Single-incision repair of acute distal biceps ruptures by use of suture anchors

doi:10.1016/j.jse.2006.03.002

Journal of Shoulder and Elbow Surgery

Volume 16, Issue 1, January–February 2007, Pages 78-83

https://doi.org/10.1016/j.jse.2006.03.002 Get rights and content

The purpose of this study is to report the results of a single limited-incision technique for repair of acute distal biceps ruptures by use of suture anchors. Sixty consecutive patients underwent distal biceps repair after an acute rupture between January 1997 and January 2001 by use of a limited antecubital incision and suture anchors. Fifty-three patients could be evaluated at a mean follow-up of 38.1 months. A limited transverse incision was made in the antecubital fossa. The retracted biceps tendon end was identified, retrieved, and lightly debrided. Two suture anchors were placed in the radial tuberosity, and the tendon was reapproximated. Final follow-up consisted of physical examination, radiographs, and Andrews-Carson elbow score tabulations. According to the Andrews-Carson scores, there were 46 excellent and 7 good results. In 2 patients, heterotopic ossification developed that resulted in a mild loss of forearm rotation and mild pain. In 1 patient, a temporary radial nerve palsy developed, which resolved completely within 8 weeks. Repair of acute distal biceps tears via a limited antecubital incision and suture anchors is a safe, effective technique.

Section snippets

Materials and methods

Sixty consecutive patients underwent distal biceps repair after an acute, complete rupture (<6 weeks), by use of a limited antecubital incision and suture anchors, between January 1997 and January 2001. All procedures were carried out via the described technique. A retrospective assessment of these patients was carried out. Requirements for inclusion in the study included a minimum follow-up of 24 months and the presence of a complete rupture of the distal biceps identified at surgery that had

Results

Of the patients, 7 had inadequate follow-up, leaving 53 as the focus of the review. The mean age of the 50 men and 3 women was 46.4 years (range, 28-73 years). No patients had undergone previous elbow surgery. All 53 were re-examined after a minimum of 24 months. The mean follow-up was 38.1 months, with a range of 24 to 61 months.

According to the Andrews-Carson evaluation,³ there were no failures in this group of patients. The Andrews-Carson scores are based on objective and subjective rating

Discussion

Ruptures of the proximal attachment of the biceps tendon represent approximately 95% of all biceps tendon ruptures.⁷ Ruptures of the distal biceps tendon are relatively uncommon. This injury almost always occurs in men who are in their fifth or sixth decade of life, but it can occur at any age.4, 9, 19 The mechanism of injury is usually eccentric loading of the biceps muscle, which can occur as a result of many actions and activities. Most patients in this study, however, reported an incident

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Cited by (85)

Clinical outcomes after refixation of subacute repaired distal biceps tendon ruptures
2022, JSES International
The aim of this study was to evaluate the clinical outcome and complication spectrum after delayed repair surgery of distal biceps tendon ruptures, postulating that satisfactory results are possible contrary to previous literature.
Forty-three of 92 patients with a full workup (= OPT in) undergoing primary distal biceps tendon repair were included in this study. The mean age of participants was 49.5 years (range = 22-66 years). This cohort was divided into two groups: patients undergoing acute repair (<21 days = AR group) and a group with delayed intervention (>21 days = SR group). Beside clinical evaluation, functional scores and detection of heterotopic ossification were documented. Strength of flexion and supination were measured using a BIODEX multipoint system. In addition, thirty-one patients were included only in the evaluation of complications in the absence of consent for clinical examination (= OPT out).
Concerning the OPT-in group, twenty-eight patients (ø age = 48.9 years; 22-63 years) received acute repair after an average of 9.2 ± 3.7 days. On the contrary, 15 patients (ø age = 50.5 years; 32-66 years) were treated with a delay after an average of 31.4 ± 10.4 days. Regarding patient-reported outcome measures, conflicting results emerge (AR/SR: Subjective Elbow Value = 87/80%, P > .05; Mayo score = 96/93 pts, P > .05; the Disabilities of the Arm, Shoulder and Hand score = 6/13 pts, P < .05; and Oxford Elbow Score = 44/39 pts, P < .05). The main complication is the paresthesia of the lateral antebrachial cutaneous nerve, which occurs more in the group of delayed repair (AR: 21.0%, SR 31.8%). Forty-one percentage of patients in the SR group described pain in the elbow with exertion in contrast to 17.3% in the AR group. In terms of elbow strength, no significant difference in the AR or SR group compared with the contralateral side could be observed.
The data suggest that delayed repair of distal biceps ruptures beyond 3 weeks may result in satisfactory clinical outcomes. However, exertional pain and paresthesia of the lateral antebrachial cutaneous nerve may diminish results.
Chronic distal biceps avulsion treated with suture button
2020, Journal of Shoulder and Elbow Surgery
Distal biceps tendon avulsions account for 3%-10% of all biceps ruptures. Treated nonoperatively, these injuries lead to a loss of endurance, supination strength, and flexion strength compared with operative repair or reconstruction. Operative management of chronic injury has classically been with graft tissue to augment the contracted muscle. We present our results for chronic distal biceps avulsions secured with suture button through a single transverse incision in high flexion without the need for allograft augmentation.
This was a retrospective review of 20 patients with 21 injuries who underwent primary surgical repair of chronic distal biceps tendon avulsions at an average of 10 weeks (range 4-42 weeks). All patients were treated with a single transverse incision with a suture button armed with nonabsorbable no. 2 core sutures. Postoperatively patients were found to have 50°-90° flexion contracture. All patients were placed in a simple sling postoperatively with gentle extension to gravity as tolerated immediately and no formal physical therapy. Patients were surveyed regarding pre- and postoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, visual analog scale (VAS) score, Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and overall satisfaction. Range of motion (ROM), flexion, and supination strength compared to the contralateral uninjured extremity were evaluated at final follow-up.
Mean clinical follow-up was 26 months. All patients regained full ROM and 5/5 flexion and supination strength at final follow-up. MEPSs were 100 for all responding patients compared with an average 47.5 preoperatively (P < .0001). The mean postoperative ASES score was 97.2 compared with 41.9 preoperatively (P < .0001). Mean OESs pre- and postoperatively were 24.2 and 48, respectively (P < .0001). The mean VAS score was 4.4 preoperatively and was reported as 0 by all patients at final follow-up (P < .0001). Two patients had transient sensory radial nerve neuropathy, and 1 patient has persistent palsy. No synostoses occurred. Four patients reported supination fatigue postoperatively compared with the uninjured extremity.
Given these results, we feel that chronic distal biceps tendon ruptures can be repaired successfully with a single incision using suture button technique without the use of a graft. Though the flexion contracture is significant postoperatively, all patients regained full ROM and had excellent postoperative functional outcome scores.
Intramedullary Cortical Button Repair for Distal Biceps Tendon Rupture: A Single-Center Experience
2019, Journal of Hand Surgery
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.
Double incision repair technique with immediate mobilization for acute distal biceps tendon ruptures provides good results after 2 years in active patients
2019, Orthopaedics and Traumatology: Surgery and Research
Surgical treatment of distal biceps tendon ruptures is recommended in an active population to avoid loss of strength, especially in supination and flexion.
A 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.
Seventy-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.
Sixteen 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.
A 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.
IV, case series, with no comparison group.
Double incision repair technique with immediate mobilization for acute distal biceps tendon ruptures provides good results after 2 years in active patients
2019, Revue de Chirurgie Orthopedique et Traumatologique
Le traitement chirurgical des ruptures aiguës du tendon du biceps distal est recommandé dans la population active pour éviter la perte de force, en particulier en supination et en flexion du coude.
La technique de double incision avec mobilisation immédiate pour la rupture aiguë du tendon du biceps distal est sûre et fournit de bons résultats après 2 ans chez les patients actifs.
Soixante-quatorze hommes (47 ± 7 ans) avec des ruptures distales aiguës de biceps ont été inclus dans cette étude monocentrique rétrospective. Tous les patients ont été opérés avec la technique de double incision modifiée par Morrey. Le tendon a été réinséré grâce à des sutures transosseuses dans la tubérosité du biceps. Les patients ont été autorisés à effectuer une mobilisation immédiate. Un suivi minimum de deux ans était requis pour l’évaluation clinique et radiologique.
Seize patients ont été perdus de vue. Au total, 58 patients ont été analysés avec un suivi moyen de 53 ± 19 mois. L’échelle d’évaluation de la douleur était de 0,22 ± 0,7. Les résultats moyens d’amplitude de mouvement comprenaient l’extension −1° ± 2°, la flexion 138° ± 6°, la pronation 72° ± 16° et la supination 81° ± 10°. Le rapport de force en flexion était de 94 ± 8 % et en supination de 90,5 ± 12 % par rapport au membre controlatéral. La valeur subjective du coude et le score DASH étaient respectivement de 94 ± 6 % et 7,5 ± 9 %. Tous les patients étaient satisfaits ou très satisfaits et tous, sauf un, sont retournés à leur sport antérieur. Nous avons noté 2 ossifications hétérotopiques et un patient a eu besoin d’une réintervention pour synostose radio-ulnaire. Aucune re-rupture ni lésion nerveuse n’a été observée.
Une technique par double voie d’abord pour la réinsertion du tendon du biceps distal est une procédure peu invasive avec des résultats fiables. La modification par Morrey de la procédure initiale associée à une mobilisation précoce est associée à un faible taux de complications et limite l’apparition de synostoses ou d’ossifications.
IV, série de cas, sans groupe de comparaison.
A comparative clinical and functional assessment of cortical button versus suture anchor in distal biceps brachii tendon repair
2019, Journal of Orthopaedic Science
The studies comparing the fixation methods being used for the ruptured distal biceps brachii tendon reinsertion show similar outcomes of cortical button and suture anchors usage, however, longer follow-up studies remain necessary. The goal of this study was to compare the clinical and functional three-year outcomes of the cortical button in contrast to the suture anchor fixation.
A retrospective cohort study comprised of 28 males on average 3 years after surgical reinsertion of the distal biceps brachii tendon with the use of a cortical button (Group I, n = 11) or a suture anchor (Group II, n = 17). The outcomes assessed were range of elbow joint and forearm motion (ROM), arm circumferences, visual analogue scale (VAS), Mayo Elbow Performance Index (MEPI), Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) and forearm flexor and supinator muscle torques measured under isometric and isokinetic conditions.
The comparison between the two studied groups revealed no statistically significant differences in ROM (p = 0.24–1.00), circumferences (p = 0.15–0.50), VAS (p = 0.71), MEPI (p = 0.23), Quick DASH (p = 0.61) or in the obtained muscle torque values (p = 0.07–1.00). However, differences in supination ROM between the surgical and non-surgical side were found in both groups (p = 0.01–0.02), and differences in pronation (p = 0.02) were found in Group II. The muscle torque values obtained in the surgical, dominant limb were lower than those in the nonsurgical, nondominant limb.
The comprehensive comparison of three-year outcomes of cortical button versus suture anchor fixations did not favour one fixation method over the other, and the results justify the clinical usage of both methods.

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Original articleSingle-incision repair of acute distal biceps ruptures by use of suture anchors

Section snippets

Materials and methods

Results

Discussion

Arthroscopy

Am J Surg

J Hand Surg [Am]

Am J Surg

J Shoulder Elbow Surg

Rupture of the distal insertion of the biceps brachii tendon

Clin Orthop Relat Res

Affections of muscles, tendons, and tendon sheaths

Rupture of the distal tendon of the biceps brachiiOperative versus non-operative treatment

J Bone Joint Surg Am

Repair of avulsed insertion of biceps

J Bone Joint Surg Br

Distal biceps brachii tendon repairAn in vitro biomechanical study of tendon reattachment

Am J Sports Med

Partial rupture of the distal biceps tendon

Clin Orthop Relat Res

Original article
Single-incision repair of acute distal biceps ruptures by use of suture anchors