This study evaluates the position of the long head of biceps tendon using ultrasound following simple tenotomy, in patients with arthroscopically repaired rotator cuff tears.

In total, 52 patients with a mean age of 60.7 years (45 to 75) underwent arthroscopic repair of the rotator cuff and simple tenotomy of the long head of biceps tendon. At two years post-operatively, ultrasound revealed that the tendon was inside the bicipital groove in 43 patients (82.7%) and outside in nine (17.3%); in six of these it was lying just outside the groove and in the remaining three (5.8%) it was in a remote position with a positive Popeye Sign. A dynamic ultrasound scan revealed that the tenotomised tendons had adhered to the surrounding tissues (autotenodesis).The initial condition of the tendon influenced its final position (p < 0.0005). The presence of a Popeye sign was statistically influenced by the pre-operative co-existence of supraspinatus and subscapularis tears (p < 0.0001).

It appears that the natural history of the tenotomised long head of biceps tendon is to tenodese itself inside or just outside the bicipital groove, while its pre-operative condition and coexistent subscapularis tears play a significant role in the occurrence of a Popeye sign.

Purpose: The purpose of our work was to assess sutures, suturing techniques, and suture anchors used in rotator cuff surgery in order to explore weak parts in our repair.

Material and Methods: Ten types of sutures, four types of suturing techniques and eight types of sutures anchors commonly used in shoulder surgery were tested. Vicryl, Ticron, Dexon, PDS, Panacryl, Ethibond, Durabraid, Fiberwire, HiFi and Orthocord sutures were tested. Simple, mattress, massive cuff tear (MCT) technique and modified Mason Allen.

(MMA) suturing technique in ex-vivo ovine healthy rotator cuff were tested. Four metallic and four bioabsorbable anchors: Arthrex, Smith+Nephew, Linvatec, Mitek and bio respectively were tested. Their pull-out strength and failure mode was determined in ex-vivo ovine humeral heads. Materials Testing Machine and attached load cell run with Emperor Software (MEC-MESIN, UK) was used for the tests with application of tensile load(60mm/min). Load and displacement were recorded at a sampling rate of 100 Hz and breaking load and stiffness were recorded.

Results: The suture mean breaking strength (N) was: Vicryl 89.0, Ticron 70.9, Dexon 111.7, PDS 92.9, Panacryl 52.9, Ethibond 64.5, Durabraid 72.6, Fiber-wire 127.2, HiFi 163.0 and Orthocord 141.8. The mean suture stiffness (N/mm) was: Vicryl 3.4, Ticron 3.0, Dexon 2.4, PDS 1.2, Panacryl 0.7, Ethibond 2.5, Durabraid 3.1, Fiberwire 9.7, HiFi 11.1, and Orthocord 6.9. The technique’s mean breaking strength (N) was: simple 54.1, mattress 102.8, MCT 194.0, MMA 227.7 and their mean stiffness (N/mm) was: simple 10.4, mattress 13.1, MCT 26.0 and MMA 18.9. The anchors had mean pull-out strength (N): Arthrex 534.0 and Smith & Nephew 574.0, Linvatec 707.2N, Mitek 736.4N and Arthrex Bio 257.4, Linvatec Bio 305.2, Mitek Bio 359.6, S& N Bio 330.6. Often either in metallic (10/20) or in bioabsorbable anchors (11/20) the eyelet fails first.

Conclusion: Modern non absorbable sutures (HiFi Orthocord Fiberwire) have higher breaking strength and stiffness than absorbable ones (p< 0.05). MCT suturing technique, arthroscopically applicable, and MMA technique, which is most commonly used in open surgery have no great differences in strength and stiffness (p=0.046 and p=0.352 respectively). Both of them have higher strength and stiffness than simple and mattress technique (p< 0.05). Metallic anchors have a higher pull-out strength than bioabsorbable ones (p< 0.05) and the eyelet is a weak point in both.

We measured torsion of the humeral head in 38 patients (40 shoulders) with recurrent anterior dislocation of the shoulder (RADS) and in 40 normal subjects. We found a reduced mean retroversion in the patients with RADS at 4.3 +/- 10.56 degrees (17 degrees anteversion to 32 degrees retroversion) as compared with 16.1 +/- 11.07 degrees in the control group (0 degrees to 49 degrees) (p = 0.0001). There was anteversion in 11 of the 40 shoulders in the RADS group (27.5%) and in none of the control group. The first dislocation had occurred after minimal force in 18 of 25 patients with less than 10 degrees retroversion, but in only three of 15 with over 10 degrees retroversion. We conclude that decreased retroversion of the humeral head is often associated with RADS and with first dislocation of the shoulder caused by minimal force.