{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T16:04:40Z","timestamp":1790093080158,"version":"4.0.1"},"reference-count":33,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To provide an updated systematic review comparing the fixation strengths of proximal biceps tenodesis (BT) constructs in cadaveric biomechanical studies, including a meta\u2010analysis between all\u2010suture versus other constructs, knot\u2010dependent versus knotless constructs, inlay versus onlay techniques, and single\u2010 versus double\u2010anchor configurations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses guidelines. Three separate databases were queried in April 2025 using relevant search terms for biomechanical studies published in 2019 or later that reported cadaveric BT load\u2010to\u2010failure results. Demographic factors, BT techniques, and ultimate failure loads (UFLs) were extracted. Four subanalyses were conducted by pooling studies with intrastudy comparisons of all\u2010suture versus other BT constructs, inlay versus onlay techniques, knotless versus knot\u2010dependent techniques, and 1\u2010implant versus 2\u2010implant constructs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 245 cadaveric specimens across 12 studies were included for analysis. Mean UFL of BT constructs ranged from 79\u2009N (interference screw) to 588\u2009N (all\u2010suture Caspari\u2010Weber technique). Knot\u2010dependent techniques showed significantly greater UFL than knotless techniques, with weighted mean difference favoring knot\u2010dependent techniques by 28.2\u2009N (95% confidence interval [CI]: [0.22, 56.17],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.05,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200953%). There were no statistically significant differences in pooled UFL results between all\u2010suture constructs versus other construct material types (95% CI: [\u221219.9, 48.2],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.42,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200974%), inlay versus onlay techniques (95% CI: [\u221275.3, 35.42],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.48,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200984%), and 1\u2010implant versus 2\u2010implant constructs (95% CI: [\u221266.9, 12.5],\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.18,\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200955%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>UFLs of proximal BT constructs showed substantial variability across techniques. No statistically significant differences were observed between inlay and onlay techniques, all\u2010suture and alternative constructs, or single\u2010 and double\u2010anchor configurations. Knot\u2010dependent constructs exhibited greater UFLs compared with knotless constructs; however, the difference was small and of uncertain clinical significance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>Knot\u2010dependent constructs were narrowly stronger than knot\u2010independent constructs in this biomechanical analysis and may provide a minor amount of added strength in early rehabilitation. However, surgeon choice should be prioritized when considering a biceps tenodesis construct.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/arj.70596","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T15:32:21Z","timestamp":1790091141000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Knot\u2010Dependent Constructs Show Narrowly Better Ultimate Failure Loads Than Knotless Constructs in Proximal Biceps Tenodesis: A Systematic Review and Meta\u2010analysis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3528-9273","authenticated-orcid":false,"given":"Kevin G.","family":"Girardi","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Rehabilitation Yale School of Medicine  New Haven Connecticut 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