For Biceps Tenodesis, Bone-Tunnel and Cortical-Surface Fixation Are Equally Good

Many orthopaedic procedures involve reattaching a tendon to bone, but the decision as to whether that fixation is made through a bone tunnel or by cortical-surface attachment is usually left up to the surgeon’s preference. In the March 21, 2018 issue of The Journal of Bone & Joint Surgery, Tan et al. attempted to determine which fixation technique, in a rabbit model, provides better tendon-to-bone healing.

The rabbits in the bone-tunnel group and the cortical surface attachment group were killed 8 weeks after biceps tenodesis surgery, and the authors performed detailed biomechanical testing, microcomputed tomography analysis, and histological analysis to evaluate the tendon healing. Here’s what they found:

• There were no significant between-group differences in mean failure loads or stiffness.
• There were no significant between-group differences in mean volume of newly formed bone or in the mineral density of newly formed bone.
• In both groups, histological analysis revealed tendon-bone interdigitation and early fibrocartilaginous zone formation on the outer cortical surface. (This article includes interactive digital whole-slide images of cortical surface attachment and bone-tunnel fixation.)

These findings led the authors to conclude that “tendon fixation in a bone tunnel and on the cortical surface resulted in similar healing profiles.” Because both techniques facilitate good tendon-to-bone healing, surgeon preference will probably continue to dictate the decision to use one method over another.