Acute Distal Biceps Tendon Ruptures Research Articles

Comparative Analysis of Surgical Approaches for Distal Biceps Tendon Rupture: Single-Incision Technique versus Double-Incision Technique.

Background: This study aimed to compare the outcomes of the single-incision technique with a distal biceps repair system versus the modified double-incision technique, specifically the Morrey-modified approach, Krackow sutures, and drill holes, for the management of acute and chronic distal biceps tendon rupture. The study was conducted at the Orthopedic-Traumatology Clinic II of SCJUPBT Timisoara, Romania, between 2014 and 2022. Methods: A total of sixty-nine patients with acute distal biceps tendon rupture and five patients with chronic distal tendon rupture were included in the study. Forty-eight cases underwent the single-incision technique with the distal biceps repair system, while twenty-four patients were treated with the modified double-incision technique. Results: Both surgical techniques demonstrated favorable outcomes in terms of successful tendon repair and functional restoration. However, the single-incision technique exhibited slightly superior results in terms of patient satisfaction, range of motion, and postoperative rehabilitation. The modified double-incision technique showed comparable outcomes but had a higher incidence of complications, particularly related to wound healing. Conclusion: The single-incision technique with the distal biceps repair system and the modified double-incision technique, including the Morrey-modified approach, Krackow sutures, and drill holes, are effective surgical approaches for the management of distal biceps tendon rupture. The single-incision technique yielded better functional outcomes and patient satisfaction, while the modified double-incision technique had a higher risk of complications. Further research with larger sample sizes and longer follow-up periods is necessary to validate these findings and determine the most appropriate surgical approach for distal biceps tendon rupture.

Shoulder & Elbow

The December 2022 Shoulder & Elbow Roundup360 looks at: Biceps tenotomy versus soft-tissue tenodesis in females aged 60 years and older with rotator cuff tears; Resistance training combined with corticosteroid injections or tendon needling in patients with lateral elbow tendinopathy; Two-year functional outcomes of completely displaced midshaft clavicle fractures in adolescents; Patients who undergo rotator cuff repair can safely return to driving at two weeks postoperatively; Are two plates better than one? A systematic review of dual plating for acute midshaft clavicle fractures; Treatment of acute distal biceps tendon ruptures; Rotator cuff tendinopathy: disability associated with depression rather than pathology severity; Coonrad-Morrey total elbow arthroplasty implications in young patients with post-traumatic sequelae.

Challenging the mechanism of distal biceps tendon rupture using a video analysis study.

The conventionally described mechanism of distal biceps tendon rupture (DBTR) is of a 'considerable extension force suddenly applied to a resisting, actively flexed forearm'. This has been commonly paraphrased as an 'eccentric contracture to a flexed elbow'. Both definitions have been frequently used in the literature with little objective analysis or citation. The aim of the present study was to use video footage of real time distal biceps ruptures to revisit and objectively define the mechanism of injury. An online search identified 61 videos reporting a DBTR. Videos were independently reviewed by three surgeons to assess forearm rotation, elbow flexion, shoulder position, and type of muscle contraction being exerted at the time of rupture. Prospective data on mechanism of injury and arm position was also collected concurrently for 22 consecutive patients diagnosed with an acute DBTR in order to corroborate the video analysis. Four videos were excluded, leaving 57 for final analysis. Mechanisms of injury included deadlift, bicep curls, calisthenics, arm wrestling, heavy lifting, and boxing. In all, 98% of ruptures occurred with the arm in supination and 89% occurred at 0° to 10° of elbow flexion. Regarding muscle activity, 88% occurred during isometric contraction, 7% during eccentric contraction, and 5% during concentric contraction. Interobserver correlation scores were calculated as 0.66 to 0.89 using the free-marginal Fleiss Kappa tool. The prospectively collected patient data was consistent with the video analysis, with 82% of injuries occurring in supination and 95% in relative elbow extension. Contrary to the classically described injury mechanism, in this study the usual arm position during DBTR was forearm supination and elbow extension, and the muscle contraction was typically isometric. This was demonstrated for both video analysis and 'real' patients across a range of activities leading to rupture.Cite this article: Bone Jt Open2022;3(10):826-831.

Anatomical intramedullary distal biceps tendon fixation. Our first experience.

BackgroundIntramedullary fixatiovn in distal biceps tendon repair has been proposed to address specific shortcomings of current fixation techniques. Previous studies described a nonanatomical repair.HypothesisThe purpose of the present study is to report the short-term outcomes of an anatomic intramedullary fixation.Study DesignWe evaluated functional and radiographic outcomes up to 6 months of follow-up.MethodsPatients with an acute distal biceps tendon rupture eligible for surgical repair were invited to take part in the study. Eleven patients were included in the final analysis. All patients were evaluated both clinically and radiographically at 2 weeks, 6 weeks, 3 months, and 6 months. Outcomes were recorded using the visual analog scale score for pain, the Mayo Elbow Performance Score, and Disabilities of the Arm, Shoulder, and Hand scores. The radiographic evaluation comprised X-ray and CT evaluation.ResultsThere were no failures of fixation in the patient group examined. Elbow mobility was symmetric for all patients from 6 months onward. Supination strength was similar uninjured side at final follow-up. Mean Disabilities of the Arm, Shoulder, and Hand score and Mayo Elbow Performance Score at final follow-up were 0 and 100, respectively. Computed tomography images showed no signs of button migration, cortical thinning due to button pressure or button breakout. The tendon could be followed to the button in all cases. One case of heterotopic ossification was seen.ConclusionsAnatomical intramedullary fixation of the DBT has excellent functional outcomes at 6 months. The anatomical repair resulted in a restoration of supination strength. This technique allows the anatomical reinsertion of the distal biceps tendon while minimizing the risk of PIN injury. The intraosseous position of the tendon avoids gap formation. No adverse reactions of the button on the bone were seen.

One-year minimum follow-up results following distal biceps tendon repair using tension slide technique

Background Tears of the distal biceps tendon are unusual and most often result from an injury or lifting a heavy object. These tears are usually complete and the muscle is separated from the bone and retracted back, causing weakness in supination and mid-prone elbow flexion. We present our results of patients undergoing repairs of these tears using the tension slide technique through a single longitudinal anterior incision who were followed up for a minimum of 1 year. Patients and methods A total of 17 patients with acute distal biceps tendon rupture were treated surgically by two surgeons, at two independent centers, using the tension slide technique (Arthrex) between 2017 and 2019. Patients were evaluated retrospectively at a minimum of 1-year follow-up using the patient-reported outcomes Quick Disabilities of the Arm, Shoulder, and Hand (DASH), Oxford elbow score (OES) and EQ-5D-5L. Results The average age at the time of injury was 49 years. All patients were right-hand dominant. Eleven injuries were on the right and remaining on the left side. All patients were males, and there was no documented history of anabolic steroid use. The average time to surgery, following injury, was 6 weeks. The mean postoperative DASH score was 4.4, the average OES was 49.17, and mean European quality of life five dimension (EQ5D) Vas was 84. The elbow range of motion (ROM) was comparable to the healthy contralateral side. There were no reported major complications, although we did have two (11%) minor complications: one case with delayed wound healing and the second patient with a delayed infection, treated with oral antibiotics for 14 days. Conclusions The utilization of the tension slide technique for repair of acute distal tendon biceps rupture using Endobutton and interference screw is safe. The complications were minor, and the function was excellent as reflected with OES and DASH scores.

Invivo evaluation of a new intramedullary distal biceps tendon fixation device.

Intramedullary fixation in distal biceps tendon repair may be a solution to address specific shortcomings of current fixation techniques. Most investigations are limited to biomechanical evaluation. The purpose of this study was to report the short-term outcomes of an intramedullary fixation device. We evaluated functional and radiographic outcomes at up to 6 months of follow-up. Patients with an acute distal biceps tendon rupture eligible for surgical repair were invited to take part in the study. Ten patients were included in the final analysis. All patients were evaluated both clinically and radiographically at 2 weeks, 6 weeks, 3 months, and 6 months. Outcomes were recorded using a visual analog scale score for pain, the Mayo Elbow Performance Score, and the Disabilities of the Arm, Shoulder and Hand score. Radiographic evaluation comprised radiographic and computed tomography evaluation. There were no failures of fixation in the patient group examined. Elbow mobility was symmetrical for all patients from 3 months onward. Supination strength was 86% of the uninjured side at final follow-up. The mean Disabilities of the Arm, Shoulder and Hand score and Mayo Elbow Performance Score at final follow-up were 0 and 100, respectively. Computed tomography images showed no signs of button migration, cortical thinning due to button pressure, or button breakout. The tendon could be followed to the button in all cases. The intramedullary fixation button technique to repair the distal biceps tendon has excellent functional outcomes at 6 months. No adverse reactions of the button on the bone were seen. As this technique minimizes the risk of posterior interosseous nerve injury and has a sufficient bone tunnel to avoid gap formation, this may be a promising new technique for distal biceps tendon rupture refixation.

Acute distal biceps tendon rupture: retrospective analysis of two different approaches and fixation techniques

PurposeThe aim of our study is to compare the modified double incision (DI) with bone tunnel reinsertion with the single-incision (SI) double tension slide technique in terms of clinical and functional outcomes and complication rates.MethodsA retrospective comparative analysis was performed on 65 patients treated for total distal biceps tendon rupture. The surgical technique adopted for each patient was based on the preference of two experienced elbow surgeons. The DASH and MAYO questionnaires, functional outcome and ROM were recorded in all subjects.ResultsOf 65 patients, we collected data of a cohort of 54 distal biceps tendon ruptures that satisfied inclusion criteria. Twenty-five were treated by modified DI and 29 SI techniques. The recovery of the complete ROM in terms of flexion/extension and prono-supination occurred in the 79.6% of the patients, without statistical significant difference between the adopted technique. We reported a complication rate of 12% and 20.7% for DI and SI techniques, respectively, without statistical correlation (P = 0.84). The average DASH score was similar for DI and SI techniques without significant differences (P = 0,848). The Mayo score results were excellent in the majority of the patients. No significant difference in MAYO results was reported comparing the surgical techniques (P = 1).ConclusionBoth techniques provide a reliable and strong repair with an optimal recovery of ROM returning to preinjury activity with substantially overlapping timelines.

Treatment of acute distal biceps tendon ruptures - A survey of the British Elbow and Shoulder Society surgical membership.

BackgroundAcute distal biceps tendon ruptures result in weakness and deformity. While in other jurisdictions the rate of surgical repair has outpaced rises in incidence, UK practice for distal biceps tendon ruptures is unknown. The aim of this survey was to characterise current UK clinical practice.MethodsAn online survey was sent to the surgeon members of the British Elbow and Shoulder Society. Questions covered respondent demographics, clinical decision making, surgical experience and willingness to be involved in future research.ResultsA total of 242 surgeons responded; 99% undertook acute distal biceps tendon repairs with 83% repairing at least half of all distal biceps tendon ruptures, and 84% of surgeons would have their own, hypothetical, acute distal biceps tendon rupture repaired in their dominant arm and 67% for their non-dominant arm. Patient age, occupation and restoration of strength were the commonest factors underpinning a recommendation of surgical fixation. Most surgeons (87%) supported a national trial to study operative and non-operative treatments.ConclusionsUK upper limb surgeons currently advise surgical repair of acute distal biceps tendon ruptures for the majority of their patients. This is despite a paucity of evidence to support improved outcomes following surgical, rather than non-operative, management. There is a clear need for robust clinical evaluation in this area.

Acute distal biceps tendon ruptures: anatomy, pathology and management - state of the art

All patients with acute complete distal biceps tendon ruptures who are not low demand or medically unfit to proceed with surgery are offered operative repair. This restores arm shape, supination strength and function, and decreases their cramping symptoms. Surgical repair technique varies significantly depending on location and training centre. Nuances in technique and appropriate implant selection need to be noted in order to achieve a strong repair allowing early active range of motion. Intimate knowledge of distal biceps tendon anatomy is key to avoid complications associated with the different approaches. The cumulative body of evidence on complications, coupled with knowledge of the different biomechanical construct strengths of the alternative methods of fixation, points to the use of the cortical button technique without the addition of an interference screw. Subtle variations in drill hole positioning on the bicipital tuberosity secures either an anatomic or non-anatomic repair. Anatomic repair results in greater supination peak torque and fatigue strength, and in greater flexion fatigue strength. It is advisable to perform an anatomic repair in elite athletes or those patients who significantly rely on supination strength and endurance for their livelihood. A universal postoperative protocol is suggested for all repairs.

Supination torque following single- versus double-incision repair of acute distal biceps tendon ruptures

Compared with single-incision (SI) distal biceps repair, double-incision (DI) repair has been described as permitting a more anatomic repair. We hypothesized that DI repair would result in greater terminal supination torque compared with SI repair for acute distal biceps ruptures. Patients were included if they sustained an isolated, acute distal biceps rupture repaired between January 2012 and December 2017. Isometric forearm supination torque in 4 positions wasmeasured using a validated uniaxial torque-testing device. Testing took place at least 12 months from surgery. The primary outcome was supination torque in the 60° supinated position. Secondary outcomes included supination torque in other forearm positions and functional outcome scores. The study included 37 patients: 15 underwent repair with the DI technique and 22 with the SI technique. The mean age was 47.3 years, the median follow-up time was 28.1 months, and demographic data were similar between cohorts. Mean supination torque, relative to the unaffected side, was 61% (95% confidence interval, 45%-77%) for DI repair vs. 80% (95% confidence interval, 69%-92%) for SI repair in the 60° supinated position (P = .036). In a multivariable linear regression model controlling for arm dominance, age, follow-up time, and workers' compensation status; SI repair was associated with greater mean supination torque than DI repair by 20% (P = .015). Contrary to our hypothesis, we found a 20% mean improvement in terminal supination torque for acute distal biceps ruptures repaired with the SI technique compared with the DI technique. This finding may have clinical significance for the more discerning, high-demand patient.

Unicortical Versus Bicortical Button Fixation For Distal Biceps Brachii Tendon Rupture: A Cadaveric Biomechanical Study

Objectives: Acute distal biceps tendon rupture is an increasingly common and more recognized injury affecting active adults. Operative repair is the preferred treatment, particularly for restoration of elbow function and strength. No prior study has biomechanically compared unicortical versus bicortical distal biceps button fixation under cyclic loading, which is most representative of postoperative physiologic conditions. We hypothesized there would be no difference in loss of force, tendon gap formation, or ultimate failure load following cyclic loading between unicortical and bicortical button techniques for the repair of distal biceps tendon rupture. Methods: Experimental testing with 13 fresh-frozen matched paired cadaver elbows was conducted. One specimen from each pair was randomized to either unicortical or bicortical distal biceps button fixation techniques, with contralateral specimen assigned to the alternate technique. In both arms of the experiment, the distal 2.5 cm of the biceps tendon was whipstitched and the free suture ends threaded in opposite directions through a 2.6 x 12 mm titanium cortical button. A 3.2 mm guide pin was drilled through the central aspect of the radial tuberosity from anterior to posterior, aiming approximately 20° in the ulnar direction. The button was inserted and deployed for either unicortical or bicortical fixation and the free suture limbs tensioned to advance tendon down to bone for final fixation. Loading was performed using an MTS servohydraulic actuator. A 25-N distal biceps preload was applied and each specimen cycled from full extension to 90° of flexion at 0.5 Hz for 3000 cycles using a displacement controlled protocol. All specimens were subsequently loaded to failure at 2 mm/s to simulate an acute postoperative load. Outcome measures were a loss of force from cycle 5 to cycle 3000, tendon gapping during cyclic loading, and ultimate failure load. Results: During cyclic loading, the mean change in force from cycle 5 to cycle 3000 was -0.33 N for the unicortical fixation group and 0.36 N for the bicortical fixation group (p=0.21). The increase in tendon gap for the unicortical fixation group was 1.02 mm and for the bicortical fixation group was 1.83 mm (p=0.37). During failure loading, the unicortical button fixation group had a mean failure load of 170.45 N and the bicortical button fixation group a mean failure load of 181.25 N (p=0.89). Conclusion: No significant differences exist between the two techniques in loss of force and tendon gap formation under cyclic loading conditions. This indicates that both unicortical and bicortical distal biceps button techniques maintained an equivalent stabilization during a simulated 3 month postoperative healing period. Additionally, there was no significant difference in failure load between the two groups indicating an equivalent response in the event of an acute injury. Clinical Relevance: Distal biceps button fixation strength and tendon gap behavior under physiologic cyclic load support the implementation of early postoperative elbow range of motion, imperative in the prevention of elbow stiffness. Unicortical fixation may be sufficient in facilitating optimal bone-tendon apposition and healing, while minimizing risk of iatrogenic injury associated with bicortical fixation.

The Biotenodesis Screw and Endobutton Technique for Repair for Acute Distal Biceps Tendon Rupture

There were no re-ruptures, fractures or hardware-related complications. Overall 95% of patients (21/22) were satisfied and rated their experience as excellent or good. Mean time to return to work was 100 days (0-280) and mean time requiring pain relief was 23 days (1-56). 55% returned to sport at their pre-injury level. One case developed heterotopic calcification and there were 3 cases of superficial infection. Mean OES and Mayo scores statistically improved from 18 (6-37) to 43 (24-48) and from 48 (5-95) to 95 (80-100) respectively (p < 0.00001).

Double incision repair technique with immediate mobilization for acute distal biceps tendon ruptures provides good results after 2 years in active patients

IntroductionSurgical treatment of distal biceps tendon ruptures is recommended in an active population to avoid loss of strength, especially in supination and flexion. HypothesisA double incision repair technique with immediate postoperative mobilization for acute distal biceps tendon ruptures is safe and provides good results after 2 years in active patients. Material and methodsSeventy-four men (47±7 years) with acute tears of the distal biceps tendon tears were included in this retrospective single-center study. All patients were operated using the double-incision repair technique described by Morrey. The tendon was inserted with transosseous sutures into the biceps tuberosity. Patients were allowed to perform immediate postoperative active mobilization. A minimum follow-up of two years was required including clinical and radiological evaluation. ResultsSixteen patients were lost to follow up leaving 58 (78%) patients for analysis with a mean follow-up of 53±19 months. At final follow-up, the mean evaluation for pain on the VAS scale was 0.22±0.7. Mean range of motion results included extension −1°±2°, flexion 138°±6°, pronation 72°±16° and supination 81°±10°. The strength ratio in flexion was 94±8% and in supination 90.5±12% compared to the contralateral limb. Subjective elbow value and DASH score were respectively 94±6% and 7.5±9%. All patients were satisfied or very satisfied and all except one returned to their previous sport. We noticed 2 heterotopic ossifications and one patient needed a reoperation for a radioulnar synostosis. Neither re-rupture nor nerve injury were observed. DiscussionA double incision technique for distal biceps tendon repair is a minimally invasive procedure with reliable results. Morrey's modification of the initial procedure associated with early mobilization is associated with a low rate of complications and limited the occurrence of synostosis or ossifications. Level of evidenceIV, case series, with no comparison group.

Distal biceps tendon rupture: advantages and drawbacks of the anatomical reinsertion with a modified double incision approach

BackgroundDistal biceps tendon rupture occurs more often in middle-aged male population, involving the dominant arm. In this retrospective study, it’s been described the occurrence of the most frequent adverse events and the clinical outcomes of patients undergoing surgical repair of distal biceps tendon rupture with the modified Morrey’s double-incision approach, to determine better indications for patients with acute tendon injury.MethodsSixty-three patients with acute distal biceps tendon rupture treated with a modified double-incision technique between 2003 and 2015 were retrospectively evaluated at a mean 24 months of follow-up. Clinical evaluation including range of motion (ROM) and isometric strength recovery compared to the healthy contralateral side assessment, together with documentation of nerve injury, was performed. Patients were asked to answer DASH, OES and MEPS scores.ResultsThe ROM recovery showed excellent results compared to the healthy contralateral side.The reported major complications included: one case of proximal radio-ulnar synostosis, 3 cases of posterior interosseous nerve (PIN) palsy and one case of a-traumatic tendon re-rupture. Concerning minor complications, intermittent pain, ROM deficiency < 30° in flexion/extension and pronation/supination, isometric flexion strength deficiency < 30% and isometric supination strength deficiency < 60%, lateral antebrachial cutaneous nerve (LACBN) injury, were observed. The average DASH score was 8.5; the average OES was 41.5 and the MEPS was 96.3.ConclusionThe Morrey modified double-incision technique finds its indication in young and active patients if performed within 2 weeks from injury. If performed by experienced surgeons, the advantages can exceed the drawbacks of possible complications.

Intramedullary Cortical Button Repair for Distal Biceps Tendon Rupture: A Single-Center Experience

The aim of this retrospective study was to evaluate the clinical outcome and complication rate of intramedullary cortical button repair for distal biceps tendon rupture (partial and complete tears). Between 2010 and 2014, a total of 28 patients with an acute distal biceps tendon rupture underwent intramedullary cortical button repair. Twenty-four patients (mean age, 49 years) with a mean follow-up of 28 months were included in the study. Twenty patients were examined clinically and by maximum isometric strength testing in flexion (at 90°) and supination of both arms. Twenty-four patients completed functional scores including the Mayo Elbow Performance Score (MEPS), the Andrews-Carson-Score (ACS) and the shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Furthermore, follow-up radiographs of 24 patients were analyzed. Compared with the contralateral elbow, the active range of motion (ROM) was the same. The mean strength for flexion was 100.8% ± 14% and for supination 93.1% ± 22% compared with the uninjured side. The mean MEPS for all patients was 95.6 ± 8.2, the mean ACS 194.2 ± 9.4 and the QuickDASH 3.8 ± 7.6. Heterotopic ossification (HO) was seen on radiographs in 46% of patients, but was symptomatic in only 1 patient. One patient suffered a tendon rerupture, and 1 asymptomatic button migration was seen in the follow-up. Intramedullary cortical button repair provides good results with respect to strength, ROM, and functional outcomes. Because the posterior cortex is not violated, the risk of iatrogenic posterior interosseous nerve injury is minimized. However, the patient should be warned of a high prevalence of postoperative HO. Therapeutic IV.

Biomechanical evaluation of distal biceps tendon repair using tension slide technique and knotless fixation technique

Acute distal biceps tendon ruptures are uncommon injuries that often affect young active males, typically resulting from an eccentric load on their dominant extremity. The purpose of this study was to compare pullout strength and tendon gapping in the tension slide technique (TST) versus a knotless fixation technique (KFT). Two sets of experiments were performed using cadaveric elbow specimens. In the first experiment, eight elbows from different cadavers were tested to compare TST with a standard locking whipstitch with KFT, four elbows in each group, using a standard locking whipstitch. In the second experiment, 12 elbows were used to study the differences between TST with a standard locking whipstitch with KFT using suture tape reinforced whipstitch (RKFT), using the TST data from the first and second experiment. Each experiment evaluated gapping after cyclic loading and the second experiment also tested the construct to load to failure. Gapping for KFT with a standard locking whipstitch was 10.64mm versus 2.69mm for the TST after 1000cycles (P=0.016). A reinforced whipstitch significantly improved the failure to gap on the KFT with no significant difference in gapping when compared to TST after 3000cycles (P=0.36). The resultant gapping for TST and KST was 2.08mm and 2.99mm (P=0.91), respectively. Load to failure for TST and KFT were 282Nm and 328Nm (P=0.20), respectively. Bone-tendon gap resistance of a KFT repair of a torn distal biceps tendon is limited by suture technique. Using a tape reinforced locking whipstitch, the repair is as strong as TST repair. Basic Science.

Intramedullary Cortical Button Fixation Of Distal Biceps Tendon Rupture: Long-term Patient Outcomes

Objectives:No consensus currently exists for optimal distal biceps rupture fixation. Dorsal cortical button (DCB) and dual incision transosseous (DITO) provide the greatest biomechanical load-to-failure, permitting earlier mobilization to prevent arthrofibrosis. Both methods have associated complications, restricted range of motion (ROM) from heterotopic ossification and proximal radioulnar synostosis for DITO while DCB has increased incidence of cutaneous and posterior interosseous nerve (PIN) injuries despite different techniques to reduce their frequency. The intramedullary cortical button (ICB) fixation technique aims to decrease PIN palsy risk, decrease implant costs and provide strong tendon-bone fixation allow for early ROM. We set out to determine the long-term efficacy of this technique and any difference in complication rates including re-rupture.Methods:31 patients underwent ICB fixation of chronic and acute distal biceps tendon ruptures without allograft with more than 1 year follow up. 21 patients completed a questionnaire and Disabilities of the Arm, Shoulder and Hand (DASH) survey. Elbow and forearm ROM, cosmesis, pain, strength, motor nerve neuropraxia, cutaneous sensory changes and other complications were obtained from the chart and questionnaire. The ICB technique utilizes a 4cm transverse anterior incision 2cm distal to the distal antecubital flexion crease. The tuberosity is prepared, creating a clean, bleeding bony surface. A #2 high-strength braided suture is passed through the toggle hole at both ends of a Smith and Nephew Endobutton. A needle passes one suture pair in the 4.7mm hole and out the 2mm hole drilled with mild convergence in the distal and proximal tuberosity footprint with a 1.5cm bony bridge. This suture pair shuttles the Endobutton into the intramedullary canal, both limbs of each suture exits their respective hole. One limb from each suture is whipstitched proximally and back distally. Tensioning the free suture limb exiting the 2mm hole and tying to its free suture pair compresses the biceps stump against the radial tuberosity and secures the Endobutton against the intramedullary cortex at the 2mm hole. Finally the free suture limb exiting the 4.7mm hole is tensioned and tied to its suture pair limb, distributing tendon compression over the entire tuberosity footprint.Results:At an average of 4 (1.3-7.4) years postoperatively, 81% were extremely and 10% very satisfied with their overall outcome. 81% reported no strength or ROM limitations, 76% had pain-free activity, 86% and 81% were extremely satisfied with postoperative elbow ROM and forearm ROM respectively. The mean DASH and sports DASH score were 3.52 and 2.5. Transient sensory changes were noted in the lateral antebrachial cutaneous nerve and superficial radial nerve distributions in 38% and 19% of patients respectively. Excluding workers compensation patients improved the percent of extremely satisfied patients to 93% and the average DASH score to 0.93. No biceps re-ruptures or PIN palsies were observed.Conclusion:The ICB technique provides secure distal biceps tendon fixation with excellent long-term patient satisfaction and comparable functional outcomes to existing fixation techniques with restoration of normative DASH scores. The ICB technique has a cutaneous nerve complication rate comparable to other single incision studies and no observed PIN palsies or wound complications were noted while decreasing the implant costs.

Delayed repair of distal biceps tendon ruptures is successful: a case-control study

The literature has shown an increased complication rate with a delay to surgical repair of acute distal biceps tendon ruptures; however, little has been documented regarding the outcome of delayed repairs. This case-control study compared a study cohort of delayed (>21 days) distal biceps tendon repairs with a control cohort repaired acutely (<21 days). Sixteen delayed repair cases were reviewed and matched with acute controls (1:3) based on repair technique, age, and workers' compensation status. The delayed cohort was reviewed and completed isometric strength testing and the Disabilities of the Arm, Shoulder and Hand questionnaire; Patient-Rated Elbow Evaluation; and American Shoulder and Elbow Surgeons elbow questionnaire. The time to surgery averaged 37 ± 12 days in the delayed cohort versus 10 ± 6 days in the acute cohort. Complications occurred in 63% of patients in the delayed cohort versus 29% in the acute cohort (P = .04); however, 90% of the delayed cohort's complications consisted of transient paresthesias. Follow-up scores on the Patient-Rated Elbow Evaluation, Disabilities of the Arm, Shoulder and Hand questionnaire, and American Shoulder and Elbow Surgeons elbow questionnaire were not statistically different between cohorts (P > .37, P > .22, and P > .46, respectively). Despite a high rate of initial complications, patients treated with distal biceps tendon repair after a delay (>21 days) can expect similar functional outcomes to those treated acutely.

Surgical Management of Acute Distal Biceps Tendon Ruptures.

➤ Acute distal biceps tendon ruptures are uncommon injuries that often affect young active males and typically result from an eccentric load on the dominant upper extremity.➤ Surgical treatment may be indicated to prevent substantial weakness in supination and flexion that can occur with nonoperative treatment.➤ Nonoperative management should be reserved for elderly or less active patients with multiple comorbidities, especially when the injury involves the nondominant arm.➤ Operative management can be performed using a single-incision or dual-incision technique, with multiple surgical options for tendon-to-bone fixation.➤ Single-incision repair techniques are more likely to be complicated by a transient neurapraxia, most often involving the lateral antebrachial cutaneous nerve, while dual-incision repair techniques are more likely to be complicated by heterotopic ossification and stiffness.

Radiological and Clinical Evaluation of the Transosseous Cortical Button Technique in Distal Biceps Tendon Repair

One of the options to repair a ruptured distal biceps tendon to the radial tuberosity is by means of a transosseous cortical button. Although excellent functional outcomes have been reported, no studies have been performed to quantify the effect of the transosseous fixation technique on the radius. Our study evaluated the clinical outcome and radiological outcome of this technique. The main goal of this study was to evaluate the radiographic evolution of the bone tunnel in the radius. Patients with an acute distal biceps tendon rupture treated with a transosseous cortical button were invited to take part in the study. Fourteen patients were included in the final analysis. All patients were evaluated both clinically and by computed tomography scanning of the proximal radius after a minimum follow-up of 2 years. Outcomes were recorded using the visual analog scale score for pain, the Mayo Elbow Performance Score, and Disabilities of the Arm, Shoulder, and Hand scores. Bone tunnel volume was measured with semiautomated computed tomography segmentation using image-processing software. There were no failures of fixation in the patient group examined. Elbow mobility, arm, and forearm circumference were symmetric for all patients. Average visual analog scale for pain was less than 2. Mean Disabilities of the Arm, Shoulder, and Hand score and Mayo Elbow Performance Score were 2.3 and 97.6, respectively. Computed tomography images showed an average closure of the radial bony tunnel of 64% of the initial volume. Biceps tendon repair with cortical button fixation only shows partial tunnel closure. This could reduce the risk of potential complications due to osteolysis, such as radius fracture or hardware failure. Functional results were excellent and comparable to other fixation methods. The role of interference screws in transosseous cortical button techniques to strengthen the repair and to avoid osteolysis may therefore be questioned. Therapeutic IV.