fractures (OTA/AO 4F1B fractures) can defunction the posterolateral corner (PLC) and result in posterolateral knee instability. Ongoing posterolateral knee instability can limit function, cause significant pain, and lead to early knee arthrosis. The anatomy of the PLC and proximal fibula limits the options for repair of this injury. The ideal method for osteosynthesis of these injuries has not been established. The goals of treatment include reconstitution of posterolateral stability, restoration of the anatomic relationship of PLC structures, and restoration of bone stock that would permit future reconstruction. This article characterizes the injury pattern, outlines the technique, and provides the clinical and radiographic outcomes of osteosynthesis of comminuted fibular head fractures using a novel application of the tension-slide technique.

Distal Biceps Tendon Repair Using a Double Tension Slide Technique

Distal biceps tendon ruptures are thought to be secondary to an acute forceful eccentric load on a degenerative tendon. Nonoperative treatment following rupture leads to significantly decreased forearm supination and elbow flexion strength. There are several techniques described in the literature for repair. This article describes, with video illustration, distal biceps tendon repair using a double tension slide technique with 2 No. 2 high-tension nonabsorbable composite sutures.

Reinsertion of distal biceps ruptures with a single anterior approach: analysis of 14 cases using tension-slide technique and interference screw.

Background:Several techniques of surgical repair of biceps tendon ruptures are described in literature. Cortical button repair have shown minimal loss of elbow flexion, supination and strength. In this retrospective study we report the outcomes in terms of elbow function and complications of tension-slide technique and interference screw.Matherials and methods:14 patients with complete distal biceps tendon rupture were included in the retrospective study and treated with the same tension-slide technique (BicepsButton® - Arthrex, Inc, Naples, Florida) evaluating the clinical and functional outcomes and the complication rate with a follow-up average of 18 months.Results:The flexion recovered compare to the healthy contralateral was 96% (min 115° - max 135°; average 128°), the extension was 97% (min: -2° - max 15°; average 4°), the supination was 90% (min 20° - max 90°; average 75°), the pronation was 95% (min 15° - max 90°; average 76°). The mean Disabilities of Arm, Shoulder and Hand (DASH) score was 8.1 ± 10.5 and Mayo Elbow Performance Score overall (MEPS) score was 97.6 ± 8.2. Two patients had LABCN paresthesia, one case, treated 2 months after injury, had posterior interosseus nerve palsy. One patient had heterotopic ossification at the radiological examination without consequences for the clinical performances. No case of non-traumatic tendon re-rupture and no case of ROM deficiency > 20%. In all case the cortical button remains well positioned and no case of osteolysis were reported.Conclusions:Distal biceps tendon repair with BicepsButton® system seems to be a safe, relyable and reproducible technique providing excellent clinical, functional and radiological outcomes. Comparing with other techniques the BicepsButton® system has the advantages of the single approach procedures, the reduction of surgical time and risk of heterotopic ossifications. (www.actabiomedica.it)

Arthroscopic Ligamentum Teres Reconstruction Using Anterior Tibialis Allograft and the Tension-Slide Technique

Once perceived to be a vestigial structure, the ligamentum teres (LT) is now increasingly understood to be critical to providing stability in the adult hip. Surgical treatment with arthroscopic debridement is usually the procedure of choice to treat LT tears. However, reconstruction is a possible alternative in select cases. The authors of a recent systematic review concluded that LT debridement may provide short-term relief of hip pain in patients with partial-thickness tears in whom conservative management has failed whereas reconstruction may be more beneficial in cases of full-thickness tears. This Technical Note describes a method for arthroscopic LT reconstruction using the tension-slide technique to fixate an anterior tibialis tendon allograft to the acetabulum.

Distal biceps tendon repair via new knotless endobutton fixation: A biomechanical study.

Distal biceps tendon repair using endobutton fixation has shown the best biomechanical results in terms of pullout strength. Here, we compared Sethi's enhanced tension adjustable endobutton technique known as the "tension slide technique" to a new knotless endobutton fixation technique without a post-fixation screw. Our new approach is as effective as the tension slide technique in terms of pullout strength and gapping after early mobilization. A biomechanical cadaveric study with 16 paired arms was performed. With the radius held in place, the distal biceps tendon was loaded at 100 N for 500 cycles and the load was then increased until failure. Gapping after loading cycles and maximum load to failure were recorded and compared. Median bone-tendon gapping was 5.77 mm (interquartile range (IQR) 4.84-9.11) for tension slide technique and 4.72 mm (IQR 1.77-6.16) for the knotless fixation (p = 0.047). Median load to failure was 257.87 N (IQR 222.07-325.35) in the tension slide technique group and 407.78 N (IQR 358.54-485.20) in the knotless group (p = 0.047). The knotless endobutton provides better pullout strength and elongation results compared to the tension slide technique without the use of an interference screw, allowing early mobilization in order to faster return to daily living activities.Level of evidence: Basic science study.

Arthroscopic-Assisted Suspensionplasty Using the Palmaris Longus Tendon for Osteoarthritis of the Thumb Carpometacarpal Joint

Osteoarthritis of the thumb carpometacarpal joint is common, especially in postmenopausal women. Numerous surgical techniques, including ligament reconstruction, partial or complete trapeziectomy, arthrodesis, and arthroplasty have been introduced. Suspensionplasty combined with trapeziectomy has been introduced to prevent proximal subsidence of the first metacarpal. To prevent excessive release of periarticular capsuloligamentous tissues, resection of the proximal part of the trapezium, and the cosmetically unappealing bump, arthroscopic partial trapeziectomy has been used as a less-invasive treatment option. With advanced techniques and devices, arthroscopic suspensionplasty with the autograft can be performed; thus far, there have been no series reporting on arthroscopic treatment options for this common condition. The purpose of this article is to present a technique for arthroscopic-assisted suspensionplasty using the palmaris longus tendon to reinforce the graft–bone interface, based on the concept of the tension slide technique to treat thumb carpometacarpal osteoarthritis.