All Arthroscopic Suprapectoral Biceps Tenodesis

Background: Biceps tendinopathy can have significant clinical manifestations in active patients. Failure to achieve resolution of symptoms through nonsurgical modalities oftentimes results in surgical intervention. The 2 most common surgical treatment options for tendinopathy of the long head of the biceps tendon (LHBT) are tenotomy and tenodesis. Both modalities have shown efficacy within the literature; however, tenodesis of the LHBT has many advantages to tenotomy. Indications: Subgroove tenodesis eliminates the potential pain generation within the bicipital groove. Despite recent proof of clinical equivalence in open versus arthroscopic tenodesis, there has been increasing interest in all-arthroscopic biceps tenodesis techniques in hopes of minimizing surgical exposure, decreasing the rate of potential neurovascular compromise, and decreasing the time to recovery. Technique: We present an all-arthroscopic technique for a subgroove biceps tenodesis using a unicortical tensionable button. The proximal biceps anchor is held in place at its insertion site with a spinal needle to prevent retraction. The lateral portal is redirected into the subdeltoid space. A novel suprapectoral biceps portal, called the Willingboro portal, is placed percutaneously 2 cm above the pectoralis tendon. Onlay fixation of the LHBT is performed proximal to the pectoralis major muscle insertion using a unicortical button. Postoperative protocol is similar to other fixation constructs. Results: Numerous arthroscopic biceps tenodesis techniques have been described with good success; however, an all-arthroscopic suprapectoral tenodesis is attractive to many reasons. The unicortical button construct shows similar load to failure strength as the bicortical button construct, both of which are greater than all other constructs described in the literature. Discussion/Conclusion: Arthroscopic subgroove biceps tenodesis using a unicortical button technique is a viable option that avoids the complications associated with an open axillary incision as well as persistent groove pain. Anchoring the biceps tendon prior to tenotomy allows for preservation of tendon length, limiting the complications associated with tendon retraction with anticipated improvement in patient-reported outcomes. The unicortical button is known to have a similar strength profile as the bicortical button technique, which is greater than other techniques described in the literature. Future studies should be aimed at assessing long-term patient-reported outcomes. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication

Trends in Osteopathic Authorship in Orthopedic Publications and Its Impact on Adult Reconstruction Match Rates

Background: Doctors of osteopathy (D.O.) have historically been underrepresented in the orthopedic literature. As adult reconstruction (AR) continues to rank among the most competitive orthopedic fellowships, participation in research likely serves a key role for successfully matching. This study sought to identify trends in D.O. orthopedic publications and assess for correlations between these trends and osteopathic AR match results. Methods: The top 10 orthopedic surgery journals based on impact factor were selected for analysis. Articles published between 2010 and 2021 were screened to assess for publications with a D.O. author, as well as authorship position. A total of 29,499 articles were available for final analysis. Data from the San Francisco Residency and Fellowship Match Services were also reviewed to evaluate the number of osteopathic applicants and their match rates during the same study period. Trends in D.O. publications and osteopathic AR match rates were then assessed for any correlations. Results: From 2010 to 2021, there was a significant increase in orthopedic and arthroplasty-related publications with a D.O. author (P < .0001), as well as D.O. first (P = .0006) and senior authorship positions (P = .009). Osteopathic match rate significantly increased during the study period (P = .003). There was a strong correlation between the increase in osteopathic match rate and arthroplasty-related publications with a D.O. author (r = 0.76). Conclusions: From 2010 to 2021, there was an upward trend of osteopathic orthopedic publications. This increase is strongly correlated with an increase in osteopathic AR match rate. Our findings suggest that authorship in publications may play a key role in successfully matching into an AR fellowship