Evaluation of a curved intramedullary button vs. traditional flat button for proximal biceps tenodesis: a biomechanical study

Background: Although variations in fixation techniques for proximal biceps tenodesis have been evaluated by different biomechanical studies, the optimal fixation technique remains unclear. To further advance the biceps tenodesis technique using unicortical button, a novel curved button was developed...

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Main Authors: Igor J. Shirinskiy, MD, Arno A. Macken, MD, Pieter Caekebeke, MD, Derek F.P. van Deurzen, MD, PhD, Gabriëlle J.M. Tuijthof, PhD, Ir, Tjarco D.W. Alta, MD, PhD, Ronald L.A.W. Bleys, MD, PhD, Rob P.A. Janssen, MD, PhD, Michel P.J. van den Bekerom, MD, PhD
Format: Article
Language:English
Published: Elsevier 2025-07-01
Series:JSES International
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Online Access:http://www.sciencedirect.com/science/article/pii/S2666638325001021
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author Igor J. Shirinskiy, MD
Arno A. Macken, MD
Pieter Caekebeke, MD
Derek F.P. van Deurzen, MD, PhD
Gabriëlle J.M. Tuijthof, PhD, Ir
Tjarco D.W. Alta, MD, PhD
Ronald L.A.W. Bleys, MD, PhD
Rob P.A. Janssen, MD, PhD
Michel P.J. van den Bekerom, MD, PhD
author_facet Igor J. Shirinskiy, MD
Arno A. Macken, MD
Pieter Caekebeke, MD
Derek F.P. van Deurzen, MD, PhD
Gabriëlle J.M. Tuijthof, PhD, Ir
Tjarco D.W. Alta, MD, PhD
Ronald L.A.W. Bleys, MD, PhD
Rob P.A. Janssen, MD, PhD
Michel P.J. van den Bekerom, MD, PhD
author_sort Igor J. Shirinskiy, MD
collection DOAJ
description Background: Although variations in fixation techniques for proximal biceps tenodesis have been evaluated by different biomechanical studies, the optimal fixation technique remains unclear. To further advance the biceps tenodesis technique using unicortical button, a novel curved button was developed. This study aimed to compare the time-zero biomechanical performance of a curved intramedullary button with that of a standard flat button in proximal biceps tenodesis. Methods: A total of 16 cadaveric fresh-frozen shoulders were randomly allocated to undergo proximal biceps tenodesis using either a standard flat button or the new curved button (developed by Materialise, Leuven, Belgium). Following the tenodesis, the biceps tendon was subjected to a cyclic load, ranging from 5 to 100N, at a frequency of 2.5 Hz for a total of 1000 cycles. After this, the tendon was loaded to failure. During testing, displacement after cyclic loading, ultimate failure load, stiffness, and modes of failure were evaluated. Results: All 16 specimens were included in the data analysis. No failure occurred during cyclic testing. After cyclic testing, the median displacement was 10.4 mm (6.1-16.1) for curved button and 11.9 mm (6.0-43.9) for flat button (P = .534). The mean ultimate load to failure for the curved button was 239.4 ± 35.1 N, and 227.0 ± 42.0 N for the flat button (P = .721). The mean stiffness was 70.0 ± 10.3 N/mm for the curved button and 61.3 ± 17.3 N/mm for the flat button (P = .242). Conclusions: In this time-zero in-vitro study, the curved and flat buttons exhibited similar biomechanical properties in terms of displacement, load to failure, and stiffness. Considering these results and the theoretical advantages of the curved button, this technique could be a new alternative for the treatment of proximal long-head biceps tendon pathology.
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spelling doaj-art-772f438669844ddd9ebb0312f6e5d9fc2025-08-20T03:34:17ZengElsevierJSES International2666-63832025-07-01941199120410.1016/j.jseint.2025.03.020Evaluation of a curved intramedullary button vs. traditional flat button for proximal biceps tenodesis: a biomechanical studyIgor J. Shirinskiy, MD0Arno A. Macken, MD1Pieter Caekebeke, MD2Derek F.P. van Deurzen, MD, PhD3Gabriëlle J.M. Tuijthof, PhD, Ir4Tjarco D.W. Alta, MD, PhD5Ronald L.A.W. Bleys, MD, PhD6Rob P.A. Janssen, MD, PhD7Michel P.J. van den Bekerom, MD, PhD8Faculty of Behavioral and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, The NetherlandsAlps Surgery Institute, Clinique Générale d'Annecy, Annecy, France; Department of Orthopaedics and Sports Medicine, Erasmus MC, Rotterdam, The NetherlandsDepartment of Orthopaedics and Traumatology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Rehabilitation Sciences, University of Hasselt, Hasselt, BelgiumAmsterdam Shoulder and Elbow Centre of Expertise (ASECE), OLVG, Amsterdam, The NetherlandsDepartment of Biomechanical Engineering, University of Twente, Enschede, The NetherlandsDepartment of Orthopaedics and Traumatology, Spaarne Gasthuis, Haarlem/Hoofddorp, The NetherlandsDepartment of Anatomy, University Medical Center Utrecht, Utrecht, The NetherlandsDepartment of Orthopaedic Surgery & Trauma, Máxima Medical Center, Eindhoven, The Netherlands; Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Paramedical Sciences, Health Innovations & Technology, Fontys University of Applied Sciences, Eindhoven, The NetherlandsFaculty of Behavioral and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), OLVG, Amsterdam, The Netherlands; Corresponding author: Michel P.J. van den Bekerom, MD, PhD, Faculty of Behavioral and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, De Boelelaan 1105, Amsterdam 1081 HV, Netherlands.Background: Although variations in fixation techniques for proximal biceps tenodesis have been evaluated by different biomechanical studies, the optimal fixation technique remains unclear. To further advance the biceps tenodesis technique using unicortical button, a novel curved button was developed. This study aimed to compare the time-zero biomechanical performance of a curved intramedullary button with that of a standard flat button in proximal biceps tenodesis. Methods: A total of 16 cadaveric fresh-frozen shoulders were randomly allocated to undergo proximal biceps tenodesis using either a standard flat button or the new curved button (developed by Materialise, Leuven, Belgium). Following the tenodesis, the biceps tendon was subjected to a cyclic load, ranging from 5 to 100N, at a frequency of 2.5 Hz for a total of 1000 cycles. After this, the tendon was loaded to failure. During testing, displacement after cyclic loading, ultimate failure load, stiffness, and modes of failure were evaluated. Results: All 16 specimens were included in the data analysis. No failure occurred during cyclic testing. After cyclic testing, the median displacement was 10.4 mm (6.1-16.1) for curved button and 11.9 mm (6.0-43.9) for flat button (P = .534). The mean ultimate load to failure for the curved button was 239.4 ± 35.1 N, and 227.0 ± 42.0 N for the flat button (P = .721). The mean stiffness was 70.0 ± 10.3 N/mm for the curved button and 61.3 ± 17.3 N/mm for the flat button (P = .242). Conclusions: In this time-zero in-vitro study, the curved and flat buttons exhibited similar biomechanical properties in terms of displacement, load to failure, and stiffness. Considering these results and the theoretical advantages of the curved button, this technique could be a new alternative for the treatment of proximal long-head biceps tendon pathology.http://www.sciencedirect.com/science/article/pii/S2666638325001021Basic Science StudyBiomechanics
spellingShingle Igor J. Shirinskiy, MD
Arno A. Macken, MD
Pieter Caekebeke, MD
Derek F.P. van Deurzen, MD, PhD
Gabriëlle J.M. Tuijthof, PhD, Ir
Tjarco D.W. Alta, MD, PhD
Ronald L.A.W. Bleys, MD, PhD
Rob P.A. Janssen, MD, PhD
Michel P.J. van den Bekerom, MD, PhD
Evaluation of a curved intramedullary button vs. traditional flat button for proximal biceps tenodesis: a biomechanical study
JSES International
Basic Science Study
Biomechanics
title Evaluation of a curved intramedullary button vs. traditional flat button for proximal biceps tenodesis: a biomechanical study
title_full Evaluation of a curved intramedullary button vs. traditional flat button for proximal biceps tenodesis: a biomechanical study
title_fullStr Evaluation of a curved intramedullary button vs. traditional flat button for proximal biceps tenodesis: a biomechanical study
title_full_unstemmed Evaluation of a curved intramedullary button vs. traditional flat button for proximal biceps tenodesis: a biomechanical study
title_short Evaluation of a curved intramedullary button vs. traditional flat button for proximal biceps tenodesis: a biomechanical study
title_sort evaluation of a curved intramedullary button vs traditional flat button for proximal biceps tenodesis a biomechanical study
topic Basic Science Study
Biomechanics
url http://www.sciencedirect.com/science/article/pii/S2666638325001021
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