All-endoscopic approach for distal biceps tendon pathology: analysis of long-term outcomes in partial and complete ruptures

Abstract

Distal biceps tendon (DBT) pathology is a spectrum that ranges from tendinopathy to complete retracted ruptures, and surgical treatment is usually performed via open approaches. The purpose of this study was to analyze safety and long-term outcomes of all-endoscopic surgery for entire spectrum of primary DBT pathology. The hypothesis was that at an all-endoscopic technique would result in satisfactory clinical outcomes and a low complication rate. Consecutive patients who underwent all-endoscopic surgery for primary isolated DBT pathology (bursitis, partial and acute/chronic complete tears) between January 2013 and December 2021 were assessed and analyzed retrospectively. Refractory bursitis and low-grade partial tears underwent endoscopic débridement, and high-grade partial tears and complete ruptures underwent all-endoscopic repair or graft reconstruction. Preoperative and follow-up assessment included functional assessment using Mayo Elbow Performance Score (MEPS) and a Patient-Reported Distal Biceps Score (PRDBS), and radiological assessment was performed using plain biplanar radiographs and sonography. Pre- and postoperative scores for the overall group, and for partial and complete tears, were compared using a paired T-test. Overall, 26 male patients underwent an all-endoscopic surgery for distal biceps tendon tears; the pathology was classified by endoscopic findings into 6 types, and follow-up period ranged from 21 to 125 months (mean 79.4 months). Nine chronic partial tears (35%) included predominantly bursitis (type I, n=2) and predominantly partial tears (type IIA and B, n=7). The complete tear group (65%) included isolated short or long head tears (type IIIA and IIIB, n=2) and complete tendon ruptures (types IV, V, and VIA-C, n=15). Endoscopic débridement of the bursitis/ low grade tears and repair of the high-grade and complete ruptures resulted in complete resolution of symptoms and significant improvement in both MEPS and PRDBS (p<0.001). Autografts were necessary in 35% (6/17) of complete tears, and no significant difference was found in functional scores in this group as compared to those where primary repairs were possible. There were 2 minor complications (7.6%) that involved transient lateral antebrachial cutaneous nerve (LACN) neuropraxia. Follow-up sonography and radiographs showed an intact tendon and absence of heterotopic ossification or synostosis. An all-endoscopic approach for treating distal biceps tendon pathology was safe and reliable and was associated with significant improvement in subjective and functional outcomes in the long term. The dual-anchor onlay repair technique showed long-term radiologically demonstrable structural integrity of the tendon and was associated with a low minor complication rate and absence of heterotopic ossification.