Distal Biceps Ruptures Research Articles

Endoscopic Distal Biceps Repair: Endoscopic Anatomy and Dual-Anchor Repair Using a Proximal Anterolateral “Parabiceps Portal”

Distal biceps rupture is associated with significant functional disability, and surgical treatment involves open or endoscopic-assisted repair of the ruptured tendon through an anterior incision. This report describes an endoscopic approach that is performed with 2 portals for visualization and instrumentation. Preoperative sonography is used to identify bony and soft-tissue landmarks. The viewing portal is a proximal anterolateral “parabiceps portal” developed by the author, and the landmarks and relevant anatomic relations have been derived from a preliminary anatomic study. The working portal is a distal anterior portal and permits access to the radial tuberosity through the internervous muscular plane. The parabiceps portal permits visualization of the anterior and medial region of the radial tuberosity. A detailed description of the endoscopic pathoanatomy of the distal biceps tendon region is presented. The distal anterior portal is used for retrieval of the ruptured tendon, and thereafter the tuberosity is debrided and anchors are placed under vision. The ruptured tendon is whipstitched and docked onto the tuberosity, and nonsliding knots are used to securely reattach the tendon to bone. Overall, the 2-portal technique provides a method for tendon repair under direct visualization and is safe and reproducible.

Distal Biceps Repair With Acellular Dermal Graft Augmentation

Rupture of the distal bicep brachii tendon has received significant attention as a result of increased awareness of injury, numerous surgical fixation techniques, and debate regarding single versus dual incision surgery. The majority of ruptures may be fixed primarily. On rare occasion, the tendon may be attritionaly thinned, or may not have the elasticity to be directly repaired back to the radial tuberosity. We describe a technique for using acellular dermal allograft to augment (not bridge) attritional distal biceps ruptures.

Dynamometer Elbow Strength and Endurance Testing After Distal Biceps Reconstruction w/Allograft

Objectives:The purpose of the current study is to investigate the functional strength outcomes of late distal biceps reconstruction using allograft tissue.Methods:Patients who underwent distal biceps reconstruction with allograft tissue between May 2007 and May 2013 were identified. Charts were retrospectively reviewed for post-operative complications, gross flexion and supination strength, and range of motion (ROM). Isokinetic strength and endurance in elbow flexion and forearm supination were measured in both arms. Tests were conducted using a dynamometer at 60o per second for isokinetic strength and 240o per second for endurance. Isometric strength testing was also measured for elbow flexion and forearm supination. Paired t tests were used for statistical analysis.Results:Ten patients with a mean age of 48 years (range 42 - 61 years) were included in the study. Distal biceps reconstruction was performed using an Achilles tendon allograft in 9 patients and a combination of tibialis anterior allograft and gracilis allograft in 1 patient. Of the reconstructions, 50% involved the dominant arm. Full ROM was observed in all patients at the time of their final follow up assessment. The mean follow-up for dynamometer strength testing was 34 months (range 13-81 months). No statistical differences were noted between data obtained from operative and contralateral extremities. The average peak torque of the operative limb (38.5± 5.9 Nm) was 91.7% of that of the contralateral limb (41.8±4.9 Nm) in flexion and 93.4% (operative, 5.7±1.3 Nm; contralateral, 6.1± 1.0 Nm) in supination. No significant differences were found in fatigue index between operative or contralateral limbs for flexion (operative, 34.1±17.1%; contralateral, 30.8±17.1%; p = 0.29) or supination (operative, 38.2±16.5%; contralateral, 42.1±11.9%; p = 0.65). . The only complication observed was a transient PIN palsy in one patient which resolved by 3 months post-operatively. All patients reported postoperative cosmetic deformity but found their gross appearance acceptable.Conclusion:Late reconstruction for chronic distal biceps rupture using allograft tissue is a safe and effective solution for symptomatic patients with functional demands in forearm supination and elbow flexion. Dynamometer testing shows near normal return of strength and endurance of both elbow flexion and supination following the procedure.

Endobutton versus transosseous suture repair of distal biceps rupture using the two-incision technique: a comparison series

The purpose of this study was to report the outcome of a large cohort of patients undergoing distal biceps tendon repair. We compared the endobutton and transosseous suture repair techniques, both performed through a 2-incision approach. At an average of 2.1 years after a distal biceps repair, 46 male patients (19 endobutton and 27 transosseous suture) were reviewed. The mean age of our patients was 50 years. Forty-three patients (93%) were satisfied with the results of their distal biceps tendon repair. The average pain score was 1.3 of 10 at a mean 2.1 years after repair. More than 80% of patients had regained their premorbid function in both recreational and occupational activities. The mean Mayo Elbow Performance Score was 93 of 100. Biodex strength testing demonstrated restoration of 92% of low-velocity supination power, 102% of high-velocity supination power, and 104% endurance compared with the contralateral limb. There was no statistically significant difference in postoperative strength between the transosseous suture and endobutton groups. There were 3 complications in this series, 1 case of heterotopic ossification and 2 cases of injury to the lateral cutaneous nerve of the forearm. In this large cohort of 2-incision distal biceps repairs, we found a high degree of patient satisfaction and a low complication rate. We did not find any difference in clinical outcome with regard to subjective patient rating, pain, range of motion, or supination strength when comparing the 2-incision endobutton and transosseous suture fixation techniques.

Reconstruction of delayed diagnoses simultaneous bilateral distal biceps tendon ruptures using semtendinosus and quadriceps tendon autografts.

IntroductionSimultaneous bilateral distal biceps rupture is rarely reported, but several issues has to be taken into account and the here presented case brings up some of these aspects.Case descriptionThis case presents a simultaneous bilateral distal biceps ruptures, and due to delayed diagnosis, bilateral muscle retraction had occurred. Surgical reconstruction was challenged both by social circumstances and by previous harvesting of the Semitendinous tendon on one side. The surgery was performed as a staged approach, using a Semitendinosus graft at one side and later using a Quadriceps tendon graft on the opposite site. At follow-up 14 month postoperatively the Oxford Elbow Score was 92 percent for both elbows and the MRI’s bilaterally demostrates that the grafts are tight.Discussion and evaluationThe Quadriceps tendon is a previously non reported type of graft material for this type of surgery. Based on the experience from this case it is concluded that six weeks after trauma the degree of retraction of the distal biceps tendon can impair direct repair.ConclusionWhen reconstruction of the ruptured distal biceps tendon is needed, subjective normal forces can be obtained using both the semitendosus graft as well as the quadriceps graft, however with a minor increased donor site morbidity with respect to the quadriceps graft.

Distal biceps reconstruction 13 years post-injury.

Distal biceps tendon ruptures are relatively rare injuries most commonly caused by an eccentric contraction of the biceps brachii. The majority of complete ruptures receive early surgical intervention, however, some patients do present in a delayed fashion. There are many surgical options at this time for acute and chronic injuries, and this case report describes an Achilles allograft reconstruction in a male who sustained a complete tear 13 years prior to presentation. At 12-month follow up, he had regained full function of his dominant extremity as evidence by returning to work with no limitations and by a Disabilities of the Arm, Shoulder, and Hand (DASH) score of zero. We are unaware of a successfully surgically reconstructed distal biceps tendon of this chronicity. As the literature on this subject is sparse, this case report gives credence to the idea that certain patients with a chronic distal biceps rupture should be considered for operative reconstruction and not relegated to continued failed conservative treatment. Discussed are the surgical treatment options and controversies for chronic distal biceps ruptures, and we review various outcome studies using different surgical techniques.

Posterior Interosseous Nerve Incarceration With Endobutton Repair of Distal Biceps

Distal biceps ruptures are uncommon injuries that comprise approximately 3% of all biceps pathology. This injury is most commonly seen in 40- to 60-year-old men, and the mechanism of injury involves a forceful extension movement to a flexed elbow. Without surgical intervention, patients are left with measurable weakness in elbow flexion and supination as well as a cosmetic deformity that often leaves them dissatisfied. Consequently, early surgical repair is advocated for physically active individuals. A variety of surgical approaches and fixation devices are currently used for distal biceps repair. The single-incision cortical button repair for distal biceps avulsions has become popular since Bain introduced the technique in 2000. The advantage of the cortical button biceps repair technique is the significantly higher failure strength than either the 2-incision technique or the suture anchor repair. The initial repair strength of the cortical button technique allows immediate active elbow range of motion and accelerated rehabilitation. Additionally, the single-incision anterior approach is less invasive than the 2-incision biceps repair and results in a lower incidence of heterotopic ossification. One disadvantage of this approach, however, is the risk of injury to the posterior interosseous nerve. The authors report a case in which the posterior interosseous nerve was incarcerated between the cortical button and the radius during acute distal biceps repair, resulting in complete posterior interosseus nerve palsy. This case report details the surgery leading to the nerve palsy and the subsequent nerve exploration that identified the cause of the nerve palsy. Recommendations are made on how to avoid this complication during distal biceps tendon repairs.

The biceps tendon: from proximal to distal: AAOS exhibit selection.

Ding, David Y. MD1; Garofolo, Garret BS1; Lowe, Dylan MD1; Strauss, Eric J. MD1; Jazrawi, Laith M. MD1 Author Information

Low incidence of tendon rerupture after distal biceps repair by cortical button and interference screw

The use of cortical suspensory fixation in conjunction with an interference screw to treat distal biceps ruptures has yielded favorable results. However, literature examining the incidence of fixation failure in a large consecutive series of patients treated with this technique is lacking. A retrospective review of electronic medical records identified 170 distal biceps ruptures in 168 consecutive patients (164 men and 4 women) treated using a cortical button in conjunction with an interference screw. The study group was an average age of 48 years (range, 20-71 years). Records were reviewed from the time of the initial clinic visit to the most recent follow-up. Early failures were defined as those that occurred within 12 weeks of the index procedure. Failed repair was defined as tendon defect, deformity, or significant weakness in supination. The early incidence of failure was 1.2%, with 2 of the fixations meeting the criteria for failure. One patient had significant brachial artery thrombosis. Other complications included posterior interosseous nerve palsy, lateral antebrachial cutaneous nerve-related complication, and numbness about the radial nerve. The use of a cortical suspensory fixation device in conjunction with an interference screw is an effective method of repairing a distal biceps rupture, with a low early rate of failure.

Complications from a Distal Bicep Repair: A Meta-Analysis of a Single Incision Versus Double Incision Surgical Technique

Objectives:Anatomical reinsertion of the distal biceps is critical for restoring elbow flexion and forearm supination strength. Surgical techniques utilizing one and two incisions have been reported in the literature, describing complications and outcomes. However, which technique is associated with a lower complication rate remains unclear.Methods:A systematic review was conducted using the PubMed, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), SPORTSDiscus, and the Cochrane Central Register of Controlled Trials database to identify articles reporting distal biceps ruptures through August 2013. We included English language publications based on adult patients with a minimum of three cases. Both single and dual incision technique studies were incorporated. The demographic and outcome data of all studies was retrieved and pooled. A Meta-analysis on the pooled data was then conducted to determine the role of surgical technique on different complications. This was adjusted for age, gender and other independent variables.Results:Fifty-five articles met the inclusion criteria. The complication rate in the single incision group was 28.3% (222/785) versus 20.9% (104/498) in the double incision group. Neuropraxia was the most common complication in the single incision group at 9.8% (77/785), while heterotopic ossification was the most common in double incision cases at 7% (35/498). Re-rupture and failed reattachment occurred in 2.5% of single incision cases, versus 0.6% of double-incision cases (p < 0.034). Posterior interosseous nerve (PIN) palsy occurred in 2.7 % (13/785) of single incision procedures versus 0.2% (1/498) in the double incision group (p< 0.001). When combining heterotopic ossification and synostosis rates, the double incision group demonstrated complications in 9.8% of cases versus 3.2% for single incision cases.Conclusion:Surgical intervention for distal biceps ruptures may help restore function to an active individual; however, this procedure is not without risk of complications. The single incision technique has a higher rate of failed re-attachment and re-rupture compared to the double incision technique. The single incision technique also has a higher rate of overall nerve palsy (PIN, LABC, and Radial Nerve) compared to the double incision technique. The double incision technique does have higher rates of HO compared to the single incision. These complications are important for surgeons to consider and disclose to patients deciding on operative repair.

Repair and Rehabilitation of Distal Biceps Ruptures

Etiology: Distal biceps tendon ruptures, which account for approximately 10% of all biceps ruptures, typically occur after a sudden, unexpected extension force to the flexed arm. Most injuries are complete ruptures, with the tendon avulsing from the radial tuberosity. Tearing of the bicipital aponeurosis may or may not occur. Patients are usually men between the ages of 30 and 60 years; complete rupture has been reported in a woman in only one instance. Although most patients are asymptomatic before rupture, it is thought that preexisting chronic degeneration plays a role in most, if not all, injuries. Mechanical impingement (decreased radioulnar distance resulting in less space available for the tendon) is also cited as a potential cause. More than 4 in 5 injuries occur in the dominant arm, and ruptures are 7.5 times more likely in smoker. Treatment and Repair Techniques: Surgical reinsertion of the biceps tendon to the radial tuberosity is considered the treatment of choice for most complete ruptures (and for partial tears that have failed nonoperative management). Nonoperative management is typically considered only for elderly, low-demand patients, or for those too ill to consider surgical intervention. Patients who choose nonoperative treatment typically lose 20% to 30% of arm flexion and 30% to 50% of supination strength and may suffer chronic activity-related arm and forearm pain. Recently, however, some authors have questioned the severity of disability associated with nonoperative management. Outcomes: In general, most studies describe excellent clinical outcomes irrespective of fixation method. Two-incision techniques may result in slightly greater flexion strength and may better restore supination strength, by virtue of positioning the repair more posteriorly, in a more anatomic position, on the tuberosity than the one-incision methods. Rehabilitation: With improvement in surgical techniques, and greater knowledge of pull out and failure complications, current rehabilitation progressions have advanced. As mentioned, the native distal bicep tendon has a strength of 200 to 225 N. The present literature suggests that surgical fixation with the Endobutton technique has a failure load of 259±28 N, obviously higher than the natural attachment. However, there should always be caution with any aggressive protocol, and communication with the physician is imperative. Particularly with a distal biceps repair, it will be very important to know the level of tendon retraction, tissue quality, and security of fixation that the surgeon was able to achieve. With this knowledge, the rehabilitation may move slower, or more quickly, but the most important factor in progression of this patient population postoperatively is the achievement of clinical milestones. Protocols are a good guideline for rehabilitation but should rarely be used as an exact recipe. The rehabilitation after repair of the distal biceps tendon has undergone evolution, but basic principles still hold true. Progression can be guided by a protocol but should be largely based on communication between physician and rehabilitation specialist. As with any surgery, parameters and outcomes may vary based on the severity of the injury and the ability of the surgeon to achieve ideal fixation. No 2 surgeries are exactly alike, but safe rehabilitation guidelines can be established for any patient with the right attention to detail.

Repair of distal biceps tendon acute ruptures with two suture anchors and anterior mini-open single incision technique: clinical follow-up and isokinetic evaluation

All the techniques described in literature for treatment of acute distal biceps tendon ruptures provide good functional outcomes. The purpose of this study is to report the results of a single limited-incision technique for repair of acute distal biceps ruptures using two suture anchors. Fourteen patients, all man, were treated consecutively from one author between January 2009 and December 2011 and evaluated at a mean follow-up of 26months. All patients were evaluated clinically, through DASH and MEPS score questionnaires, and with isokinetic biomechanical tests. All patients achieved complete elbow flexion and extension. Deficit for supination of the forearm was found in only two patients (7° and 13°). Mean DASH score was 4.7 points, and mean MEPS was excellent (96.8 points). There was no nervous complication involving posterior interosseous nerve (PIN) and no case of failure of the sutures. The isokinetic evaluation detected an average flexion strength increase by 10.2% compared to the opposite arm not operated. Our study shows that mini-open access and fixation with two suture anchors achieved in medium-term excellent functional and cosmetic results needed short rehabilitation times and is minimally invasive.

Factors affecting supination strength after a distal biceps rupture

This study quantified pain (visual analog pain scale [VAPS]), disability (Disabilities of the Arm, Shoulder and Hand [DASH]) and isometric supination torque at 3 forearm positions in a prospective cohort of biceps-deficient arms to assess the potential for functional return with nonoperative treatment. Twenty-three men (50 ± 11 years) with complete unilateral distal biceps avulsion underwent isometric supination strength testing of both limbs at 60° of supination, 0° (neutral), and 60° of pronation. After exclusion of 1 outlier patient, the mean time from injury to evaluation was 44 days (range, 4-455 days). Pain level (VAPS) and functional outcome (DASH) were assessed; supination strength was normalized to the uninjured arm. The uninjured arm was stronger (P < .001), and peak torque varied with forearm position (P < .043). Peak torque was greater in pronation compared with supination, regardless of injury (P < .002). No differences were detected in supination strength as a result of forearm position or arm dominance. Supination strength did not correlate with time from injury to evaluation. One patient regained supination strength (115%) at 60° of pronation and 72% in neutral with a lengthy time from injury. VAPS (5 of 10) and DASH (39 of 100) scores decreased with time and did not relate to supination strength. Biceps tendon rupture led to a 60% decrease in supination strength in the neutrally oriented forearm. Peak torque observations can be explained using forearm moment arms. VAPS and DASH scores decreased with time but did not affect strength. We speculate that supination strength from pronation to neutral can improve as one strengthens the brachioradialis but strength deficits from neutral to supination are more difficult to overcome.

Rotura del Bíceps Distal. Evaluación de resultados con técnica de doble fijación

&lt;div class="page" title="Page 1"&gt;&lt;div class="layoutArea"&gt;&lt;div class="column"&gt;&lt;p&gt;&lt;strong&gt;In­tro­duc­ción: &lt;/strong&gt;&lt;span&gt;La rotura del bíceps distal es una lesión poco frecuente producida por la aplicación de una fuerza excéntrica sobre el codo flexionado. El objetivo de este trabajo es analizar los resultados obtenidos para la reinserción del bíceps distal mediante técnica de doble fijación con botón de anclaje cortical y tornillo interferencial de biotenodesis a través de una incisión anterior única. &lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materiales­ y­ Métodos: &lt;/strong&gt;&lt;span&gt;Entre agosto de 2008 y febrero de 2013, registramos 19 casos de rotura del bíceps distal tratados quirúrgicamente por vía anterior limitada. Los 17 últimos casos consecutivos fueron tratados con doble fijación utilizando botón extracortical y tornillo de biotenodesis, y forman parte del estudio. Todos eran hombres, con una mediana de la edad de 41 años (rango 27-59). Los pacientes fueron evaluados con el Cuestionario DASH y el Puntaje Subjetivo/Objetivo de Andrews y Carson, y la fuerza de flexión y supinación se controló con la escala del British Medical Research Council modificada por Mackinnon y Dellon (M0-M5).&lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Resultados: &lt;/strong&gt;&lt;span&gt;El cuestionario DASH arrojó un valor mediano de 1,7 (0-5,83) y el de Andrews y Carson, de 195 (170-200) para el total; con 15 resultados excelentes y 2 buenos. Todos consiguieron una fuerza M5 para flexión y supinación de antebrazo. El seguimiento tuvo una mediana de 12 meses (4-32). En dos pacientes, se registraron complicaciones, ambas con recuperación ad íntegrum. &lt;/span&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusión: &lt;/strong&gt;&lt;span&gt;La técnica descrita ha demostrado ser confiable y eficaz, y permitió lograr resultados satisfactorios y una baja tasa de complicaciones.&lt;/span&gt;&lt;/p&gt;&lt;div class="page" title="Page 1"&gt;&lt;div class="layoutArea"&gt;&lt;div class="column"&gt;&lt;p&gt; &lt;/p&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;&lt;/div&gt;

Factors Affecting Supination Strength Following a Distal Biceps Rupture

Advocates for the non-operative treatment of distal biceps ruptures emphasize the limited functional loss.1,2 Isometric supination loss of 26%-40% has been reported in a neutral forearm testing position.2,3 The amount of strength loss in other forearm positions, i.e. pronation and/or supination, has not been published to date. Biomechanical studies have demonstrated that the native biceps moment arm, the ability of the biceps to generate a torque, changes significantly with forearm position.4-7

Factors Affecting Supination Strength Following a Distal Biceps Rupture

14 FACTORS AFFECTING SUPINATION STRENGTH FOLLOWING A DISTAL BICEPS RUPTURE Christopher C. Schmidt, MD, Brandon Brown, Prasad J. Sawardeker, MD, Martin deGravelle, Mark C. Miller, PhD, Allegheny General Hospital, Pittsburgh and the University of Pittsburgh, Pittsburgh, Pennsylvania, USA Introduction:Advocates for the non-operative treatment of distal biceps ruptures emphasize the limited functional loss. Isometric supination loss of 26%-40% has been reported in a neutral forearm testing position. The amount of strength loss in other forearm positions, i.e. pronation and/or supination, has not been published to date. Biomechanical studies have demonstrated that the native biceps moment arm, the ability of the biceps to generate a torque, changes significantly with forearm position. The purpose of this study is to quantify the effects of a complete distal biceps rupture compared to the uninjured limb in 60 of supination, (0 ) neutral and 60 of pronation. We hypothesize that supination strength loss will be significant, vary with forearm position, and be independent of arm dominance. Furthermore, strength will positively correlate with time from injury and negatively correlate with high perception of pain and low reported disability. Methods: Twentythree consecutive adult males with an average age of 50 6 11 years suffered a complete distal biceps avulsion. There were 12 dominant and 11 non-dominant arm injuries. The patients underwent prospective isometric supination strength testing using a custom-made torque-measuring device and a previously published protocol. The average time of injury to evaluation was 518 days (median of 24), ranging from 4 days to 30 years. Peak torque was recorded for each arm at three forearm positions: 60 of supination, (0 ) neutral and 60 of pronation. Strength loss was expressed as the ratio of the injured side to the uninjured side. Pain level was assessed using a numeric visual analog pain scale (VAPS), ranging from 0-10. Functional outcomes were measured using the DASH questionnaire. Strength data was compared to arm dominance, test angle, and biceps injury using a 3-way ANOVA, while relationships to strength were analyzed using linear regression (significance set at p1⁄40.05). Results: Peak torque values in the injured arm were statistically less than the uninjured arm (p 0.002), but not in supination (p1⁄40.157). The average VAPS score was 5 6 2 and DASH score was 38 6 21. Strength was not related to VAPS or DASH scores at any test angle (p>0.105). Time from injury and the VAPS score were negatively correlated (p1⁄40.029), while time from injury and DASH were not (p1⁄40.244). Discussion: The study clearly shows that a patient can expect to lose 60% of their supination strength in neutral. The loss of supination strength is independent of forearm position. However, patients were strongest in pronation and weakest in supination with or without an intact distal biceps. This finding maybe due in part to the co-contraction of the brachioradialis muscle; which acts as a supinator of a pronated forearm, and a pronator of a supinated forearm. Surprisingly, perceived disability and pain associated with the injury were not indicative of reduced strength. However the strength improved over time in pronation and neutral, but not in supination. We speculate that supination strength from pronation to neutral can improve as one strengthens the brachioradialis, but that strength deficits from neutral to supination will be more difficult to overcome.

Distal biceps tendon rupture: Current concepts

BackgroundDistal biceps tendon rupture is not a very common injury and the literature remains scarce, mainly limited to case series. While surgical repair has become popular, it is not universally accepted and there are insufficient data regarding patient satisfaction following repair. The purpose of this study was to assess the results of anatomical reinsertion according to objective muscle strength testing and patient-reported outcome measures. Patients and methodsTwenty-four patients underwent surgical repair over the last 10 years. All patients underwent clinical assessment using the Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score and Oxford Elbow score. Measurement of range of motion, supination and flexion strength testing was done using a Biodex isokinetic dynamometer. ResultsNinety-five percent of the patients had good or excellent results following surgery as defined by Mayo and Oxford Elbow scores. The average DASH score following surgery was 7.1, nearly the same as the score of 6.2 in the normal population. The mean elbow flexion arc was 134°±10.8 (range, 125–150°; 95% confidence interval (CI) 129.6–137.8) with no flexion contractures in the operated side compared with the unaffected elbow. The range of pronation–supination was also comparable in both sides.The average torque in flexion improved by 19.8% (p=0.25) while supination torque was reduced by 4% (p=0.12) when compared to the uninjured side. There was 8% incidence of persistent neuropraxia of the antebrachial cutaneous nerve of the forearm and 4% incidence of asymptomatic heterotopic ossification. ConclusionSurgical repair of distal biceps ruptures provides consistently good results in terms of patient-scored outcomes. Objective muscle strength testing does not reveal statistical difference between the injured and the opposite side.

Complications Following Distal Biceps Repair

Distal biceps rupture is a relatively uncommon injury. Surgical repair is performed in patients who seek increased flexion and supination strength over that which results from nonoperative treatment. The purpose of this study was to evaluate complications associated with surgical repair of the distal biceps tendon in a large series of patients. We retrospectively reviewed 198 consecutive patients with distal biceps ruptures treated with surgical repair, and evaluated time from injury to repair, surgical technique, and complications. A total of 72 patients (36%) developed complications; 6 patients underwent additional surgery. Minor complications included lateral antebrachial cutaneous nerve paresthesia (26%), radial sensory nerve paresthesia (6%), and superficial infection (2%). Major complications included posterior interosseous nerve injury (4%), symptomatic heterotropic ossification (3%), and re-rupture (2%). Minor complications were common after distal biceps tendon repair; however, most were sensory nerve injuries that resolved with time. Major complications were infrequent, and few patients required revision surgery. Complications were more common after distal biceps tendon repair performed more than 28 days after rupture. Therapeutic IV.

Single Versus Double-Incision Technique for the Repair of Acute Distal Biceps Tendon Ruptures

This clinical trial was done to evaluate outcomes of the single and double-incision techniques for acute distal biceps tendon repair. We hypothesized that there would be fewer complications and less short-term pain and disability in the two-incision group, with no measureable differences in outcome at a minimum of one year postoperatively. Patients with an acute distal biceps rupture were randomized to either a single-incision repair with use of two suture anchors (n = 47) or a double-incision repair with use of transosseous drill holes (n = 44). Patients were followed at three, six, twelve, and twenty-four months postoperatively. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) elbow score. Secondary outcomes included muscle strength, complication rates, and Disabilities of the Arm, Shoulder and Hand (DASH) and Patient-Rated Elbow Evaluation (PREE) scores. All patients were male, with no significant differences in the mean age, percentages of dominant hands affected, or Workers' Compensation cases between groups. There were also no differences in the final outcomes (at two years) between the two groups (p = 0.4 for ASES pain score, p = 0.10 for ASES function score, p = 0.3 for DASH score, and p = 0.4 for PREE score). In addition, there were no differences in isometric extension, pronation, or supination strength at more than one year. A 10% advantage in final isometric flexion strength was seen in the patients treated with the double-incision technique (104% versus 94% in the single-incision group; p = 0.01). There were no differences in the rate of strength recovery. The single-incision technique was associated with more early transient neurapraxias of the lateral antebrachial cutaneous nerve (nineteen of forty-seven versus three of forty-three in the double-incision group, p < 0.001). There were four reruptures, all of which were related to patient noncompliance or reinjury during the early postoperative period and appeared to be unrelated to the fixation technique (p = 0.3). There were no significant differences in outcomes between the single and double-incision distal biceps repair techniques other than a 10% advantage in final flexion strength with the latter. Most complications were minor, with a significantly greater prevalence in the single-incision group.

Elbow arthroscopy in acute injuries

Arthroscopy of the elbow has become a standard treatment option for many indications. The purpose of this article is to review literature concerning the use of arthroscopy for acute elbow injuries. The main medical literature databases were searched for articles on the use of elbow arthroscopy in acute injuries. A total of 13 publications relevant to the topic were included. The Coleman methodology score was used to assess the methods of each article. All published articles have been case reports or retrospective case series. In fracture treatment, arthroscopy has been used in the treatment of displaced radial head, coronoid and capitellum fractures in adults and displaced radial neck and lateral humeral condyle fractures in children with good results. Endoscopic techniques have been used in distal biceps rupture and medial avulsion of the triceps. And also new techniques have been developed for the treatment of intra-articular soft-tissue lesions like rupture of the radial ulnohumeral ligament complex. One of the 13 studies analyzed was considered of good quality, 5 of moderate quality and all others of poor quality with inconsistent methodology and outcomes. The range of treatments using elbow arthroscopy in acute injuries is expanding and brings new controversies and challenges. Single reports of arthroscopically treated bony and soft-tissue injuries of the elbow showed satisfactory results. However, further randomized prospective studies are needed to evaluate their safety and efficacy compared with open 'gold standard' techniques. IV.