Elbow
Anatomic repair of the distal biceps tendon cannot be consistently performed through a classic single-incision suture anchor technique

https://doi.org/10.1016/j.jse.2014.06.051Get rights and content

Background

Distal biceps tendon ruptures commonly occur in active men, and surgical repair through a single-incision technique using suture anchors has become common. The current study assessed whether an anatomic repair of the biceps to the radial tuberosity can be consistently achieved through a single-incision technique.

Methods

Acute distal biceps tendon repairs using the single-incision technique were retrospectively reviewed. Computed tomography (CT) scans were obtained to investigate tuberosity dimensions and the position of the suture anchors. An isokinetic dynamometer was used to obtain flexion and supination strength. Disabilities of the Arm, Shoulder and Hand (DASH) scores were collected.

Results

CT scans were performed in 27 patients, of which, 21 underwent strength testing. The suture anchor placement averaged 50° radial to the apex of the tuberosity. Strength testing showed flexion strength of the repaired side was equal (97%-106%) to the normal side. Supination strength (80%-86%) and work (66%-75%) performed were both weaker on the repaired side (66%-75%; P < .05). The average DASH score was 10.7.

Conclusions

Ideal suture anchor placement, in the ulnar aspect of the tuberosity, could not be reliably achieved through this single-incision technique. This could have clinical importance because supination strength was not fully restored in this group of patients.

Section snippets

Patients

A retrospective review of acute distal biceps tendon repairs was performed at our institution during a 3-year period (2007-2010), selecting those patients whose surgical repair was performed by 1 of 3 upper extremity fellowship-trained surgeons. Patient lists were acquired through the surgeons' office records. Inclusion criteria were patients with a complete distal biceps tendon rupture who underwent a biceps repair through a single anterior incision using suture anchors and at least 1 year of

Tuberosity and anchor position

The average radial tuberosity measured 25 mm in length (range, 20-33 mm) and was located 20 mm (range, 14-25 mm) from the central concavity of the radial head. The average distance between suture anchors was 9 mm (range, 6-15 mm). The apex of the radial tuberosity measured 56° degrees (range, 43°-67°) ulnar from the midsagittal axis as calculated from the distal radius. The average angular position of the proximal suture anchors was 50° (range, 8°-97°) radial from the tuberosity apex.

Discussion

The purpose of this study was to analyze suture anchor location in patients who underwent a distal biceps tendon repair using a single-incision technique. We found that suture anchors were consistently placed radial to the apex of the radial tuberosity. In our study of 27 patients, the average placement was 50° radial to the apex.

Forthman et al13 concluded that given the significant ulnar location of the radial tuberosity apex and that the midportion of distal biceps tendon inserted just 3-mm

Conclusion

To our knowledge, this is the first study to critically analyze the postoperative suture anchor position after repair of the distal biceps tendon. It emphasizes the need for maximal intraoperative supination and a focused effort to achieve suture anchor placement on the ulnar portion of the tuberosity. The ability to achieve this can be limited by patient factors such as a muscular build and variability of the biceps tuberosity. Achieving an anatomic repair could be improved by using flexible

Disclaimer

This study was funded through the University of Ottawa, Division of Orthopaedic Surgery Trauma Fund.

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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This study was approved by the Ottawa Hospital Research Ethics Board (Protocol ID: 209665-01H).

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