Biomechanical characterization of unicortical button fixation: a novel technique for proximal subpectoral biceps tenodesis

Proximal biceps tenodesis is one method for treating biceps-related pain. Tenodesis protects the length-tension relationship of the biceps muscle, maintains strength, and provides a better cosmetic appearance than tenotomy. The purpose of this investigation was to compare the mechanical properties of a unicortical metal button and an interference screw in proximal biceps tenodesis. Six pairs of fresh-frozen shoulders were dissected, leaving the proximal biceps tendon as a free graft. On each pair of shoulders, a biceps tenodesis was performed using an interference screw or a unicortical metal button. The specimens were mounted and a cyclic load (10-60 N) was applied at 1 Hz for 200 cycles, followed by an axial load to failure. The displacement, ultimate load to failure, and mode of failure were recorded. Displacement in response to cyclic loading was 3.7 +/- A 2.2 mm for the interference screw and 1.9 +/- A 1.0 mm for the cortical button (P = 0.03). Load at failure for the interference screw was 191 +/- A 64 N (stiffness: 24 +/- A 11 N/mm) and 183 +/- A 61 N (stiffness: 24 +/- A 7. N/mm) for the unicortical button (P = n.s. for both cases). As a novel technique for subpectoral biceps tenodesis, a unicortical button demonstrated significantly less displacement in response to cyclic loading than the interference screw. The ultimate load to failure and stiffness for the two methods were not different. In this way, a unicortical button may provide a reliable alternative method of fixation with a potentially lower risk of post-operative humeral fracture and a construct that permits early mobilization following biceps tenodesis.