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Simpson ER, Jawanda H, Patel I, Verma NN, Parvaresh KC. No Clinically Significant Differences in Patient-Reported Outcomes and Range of Motion Between Early and Delayed Mobilization After Primary Distal Biceps Tendon Repair: A Systematic Review and Meta-analysis. Am J Sports Med 2025:3635465251317207. [PMID: 40108749 DOI: 10.1177/03635465251317207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2025]
Abstract
BACKGROUND Currently, there is no uniform rehabilitation program concerning mobilization after a distal biceps tendon repair. A systematic review was conducted to investigate the effect of restrictions within the immediate postoperative period to evaluate clinical outcomes relative to mobilization after surgical repair of complete distal biceps tendon tears. HYPOTHESIS Early mobilization will not have a significant difference on outcomes compared with delayed mobilization. STUDY DESIGN Meta-analysis; Level of evidence, 3. METHODS The authors performed a systematic review in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines of studies reporting outcomes of the distal biceps tendon repair. The early mobilization cohort included studies with no restrictions beyond 2 weeks after surgery, and the delayed mobilization cohort included studies with continued restrictions beyond 2 weeks after surgery. RESULTS A total of 26 studies with 1114 patients (643 in the delayed mobilization cohort and 471 in the early mobilization cohort) met the inclusion criteria, with a weighted mean patient age of 45.14 years (range, 18-76 years) and a mean follow-up of 27.9 months (range, 3-120 months). Meta-analysis at the 24-month follow-up found that range of motion (ROM) was not significantly different across early and delayed mobilization cohorts for flexion (mean, 137.38° vs 140.42°; P = .34) and extension (mean, 3.23° vs 1.5°; P = .91). Early mobilization was found to be significantly associated with less pronation (mean, 75.68° vs 83.18°; P = .0019) and supination (mean, 76.38° vs 83.93°; P = .0049). Analysis of patient-reported outcomes (PROs) found that Disabilities of the Arm, Shoulder and Hand scores (mean, 3.93 vs 4.21; P = .77) and Mayo Elbow Performance Score values (mean, 96.33 vs 97.11;P = .65) were not significantly different across cohorts. Failure analysis found a significant difference when comparing proportion (mean, 0.0006 vs 0.0185; P = .0029) but no difference when comparing incidence rate (mean, 0.0001 vs 0.0001; P = .647). Complication analysis found no statistical difference in proportion (mean, 0.2181 vs 0.1918; P = .7388) or incidence rate (mean, 0.0012 vs 0.008; P = .344). CONCLUSION These results suggest there may be no clinically significant difference in failure rates, complications, ROM, or PROs for early versus delayed mobilization after primary distal biceps tendon repair.
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Affiliation(s)
| | - Harkirat Jawanda
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ishani Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Fisher BT, Chong ACM, Feltz KP, Berglund HT, Hurd JL. Outcomes of utilizing double-incision technique with combination of cortical button and interference screw fixation for distal biceps rupture: A case series. Shoulder Elbow 2025:17585732241312212. [PMID: 39866906 PMCID: PMC11755422 DOI: 10.1177/17585732241312212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 12/18/2024] [Accepted: 12/18/2024] [Indexed: 01/28/2025]
Abstract
Background Distal biceps tendon rupture is an injury that causes a significant reduction in strength and endurance. Combined cortical button and interference screw fixation has been utilized via single-incision technique. There are limited data describing this technique utilizing a double-incision approach. This study describes patient outcomes for primary distal biceps repair with combined cortical button and interference screw fixation via double-incision approach. Methods This is a case series analysis of patients within a single Midwest institution between January 2006 and February 2020. We examined patient demographics, intraoperative efficiency variables, patient outcomes, and postoperative complications. Results Sixty-two cases were included (62 males; 44 acute complete ruptures, 1 acute partial rupture, 8 chronic complete ruptures, 9 chronic partial ruptures). Average operative time was 48 ± 23 min. Nonformal manner postoperative range of motion (ROM) results show 89%-92% within satisfactory elbow ROM parameters. There were two reported postoperative complications, but no instances of neurapraxia, wound dehiscence, synostosis, proximal radius fracture, or fixation failure. Conclusion The findings of this study demonstrate that the described technique is safe, reliable, and effective. This will help surgeons determine the best method of fixation and approach with the goal of minimizing postoperative complications in patients with distal biceps ruptures.
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Affiliation(s)
- Brandon T Fisher
- Department of Sanford Medical Education, Sanford Health, Fargo, ND, USA
- School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, USA
| | - Alexander CM Chong
- Department of Sanford Medical Education, Sanford Health, Fargo, ND, USA
- School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, USA
| | - Kevin P Feltz
- Department of Sanford Medical Education, Sanford Health, Fargo, ND, USA
- School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, USA
| | - Howard T Berglund
- Department of Sanford Medical Education, Sanford Health, Fargo, ND, USA
- School of Medicine & Health Sciences, University of North Dakota, Grand Forks, ND, USA
| | - Jason L Hurd
- Department of Shoulder & Elbow, Orthopedic Institute, Sioux Falls, SD, USA
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Boufadel P, Daher M, Lopez R, Fares MY, Lawand J, Khan AZ, Abboud JA. Return to Sport After Distal Biceps Tendon Repair: A Systematic Review. Am J Sports Med 2025:3635465241295618. [PMID: 39836380 DOI: 10.1177/03635465241295618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2025]
Abstract
BACKGROUND Ruptures of the distal biceps tendon (DBT) can affect the range of motion and strength of the elbow, raising concerns for patients seeking to restore normal function and engage in their regular activities, particularly returning to previous levels of sport participation. PURPOSE To characterize and assess the rate and timing of return to sport (RTS) after DBT repair. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS PubMed, Embase, and Google Scholar (pages 1-20) were searched from database inception to December 6, 2023 for clinical studies reporting RTS outcomes after DBT repair. The extracted data consisted of patient characteristics; information on the incision approach, fixation method, and rehabilitation protocol; and outcome data including RTS rates, patient-reported outcome measure scores, and complications. RESULTS A total of 42 studies, including 1093 patients (1100 elbows), met the inclusion criteria. The mean age of patients was 44.9 years, and 99.2% of patients were male. The mean follow-up time was 31.5 months. Ruptures were acute in 87.6% of cases, the dominant arm was injured in 64.9%, and the cause of the injury was sport related in 43.5%. The overall RTS rate was 91.5%, with 85.2% of patients returning to preinjury levels or higher, at a mean time of 6.3 months. Patients had excellent functional outcomes, irrespective of the incision approach or fixation method, although trends associated with a higher RTS rate were observed with bone tunnel fixation, ≤2 weeks of postoperative immobilization, early initiation of active range of motion postoperatively, and initiation of strengthening at ≤10 weeks. Single-incision repair had higher rates of nerve-related complications and reruptures compared with double-incision repair, and cortical button fixation had a higher rate of nerve-related complications among the fixation methods. CONCLUSION There was a high rate of RTS after DBT repair at 6 months postoperatively. A positive trend for RTS was observed with respect to rehabilitation protocols favoring earlier active mobility.
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Affiliation(s)
- Peter Boufadel
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Mohammad Daher
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Ryan Lopez
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Mohamad Y Fares
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Jad Lawand
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Adam Z Khan
- Southern California Permanente Medical Group, Panorama City, California, USA
| | - Joseph A Abboud
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
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Clark DS, Moore BP, Somerson JS. Sensory neurapraxia after distal biceps repair is not associated with patient-reported outcomes or satisfaction: a retrospective cohort study. J Shoulder Elbow Surg 2024; 33:2695-2701. [PMID: 39121947 DOI: 10.1016/j.jse.2024.05.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/24/2024] [Accepted: 05/31/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Cutaneous neurapraxia is the most common complication following distal biceps tendon repair (DBTR). Currently, no patient demographic factors have been implicated in its occurrence, course, or resolution. The purpose of this study is to explore various patient demographics and their association with postoperative neurapraxia. Further it investigates how mental health scores correlate with patient-reported outcomes, and whether occurrence of neurapraxia alters this association. METHODS This retrospective review evaluates a consecutive series of patients who underwent distal biceps repair with a single-incision cortical button technique. Patients with reported outcome data at a minimum of 1 year (n = 47) were included for analysis. Demographic data including age, sex, body mass index, diabetes, smoking status, and occurrence of neurapraxia were recorded. Patient-reported outcome measures include the American Shoulder and Elbow Surgeons-Elbow score, Single Assessment Numeric Evaluation score, Visual Analog Scale for pain, Disabilities of the Arm, Shoulder, and Hand Score, and Veterans RAND 12 (VR-12) Mental Component Score and Physical Component Score quality-of-life assessment. RESULTS Postoperative neurapraxia of any duration occurred in 45% (21/47) of patients in this cohort following DBTR. Of these, 62% (13/21) reported resolution of symptoms by the latest follow-up. Mean time to resolution of neurapraxia was 148 days. Patient age, body mass index, smoking history, time to surgery, tear thickness, and increasing surgeon experience across the study period were not significantly associated with the incidence or time to resolution of postoperative neurapraxia. Scores for patient satisfaction, Visual Analog Scale, American Shoulder and Elbow Surgeons, Disabilities of the Arm, Shoulder, and Hand Score, Single Assessment Numeric Evaluation, VR-12 Mental Component Score, VR-12 Physical Component Score, and flexion ROM did not differ significantly between patients with and without postoperative neurapraxia. CONCLUSION Patient satisfaction following DBTR was not significantly associated with postoperative neurapraxia. Patient and surgical characteristics did not influence the occurrence or time to resolution of neurapraxia. The occurrence of postoperative neurapraxia did not result in significant functional limitations.
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Affiliation(s)
- David S Clark
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA.
| | - Brady P Moore
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA
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Hochreiter B, Eckers F, Calek AK, Cassidy JT, Amaranath JE, Leung M, Ek ET. Distal biceps tendon repair using a double intracortical button anatomic footprint repair technique. J Shoulder Elbow Surg 2024; 33:2243-2251. [PMID: 38688419 DOI: 10.1016/j.jse.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Distal biceps tendon repair is usually performed via a double-incision or single-incision bicortical drilling technique. However, these techniques are associated with specific complications and usually do not allow for anatomic footprint restoration. It was the aim of this study to report the clinical results of a double intracortical button anatomic footprint repair technique for distal biceps tendon tears. We hypothesized that this technique would result in supination strength comparable to the uninjured side with a low rerupture rate and minimal bony or neurologic complications. MATERIAL AND METHODS This was a retrospective, single-surgeon cohort study of a consecutive series of 22 patients with a mean (standard deviation) age of 50.7 (9.4) years and at least 1-year follow-up after distal biceps tendon repair. At final follow-up, complications, range of motion (ROM), the Patient-rated Elbow Evaluation (PREE), Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, visual analog scale (VAS) for pain, patient satisfaction, and supination strength in neutral as well as 60° of supination were analyzed. Radiographic evaluation was performed on a computed tomography scan. RESULTS One patient (4.5%) experienced slight paresthesia in the area of the lateral antebrachial cutaneous nerve. Heterotopic ossification was seen in 1 patient (4.5%). All patients recovered full ROM except for 1 who had 10° of loss of flexion and extension. Median PREE score was 4.6 (0-39.6), median MEP was 100 (70-100), and median DASH score was 1.4 (0-16.7). All but 1 patient were very satisfied with the outcome. The affected arm had a mean of 98% (±13%) of neutral supination strength (P = .633) and 94% (±12%) of supination strength in 60° (P = .054) compared with the contralateral, unaffected side. There were 4 cases (18.2%) of cortical thinning due to at least 1 button and 1 case of button pullout (4.5%). CONCLUSIONS The double intracortical button anatomic footprint repair technique seems to provide reliable restoration of supination strength and excellent patient satisfaction while minimizing complications, particularly nerve damage and heterotopic ossification.
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Affiliation(s)
- Bettina Hochreiter
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC, Australia; Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Franziska Eckers
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC, Australia; Department of Orthopedics, University Hospital Basel, Basel, Switzerland
| | - Anna-Katharina Calek
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC, Australia; Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | | | - Megan Leung
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC, Australia; Department of Surgery, Monash University, Melbourne, VIC, Australia
| | - Eugene T Ek
- Melbourne Orthopaedic Group, Windsor, Melbourne, VIC, Australia; Department of Surgery, Monash University, Melbourne, VIC, Australia
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Tagliero AJ, Till SE, Pan X, Reinholz AK, Johnson AC, Sanchez-Sotelo J, Barlow JD, Camp CL. Long-term Outcomes of Complete Tears of the Distal Biceps Tendon: An Analysis of Surgical Management at a Median Follow-up of 14.7 Years. Orthop J Sports Med 2024; 12:23259671241283787. [PMID: 39421041 PMCID: PMC11483819 DOI: 10.1177/23259671241283787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 10/19/2024] Open
Abstract
Background Surgical repair of full thickness biceps tears has demonstrated adequate outcomes in short and mid-term studies. However, data on the long-term outcomes of full thickness distal biceps injuries and their treatment are currently lacking. Purpose/Hypothesis The purpose of this study was to report on patient demographics, injury characteristics, and long-term outcomes for patients with full-thickness distal biceps tears. It was hypothesized that complete distal biceps tears managed operatively would demonstrate robust clinical success at long-term follow-up. Study Design Case series; Level of evidence, 4. Methods Patients with magnetic resonance imaging-confirmed, complete distal biceps tendon rupture sustained between 1996 and 2016 were identified. Patients were cross-referenced with a regional geographic database. Results A total of 66 patients (3 female, 63 male) with a median age of 50.8 years (IQR, 41.5-60.4) and a median clinical follow-up of 14.7 years (IQR, 9.6-17.9 years) were included. Patients who sustained a full-thickness distal biceps tendon tear were likely to be in their early 50s, male, right-hand dominant, current/former smokers, and laborers with a history of traumatic injury during an intentional movement. Most of these patients had pain and supination weakness but no loss of range of motion. All included tears were treated operatively. At final follow-up, patients maintained a majority of near-normal range of motion (median total arc of flexion/extension 140° and supination/pronation 80°), excellent elbow flexion strength (91% of patients had full strength), and adequate elbow supination strength (76% of patients had full strength). The overall complication rate was 24%, with 16 out of 66 patients experiencing some type of complication between infection, rerupture, heterotopic ossification, reoperation, and nerve complications. Overall return to work was 98%, and 85% of those who returned to work did so without restrictions. Conclusion Complete tears of the distal biceps were most common in patients 50 years of age, male sex, right-hand dominant, and current/former smokers. The most common profession was laborer, and injuries were primarily traumatic in nature during intentional activity. Patients managed operatively demonstrated high rates of success at long-term follow-up with respect to elbow function and clinical outcomes.
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Affiliation(s)
- Adam J. Tagliero
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara E. Till
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Xuankang Pan
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anna K. Reinholz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam C. Johnson
- Department of Musculoskeletal Radiology, Mayo Clinic, Rochester Minnesota, USA
| | | | - Jonathan D. Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Prada C, Li Z, Sritharan P, Khan M, Marcano-Fernández F, Al Mana L, Alolabi B. Distal biceps tendon injuries treatment: A survey of orthopaedic surgeons' current practice and preferences. Shoulder Elbow 2024; 16:646-653. [PMID: 39650265 PMCID: PMC11622323 DOI: 10.1177/17585732231215504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 12/11/2024]
Abstract
Purpose Distal biceps tendon (DBT) injuries are relatively uncommon. Controversies exist regarding the best approach, leading to variations in treatment. This study aims to understand the preferences and practices of orthopedic surgeons regarding management of DBT injuries, as well as assess the feasibility of a future pilot randomized controlled trial (RCT) to evaluate the impact of various surgical factors on patient outcomes. Methods A cross-sectional international survey was conducted amongst surgeons treating patients with DBT injuries. The survey included questions about treatment preferences, surgical techniques, case volumes, and interest in participating in a future RCT. Results Responses from 491 orthopedic surgeons from 26 countries/territories were obtained. Most surgeons had limited exposure to DBT ruptures. Variations were observed in the work-up process, with some relying solely on clinical examinations while others used diagnostic imaging. A single incision approach was the most common surgical technique, and tendon fixation with suspensory cortical buttons was frequently preferred. Most surgeons did not explore or repair the bicipital aponeurosis. Interest in participating in a future RCT varied for different surgical controversies. Conclusion This survey provides valuable insights into surgeons' preferences and practices for DBT injury management. The study highlights the need for standardization in the work-up process and the use of evidence-based guidelines. Current practices may be influenced by factors such as training, implant availability, and costs. The survey also identified surgeons and centers interested in collaboration for future multicenter trials, allowing for equitable access to surgical collaboration opportunities and addressing the lack of evidence in DBT rupture treatment. Level of Evidence Level V, expert-opinion.
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Affiliation(s)
- Carlos Prada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Zhi Li
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Praveen Sritharan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Latifah Al Mana
- Division of Orthopaedic Surgery, Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Ford BT, Caputo AE. Painful Entrapment of the Lateral Antebrachial Cutaneous Nerve After Distal Biceps Repair: A Case Report. JBJS Case Connect 2024; 14:01709767-202409000-00045. [PMID: 39241097 DOI: 10.2106/jbjs.cc.24.00165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2024]
Abstract
CASE A 46-year-old man presented with continued pain after distal biceps repair. On revision surgery, he was found to have entrapment of the lateral antebrachial cutaneous nerve (LABCN). After nerve transection, relocation to its native course, and subsequent repair, the patient experienced complete resolution of his preoperative symptomatology. CONCLUSION To the author's knowledge, the current study is the first to describe symptomatic entrapment of the LABCN after distal biceps repair with a satisfying outcome after nerve transection, relocation, and repair.
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Affiliation(s)
- Brian T Ford
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut
| | - Andrew E Caputo
- Orthopedic Associates of Hartford, Farmington, Connecticut
- Bone and Joint Institute, Hartford, CT
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Worden JA, Gabig AM, Cooke HL, Gottschalk MB, Wagner ER. The Top 100 Classical and Contemporary Papers on Elbow Surgery: A Trend Analysis of Elbow Surgery Literature. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202403000-00002. [PMID: 38421605 PMCID: PMC10906574 DOI: 10.5435/jaaosglobal-d-23-00287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Bibliometric analyses provide an aggregate of the most frequently cited literature in a given field. The purpose of this study was to analyze the top 100 most-cited classical and contemporary papers relating to elbow surgery to serve as a reference for surgeons and trainees for educational and research purposes. METHODS A search was conducted for all papers containing the term "elbow" in the categories Orthopedics, Surgery, and Sports Science in the Clarivate Web of Science. Classical papers were those published from 1980 to 2009, and contemporary papers were those published from 2010 to 2019. Articles were assessed by country of origin, authors and their credentials, parent journal, level of evidence, and topic. RESULTS Citation frequency ranged from 86 to 867. Among the classical group, there were more level IV papers compared with level I papers; however, the opposite was true in the contemporary group. The most common topic in the classical group was elbow anatomy and function, and the most common topic in the contemporary group was lateral epicondylitis and medial epicondylitis and associated therapies. DISCUSSION This bibliometric analysis serves to help guide surgeons and trainees on the highly cited articles and important topics in elbow surgery, demonstrating a shift to prospective randomized controlled trials in recent years. LEVEL OF EVIDENCE Level V (Systematic Review with Level V as Lowest LOE).
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Affiliation(s)
- Jacob A. Worden
- From the Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA (Mr. Worden), and the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Gabig, Ms. Cooke, Dr. Gottschalk, and Dr. Wagner)
| | - Andrew M. Gabig
- From the Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA (Mr. Worden), and the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Gabig, Ms. Cooke, Dr. Gottschalk, and Dr. Wagner)
| | - Hayden L. Cooke
- From the Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA (Mr. Worden), and the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Gabig, Ms. Cooke, Dr. Gottschalk, and Dr. Wagner)
| | - Michael B. Gottschalk
- From the Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA (Mr. Worden), and the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Gabig, Ms. Cooke, Dr. Gottschalk, and Dr. Wagner)
| | - Eric R. Wagner
- From the Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, GA (Mr. Worden), and the Department of Orthopaedic Surgery, Emory University, Atlanta, GA (Dr. Gabig, Ms. Cooke, Dr. Gottschalk, and Dr. Wagner)
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Jain S, Patkar H, Mohan R. Is the Complication Rate in the Surgical Repair of the Distal Biceps Tendon Rupture Influenced by the Timing, Type of Incision and Method of Fixation? Indian J Orthop 2024; 58:79-88. [PMID: 38161394 PMCID: PMC10754795 DOI: 10.1007/s43465-023-01057-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/12/2023] [Indexed: 01/03/2024]
Abstract
Background Distal biceps tears are uncommon injuries, typically leading to significant loss of elbow flexion and supination strength; surgical repairs restore muscular strength and endurance. The aim of this study was to compare the complication rate of early (< 21 days) vs delayed (> 21 days) repair and the effect of types of incision and fixation methods used in the repair. Methods A total of 86 cases were retrospectively reviewed, and 66 cases were included in the study after exclusion. Different preoperative and intraoperative variables and postoperative outcome measures were recorded. We analysed the effects of early and delayed repair, types of incision and fixation methods on the complications. Results 31 had an early, and 35 had delayed distal biceps repair. The mean follow-up was 14.92 weeks. 13.6% had major, and 40.9% had minor complications. No significant difference was noted in complications between the two groups (54.8% vs 54.3%). Higher complications were observed when surgery was done using a single anterior incision compared to 2 anterior incisions (68.8% vs 16.7%, p=0.0002). Overall, higher (76.3% vs 25.9%, p=0.0001) complications were noted in patients where fixation was done using a cortical button & interference screw in comparison to the cortical button alone. Conclusion No significant difference in complication was noted between early and delayed repair. However, more complications were noted in the single anterior incision compared to the two anterior incision technique. Higher complications were also observed with the cortical button and interference screw fixation method compared to the cortical button alone.
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Affiliation(s)
- Sanjay Jain
- Department of Trauma and Orthopaedics, North Manchester General Hospital, Delaunays Road, Manchester, M8 5RB UK
| | - Harshal Patkar
- Department of Trauma and Orthopaedics, Cumberland Infirmary, Newton Road, Carlisle, CA2 7HY Cumbria UK
| | - Rama Mohan
- Department of Trauma and Orthopaedics, North Manchester General Hospital, Delaunays Road, Manchester, M8 5RB UK
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Geuskens W, Caekebeke P, VAN Riet R. Prevalence and clinical implications of heterotopic ossification after distal biceps tendon repair. Acta Orthop Belg 2023; 89:695-700. [PMID: 38205763 DOI: 10.52628/89.4.12447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Complete distal biceps tendon ruptures are relatively uncommon. Conservative treatment may result in persistent pain and weakness. Therefore, surgical repair is usually indicated in order to restore strength. Different surgical techniques and fixation methods have been described. The most reported complications after surgery are iatrogenic nerve damage, heterotopic ossification (HO) and re-rupture. Heterotopic ossification can be variable in size. Significant HO can limit range of motion while minor HO often remains asymptomatic. The overall presence of HO is likely underreported in literature, as imaging is reserved for symptomatic patients. The purpose of this study is to report the prevalence and clinical implications of heterotopic ossification after surgical repair of the distal biceps tendon. This retrospective study assessed the prevalence and clinical relevance of postoperative HO after distal biceps tendon repair. CT-scans were used to evaluate size and location of the HO. VAS scores, DASH scores, MEPI, and range of motion (ROM) were assessed to evaluate pain, patient satisfaction and elbow function. HO was observed on CT images of 19 out of 35 patients (54%). The use of interference screws, timing of surgery after rupture and timing of radiographic assessment postoperatively did not influence the prevalence of HO. The presence of HO had no statistically significant impact on the VAS scores, ROM measurements and MEPI and DASH scores. According to our findings, the overall incidence of HO is higher than previously reported but there are no differences in clinical outcomes when compared to patients without HO.
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Li J, Seiler LM, Hoekzema NA, Johnson TR, Lee J, Ridenauer JL, Tanner CM. Distal biceps reconstruction: a long-term follow-up of the complications and durability of the single-incision power optimizing cost-effective (SPOC) repair. JSES Int 2023; 7:2547-2552. [PMID: 37969532 PMCID: PMC10638596 DOI: 10.1016/j.jseint.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background The Single-Incision Power Optimizing Cost-Effective Repair (SPOC) method reattaches the distal biceps tendon to its original posterior anatomic footprint and utilizes the anterior cortex of the supinated radius for fixation. The purpose of the study was to define the long-term complications and durability of the SPOC method. Methods Two hundred and eighteen patients underwent the SPOC repair of distal biceps ruptures from 2008 to 2020, with 185 having at least 1-year follow-up data. The average follow-up was 50.1 months. Information regarding smoking, body mass index, interval between injury and surgery, peripheral nerve injury, heterotopic ossification, vascular injury, re-rupture, chronic regional pain syndrome, fracture of the radius, loss of motion, pain with use, and deformity were acquired. Results No complication occurred beyond the third postoperative month. No patient complained of severe lateral antebrachial cutaneous nerve-related symptoms. Major complications exclusive of re-rupture occurred include 1 case of heterotopic ossification and 1 deep infection. Major complications with re-ruptures occurred in 9 patients (4.8%). Seven of the re-ruptures (78%) were associated with an unexpected forceful contraction within the first 4 weeks postop. All complications aside from 1 minor complication occurred in the chronic group. Long term follow-up revealed no re-ruptures and high satisfaction rate with return of strength, motion, and biceps profile. Conclusion The safety profile of the SPOC repair is consistent with those of other published repairs. Major complications were associated with prolonged intervals between injury and reconstruction. Re-ruptures were associated with worker's compensation status and patient noncompliance with postoperative protocols.
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Affiliation(s)
- Jefferson Li
- University of California-Fresno, Fresno, CA, USA
| | | | | | | | - Julia Lee
- Sierra Pacific Orthopedics, Fresno, CA, USA
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Kobayashi Y, Uchiyama Y, Yoshida S, Saito I, Ishii T, Nakajima D, Yanagisawa S, Watanabe M. Functional reconstruction of elbow flexion with latissimus dorsi muscle rotational transfer: two case reports. J Med Case Rep 2023; 17:454. [PMID: 37904251 PMCID: PMC10617077 DOI: 10.1186/s13256-023-04178-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/13/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND We report two cases of biceps brachii and brachialis paralysis due to musculocutaneous nerve injury in which elbow joint flexion was reconstructed using rotational transfer of the latissimus dorsi muscle with sutures to the radial and ulnar tuberosities, thereby enabling flexion by simultaneous activation of the humeroradial and humeroulnar joints. In cases of associated brachialis paralysis, weaker flexion strength can be expected when the forearm is in a pronated position than when it is in a supinated state. To the best of our knowledge, no previous study has reported the rotational position of the forearm during elbow joint flexion reconstruction. CASE PRESENTATION Case 1 involved a 30-year-old Asian male who presented with a rupture of the musculocutaneous, median, radial, and ulnar nerves. Reconstruction was performed by rotational transfer of the latissimus dorsi muscle. In this case, the supination and pronation flexion forces were equal. Case 2 involved a 50-year-old Asian man who presented with partial loss of the musculocutaneous nerve, biceps brachii, and pectoralis major due to debridement. Reconstruction was performed by rotational transfer of the latissimus dorsi muscle. In this case, supination and pronation flexion strengths were demonstrated to be equal. Our reconstruction method used the rotational transfer of the latissimus dorsi muscle; the distal muscle flap was divided into radial and ulnar sides to allow elbow joint flexion by simultaneously activating the humeroradial and humeroulnar joints. These sides were then fixed to the anchors at the radial and ulnar tuberosities. Finally, they were wrapped around the myotendinous junction of the biceps brachii or brachialis and secured using sutures. CONCLUSIONS Although larger studies are required to verify these methods, this case study successfully demonstrates the following: (1) the flexion strength in the supinated position was equal to that in the pronated position; (2) the stability of the humeroradial and humeroulnar joints was unaffected by the forearm's rotational position; and (3) a satisfactory range of motion of the elbow joint was obtained, with no complications.
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Affiliation(s)
- Yuka Kobayashi
- Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Ishikawacho, Hachioji, Tokyo, 192-0032, Japan.
| | - Yoshiyasu Uchiyama
- Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Ishikawacho, Hachioji, Tokyo, 192-0032, Japan
| | - Shinji Yoshida
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, 259‑1193, Japan
| | - Ikuo Saito
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, 259‑1193, Japan
- Department of Orthopaedic Surgery, Isehara Kyodo Hospital, Kanagawa, 259-1187, Japan
| | - Takayuki Ishii
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, 259‑1193, Japan
| | - Daisuke Nakajima
- Department of Orthopaedic Surgery, Tokai University Hachioji Hospital, Ishikawacho, Hachioji, Tokyo, 192-0032, Japan
| | - Shou Yanagisawa
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, 259‑1193, Japan
| | - Masahiko Watanabe
- Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, Kanagawa, 259‑1193, Japan
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Rosenthal R, Ting RS, Sher D. Management of distal biceps tendon ruptures: a survey of fellowship-trained subspecialist elbow surgeons. J Shoulder Elbow Surg 2023; 32:e495-e503. [PMID: 37414354 DOI: 10.1016/j.jse.2023.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND There are several approaches to the management of distal biceps tendon ruptures, with no consensus on what constitutes best practice. METHODS An online survey queried the perceptions and management of distal biceps tendon ruptures amongst fellowship-trained subspecialty elbow surgeons, which primarily comprised of members of the Shoulder and Elbow Society of Australia, the national subspecialist interest group of the Australian Orthopaedic Association and the Mayo Clinic Elbow Club (Rochester, MN, USA). RESULTS One hundred surgeons responded. The median (IQR) experience as orthopedic surgeons amongst respondents was 17 (10-23) years; 78% of respondents saw >10 cases of distal biceps tendon ruptures annually; 95% of respondents would recommend surgery for symptomatic radiologically-confirmed partial tears, the most common indications being pain (83%), weakness (60%), and tear size (48%). Forty-three percent of respondents would have grafts available for tears older than 6 weeks. The one-incision approach (70%) was preferred over two incisions (30%); 78% of one-incision users believed that their repair location was anatomic, compared to 100% of two-incision users. One-incision users were more likely to have encountered lateral antebrachial cutaneous nerve (78% vs. 46%) and superficial radial nerve palsies (28% vs. 11%). Two-incision users were more likely to have encountered posterior interosseus nerve palsy (21% vs. 15%), heterotopic ossification (54% vs. 42%), and synostosis (14% vs. 0%). Re-ruptures were the most common cause of reoperation. The more conservative a respondent's postoperative immobilization was, the less likely they were to have ever encountered re-rupture (14% amongst cast users, 29% amongst splint/brace users, 49% amongst sling users, 100% amongst non-immobilizers). Thirty percent of respondents who placed elbow strength restrictions for 6 months postoperatively encountered re-rupture, compared to 40% amongst those who restricted for 6-12 weeks postoperatively. CONCLUSIONS The operation rate for repair of distal biceps tendon ruptures amongst subspecialist elbow surgeons is high, as seen in our cohort. However, there is a large variation in the approach toward its management. One incision (anterior) was preferred over two incisions (anterior and posterior). Complications from repair of distal biceps tendon ruptures can be expected even amongst subspecialists, and are associated with surgical approach. The responses imply that more conservative postoperative rehabilitation may be associated with a lower risk of re-rupture.
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Affiliation(s)
- Ron Rosenthal
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Ryan S Ting
- University of New South Wales, St. George and Sutherland Clinical Campuses, Sydney, NSW, Australia
| | - Doron Sher
- Concord Repatriation General Hospital, Sydney, NSW, Australia.
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15
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Chan J, Habis AA, Alzaben E, Bicknell RT, Daneshvar P. Avoiding the posterior interosseous nerve during 2-incision distal biceps tendon repair: an anatomic study. J Shoulder Elbow Surg 2023; 32:2152-2160. [PMID: 37331500 DOI: 10.1016/j.jse.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/15/2023] [Accepted: 05/06/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND The posterior interosseous nerve (PIN) is the most commonly injured motor nerve during distal biceps tendon repair resulting in severe functional deficits. Anatomic studies of distal biceps tendon repairs have evaluated the proximity of the PIN to the anterior radial shaft in supination, but limited studies have evaluated the location of the PIN in relation to the radial tuberosity (RT), and none have examined its relation to the subcutaneous border of the ulna (SBU) with varying forearm rotation. This study evaluates the location of the PIN in relation to the RT and SBU to help guide surgeons in safe placement of the dorsal incision and the safest zones of dissection. METHODS The PIN was dissected from arcade of Frohse to 2 cm distal to the RT in 18 cadaver specimens. Four lines were drawn perpendicular to the radial shaft at the proximal, middle, and distal aspect of and 1 cm distal to the RT in the lateral view. Measurements were recorded with a digital caliper along these lines to quantify the distance between the SBU and RT to the PIN with the forearm in neutral, supination, and pronation with the elbow at 90° flexion. Measurements were also made along the length of the radius at the volar, middle, and dorsal surfaces at the distal aspect of the RT to assess its proximity to the PIN. RESULTS Mean distances to the PIN were greater in pronation than supination and neutral. The PIN crossed the volar surface of the distal aspect of the RT -6.9 ± 4.3 mm (-13, -3.0) in supination, -0.4 ± 5.8 mm (-9.9, 2.5) in neutral, and 8.5 ± 9.9 mm (-2.7, 13) in pronation. One centimeter distal to the RT, mean distance to the PIN was 0.54 ± 4.3 mm (-4.5, 8.8) in supination, 8.5 ± 3.1 mm (3.2, 14) in neutral, and 10 ± 2.7 mm (4.9, 16) in pronation. In pronation, mean distances from the SBU to the PIN at points A, B, C, and D were 41.3 ± 4.2, 38.1 ± 4.4, 34.9 ± 4.2, and 30.8 ± 3.9 mm, respectively. CONCLUSION PIN location is quite variable, and to avoid iatrogenic injury during 2-incision distal biceps tendon repair, we recommend placement of the dorsal incision no more than 25 mm anterior to the SBU and carrying out deep dissection proximally first to identify the RT before continuing the dissection distally to expose the tendon footprint. The PIN was at risk of injury along the volar surface at the distal aspect of the RT in 50% with neutral rotation and 17% with full pronation.
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Affiliation(s)
- Julie Chan
- Department of Surgery, Queen's University, Kingston, ON, Canada.
| | - Ahmed A Habis
- Department of Surgery, Queen's University, Kingston, ON, Canada; Department of Orthopaedic Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Essam Alzaben
- Department of Surgery, Queen's University, Kingston, ON, Canada; Department of Orthopaedic Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ryan T Bicknell
- Department of Surgery, Queen's University, Kingston, ON, Canada; Centre for Health Innovation, Queen's University, Kingston, ON, Canada; Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada
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16
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Tate Q, Ferreira-Dos-Santos G, Vydra D, Ferreira-Silva N, Gupta S, Hurdle MFB. Ultrasound-Guided Percutaneous Peripheral Nerve Stimulation of the Musculocutaneous Nerve for Refractory Antecubital ElbowPain-Brief Technical Report and Illustrative Case Report. Can J Pain 2023; 7:2249054. [PMID: 37771636 PMCID: PMC10524777 DOI: 10.1080/24740527.2023.2249054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/16/2023] [Indexed: 09/30/2023]
Abstract
Chronic pain following distal biceps rupture (DBR) is often nonspecific in that it may arise due to the injury, subsequent surgical repair, or a combination of factors, making the painful symptoms challenging to treat. Peripheral nerve injury in the setting of DBR most commonly affects the musculocutaneous nerve or one of its terminal branches and may lead to chronic neuropathic pain involving the elbow and lateral/radial aspect of the forearm. In this brief technical report, we describe an ultrasound-guided (USG) technique for percutaneous implantation of a peripheral nerve stimulator (PNS) targeting the musculocutaneous nerve, along with an illustrative case report of successful treatment of chronic refractory pain following DBR utilizing this technique. Six months postimplantation, the patient reported a greater than 60% baseline pain intensity reduction, and no complications were noted.
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Affiliation(s)
- Quinn Tate
- Department of Physical Medicine and Rehabilitation, Penn Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Guilherme Ferreira-Dos-Santos
- Division of Pain Medicine, Department of Anesthesiology, Reanimation, and Pain Medicine, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Catalonia, Spain
| | - Darrell Vydra
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Nuno Ferreira-Silva
- Department of Physical Medicine and Rehabilitation, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Sahil Gupta
- Department of Pain Medicine, Mayo Clinic, Jacksonville, Florida, USA
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17
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Wörner EA, Nagel M, Kodde IF, Eygendaal D, The B. Return to sports following distal biceps tendon repair: A current concepts review. J ISAKOS 2023; 8:227-231. [PMID: 36924828 DOI: 10.1016/j.jisako.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/07/2023] [Accepted: 02/19/2023] [Indexed: 03/17/2023]
Abstract
Distal biceps tendon ruptures are relatively rare injuries but tend to occur in active and athletic populations, especially in weightlifting and contact sports. The distal biceps tendon is an important supinator of the forearm and flexor of the elbow, thus an injury to this ligament can be invalidating for athletes. The aim of this review was to determine the ability and the time to return to sports following distal biceps tendon repair in athletes and the level of performance. The literature is scarce about the return to sports among athletes. Most studies include athletes are National Football League (NFL) players, others are weightlifters and a few recreational athletes. The return to play rate after distal biceps tendon repair is high. The performances of the returned players were similar to matched players and most players returned to the same level. Most players-depending on the sport-were not able to return to competition within the same season. In order to manage expectations, it should be discussed preoperatively with the athlete (and their coach) that the return to sports rate is high, but the return will probably be the following season.
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Affiliation(s)
- E A Wörner
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands; Department of Orthopaedic Surgery, Amphia Hospital, Molengracht 21, 4818 CK Breda, Netherlands.
| | - M Nagel
- Department of Orthopaedic Surgery, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - I F Kodde
- Department of Orthopaedic and Trauma Surgery, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE Deventer, Netherlands
| | - D Eygendaal
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - B The
- Department of Orthopaedic Surgery, Amphia Hospital, Molengracht 21, 4818 CK Breda, Netherlands
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18
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Ernstbrunner L, Almond M, Rupasinghe HS, Jo OI, Zbeda RM, Ackland DC, Ek ET. Biomechanical Comparison of Distal Biceps Tendon Repair Techniques: Extracortical Single-Button Inlay Fixation Versus Intracortical Double-Button Onlay Anatomic Footprint Fixation. Am J Sports Med 2023:3635465231171131. [PMID: 37184036 DOI: 10.1177/03635465231171131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Extracortical single-button (SB) inlay repair is a commonly used distal biceps tendon technique. However, complications (eg, neurovascular injury) and nonanatomic repairs have led to the development of intracortical fixation techniques. PURPOSE To compare the biomechanical stability of extracortical SB repair with an anatomic intracortical double-button (DB) repair technique. STUDY DESIGN Controlled laboratory study. METHODS The distal biceps tendon was transected in 18 cadaveric elbows from 9 donors. One elbow of each donor was randomly assigned to the extracortical SB or anatomic DB group. Both groups were cyclically loaded with 60 N over 1000 cycles between 90° of flexion and full extension. The elbow was then fixed in 90° of flexion and the repair construct loaded to failure. Gap formation and construct stiffness during cyclic loading and ultimate load to failure were analyzed. RESULTS When compared with the extracortical SB technique after 1000 cycles, the anatomic DB technique showed significantly less gap formation (mean ± SD, 2.7 ± 0.8 vs 1.5 ± 0.9 mm; P = .017) and significantly more construct stiffness (87.4 ± 32.7 vs 119.9 ± 31.6 N/mm; P = .023). Ultimate load to failure was not significantly different between the groups (277 ± 93 vs 285 ± 135 N; P = .859). The failure mode in the anatomic DB group was significantly different from that of the extracortical SB technique (P = .002) and was due to fracture avulsion of the cortical button in 7 of 9 specimens (vs none in the SB group). CONCLUSION Our study shows that the intracortical DB technique produces equivalent or superior biomechanical performance to that of the SB technique. The DB technique may offer a clinically viable alternative to the SB repair technique. CLINICAL RELEVANCE This study suggests, at worst, an equivalent and, at best, a superior biomechanical performance of intracortical anatomic DB footprint repair at the time of surgery. However, the mode of failure suggests that this technique should not be used in patients with poor bone quality.
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Affiliation(s)
- Lukas Ernstbrunner
- Melbourne Orthopaedic Group, Melbourne, Australia
- Hand and Wrist Biomechanics Laboratory, O'Brien Institute / St Vincent's Institute, Fitzroy, Australia
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Australia
| | - Mitchell Almond
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Harshi S Rupasinghe
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Olivia I Jo
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Australia
| | | | - David C Ackland
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Eugene T Ek
- Melbourne Orthopaedic Group, Melbourne, Australia
- Hand and Wrist Biomechanics Laboratory, O'Brien Institute / St Vincent's Institute, Fitzroy, Australia
- Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Australia
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19
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Cheng C, Dong O, Klyce W, Lee A, Bafus BT. Short-term outcome of unicortical, intramedullary repair of distal biceps ruptures - A retrospective cohort study. JSES Int 2023; 7:348-350. [PMID: 36911763 PMCID: PMC9998733 DOI: 10.1016/j.jseint.2022.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Modern distal biceps reconstruction techniques generally have satisfactory outcomes, but are not without complications. Posterior interosseous nerve (PIN) palsy is a rare but potentially devastating complication of bicortical metal button fixation. Recently, a unicortical, intramedullary, repair technique utilizing a suture anchor has been described. The primary aim of this study was to compare short-term functional and patient-reported outcomes and complication rates in patients receiving unicortical intramedullary repair (UR) with suture anchor against those receiving bicortical repair (BR) with metallic button. We hypothesized that UR would have equally satisfactory outcomes without the complication profile. Methods Retrospective chart review was conducted for all patients undergoing operative fixation of distal biceps tendon ruptures from 2015 to 2021 at our tertiary referral center. Twenty patients received BR, and eight patients received UR. Patient demographics and surgical complications were compared. QuickDASH scores at two-month and latest in-person and telehealth postoperative visits, as well as elbow and forearm range of motion at last clinical visit, were collected and analyzed. Results Average patient age in the BR & UR cohorts were 49.3 ± 9.3 and 42.1 ± 6.2 years, respectively, with a male predominance. There was no statistical difference in patient age, sex, hand dominance, injury laterality, injury chronicity, and follow-up duration. Range of motion was comparable and excellent in both groups. Latest follow-up was 3.0 ± 0.5 years in the BR and 1.5 ± 0.4 years in the UR cohorts. QuickDASH scores improved between the two-month and latest time points in each cohort however did not differ significantly in head-to-head comparison. Complications included a case of PIN palsy, distal biceps tendon rerupture, and lateral antebrachial cutaneous nerve (LABC) neuropraxia in the BR group and two cases of LABC neuropraxia in the UR group. The number needed to treat (NNT) for the prevention of one additional case of PIN palsy using UR is 22 patients. Discussion Short-term functional and patient-reported outcomes in traditional BR and newly reported UR of distal biceps tendon ruptures are comparable and excellent. UR did not have higher failure rate despite follow-up periods beyond what is typically reported for tendon reruptures. In this limited retrospective cohort study, UR also did not encounter postoperative PIN palsy and had an NNT of 22 patients. In the appropriate clinical setting, this provides early evidence supporting the utilization of unicortical intramedullary suture anchor fixation of distal biceps tendon ruptures as well as associated perioperative interventions such as preoperative nerve blocks.
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Affiliation(s)
- Christopher Cheng
- Department of Orthopaedic Surgery, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Oliver Dong
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Walter Klyce
- Department of Orthopaedic Surgery, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Adrienne Lee
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, USA
| | - Blaine Todd Bafus
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, USA
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20
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Yari S, Qawasmi F, Nelson JP, McGrady LM, Grindel SI, Wang M. Biomechanical Comparison of Two Surgical Repair Techniques of the Distal Biceps Tendon. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [DOI: 10.1016/j.jhsg.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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21
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Adams B, Yow B, Daniels C, Morgan E. Revision Distal Biceps Tendon Repair Using Original Intramedullary Buttons. Arthrosc Tech 2023; 12:e297-e300. [PMID: 36879875 PMCID: PMC9984848 DOI: 10.1016/j.eats.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/02/2022] [Indexed: 01/20/2023] Open
Abstract
There are several techniques used for tendon fixation in distal biceps tendon repair. Intramedullary unicortical button fixation has the advantage of high biomechanical strength, minimal proximal radial bone removal, and low risk of injury to the posterior interosseous nerve. One disadvantage in revision surgery is retained implants in the medullary canal. This article describes a novel technique for revision distal biceps repair initially fixed with intramedullary unicortical buttons, using the original implants.
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Affiliation(s)
- Bryan Adams
- John A. Feagin, Jr. Sports Medicine Fellowship, Keller Army Community Hospital, West Point, New York
| | - Bobby Yow
- John A. Feagin, Jr. Sports Medicine Fellowship, Keller Army Community Hospital, West Point, New York
| | - Christopher Daniels
- John A. Feagin, Jr. Sports Medicine Fellowship, Keller Army Community Hospital, West Point, New York
| | - Emily Morgan
- Madigan Army Medical Center, Tacoma, Washington, U.S.A
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Distale Bizepssehnenruptur. ARTHROSKOPIE 2023. [DOI: 10.1007/s00142-022-00568-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ZusammenfassungDie Ruptur der distalen Bizepssehne tritt am häufigsten bei Männern im mittleren Alter auf (30 bis 50 Jahre). Der typische Mechanismus ist die exzentrische Belastung in strecknaher Ellbogenstellung in Supination, wobei diese Verletzung mit Kraftsport und körperlich belastender Tätigkeit assoziiert ist. Epidemiologische Daten weisen auf eine Zunahme von distalen Bizepsrupturen in den letzten Jahrzehnten hin. Risikofaktoren wie die Verwendung anaboler Steroide, Kraftsport und Nikotinabusus zeigen einen Zusammenhang mit der Verletzung. Bei reduziertem Patientenanspruch oder relevanten Komorbiditäten ist auch unter einer konservativen Behandlung ein gutes funktionelles Ergebnis mit subjektiv guter Patientenzufriedenheit zu erreichen, allerdings unter zu erwartender relevanter Kraftminderung in Flexion (20 %) und Supination (40 %). Durch eine operative Refixation lässt sich das beste funktionelle Resultat erzielen, allerdings einhergehend mit einem nicht unerheblichen Komplikationsrisiko.
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23
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Nanoscopic Distal Biceps Repair With Cortical Button and Interference Screw. Arthrosc Tech 2023; 12:e153-e159. [PMID: 36879858 PMCID: PMC9984725 DOI: 10.1016/j.eats.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/19/2022] [Indexed: 01/20/2023] Open
Abstract
Distal biceps pathology can be addressed using different techniques, each with its advantages and disadvantages. The current trend is to move toward minimally invasive procedures based on feasibility and known clinical benefits. Endoscopy for distal biceps pathology is a safe procedure. Through the NanoScope, this procedure is even more effective and safer.
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24
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Ferreira-Silva N, Ferreira-Dos-Santos G, Gupta S, Hunt CL, Eldrige JS, Pingree MJ, Clendenen SR, Hurdle MFB. Ultrasound-guided percutaneous peripheral nerve stimulation for chronic refractory neuropathic pain: a unique series. Pain Manag 2023; 13:15-24. [PMID: 36408639 DOI: 10.2217/pmt-2022-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
During the last two decades, with the advent of recent technology, peripheral nerve stimulation has become an appealing modality at the forefront of pain management. In this case series, we document the clinical rationale and technical considerations on three of the most challenging cases, refractory to previous interventions, that were treated by our team with an ultrasound-guided percutaneous peripheral nerve stimulator targeting the musculocutaneous, bilateral greater occipital and subcostal nerves. At the 6-month follow-up, all patients experienced greater than 50% relief of baseline pain, with a near-complete resolution of pain exacerbations. Furthermore, to our knowledge, this is the first report of an ultrasound-guided percutaneous technique of a peripheral nerve stimulator targeting the musculocutaneous and subcostal nerves.
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Affiliation(s)
- Nuno Ferreira-Silva
- Department of Physical Medicine & Rehabilitation, Hospital Professor Doutor Fernando Fonseca. Amadora, 2720-276, Portugal
| | - Guilherme Ferreira-Dos-Santos
- Department of Anesthesiology & Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto. Toronto, ON, M5T 2S8, Canada
| | - Sahil Gupta
- Department of Pain Medicine, Mayo Clinic. Jacksonville, FL 32224, USA
| | - Christine L Hunt
- Department of Pain Medicine, Mayo Clinic. Jacksonville, FL 32224, USA
| | - Jason S Eldrige
- Department of Pain Medicine, Mayo Clinic. Jacksonville, FL 32224, USA
| | - Matthew J Pingree
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic. Rochester, MN 55905, USA
| | - Steven R Clendenen
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic. Jacksonville, FL 32224, USA
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Bicortical suspensory button fixation yields greater ultimate load to failure over unicortical all-suture anchor fixation in distal biceps brachii tendon repair. J Shoulder Elbow Surg 2022; 31:2347-2357. [PMID: 35598835 DOI: 10.1016/j.jse.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Various distal biceps tendon repair techniques exist, each with their own biomechanical profile. Recently, all-suture anchor fixation has recently become an intriguing option for distal biceps fixation, compared with the proven track record of the suspensory cortical button. In addition, intramedullary techniques have been utilized as a means to avoid complications such as nerve damage seen with extramedullary fixation. PURPOSE The purpose of this study is to perform a comparative biomechanical analysis of 4 unique distal biceps tendon fixation methods: Unicortical/intramedullary all-suture anchor fixation (UIAS), Bicortical/extramedullary all-suture anchor fixation (BEAS), Unicortical/intramedullary suspensory button fixation (UISB), and Bicortical/extramedullary suspensory button fixation (BESB). STUDY DESIGN Controlled Laboratory study. METHODS 24 fresh-frozen cadaveric elbows were randomized into 4 groups providing data from 6 specimens, with each group undergoing a different repair technique. The specimens underwent 2 studies: Cyclic loading and Ultimate Load to failure (ULTF) testing. The repaired elbows were cycled 3000 times between 0 and 90 degrees of flexion, with displacement under cyclic loading at the repair site measured using a differential variable reductance transducer. ULTF test was performed with the elbow flexed at 90 degrees. The modes of failure were recorded. RESULTS The mean cyclic displacements between the 4 groups were as follows: UIAS: 1.45 ± 1.04 mm; BEAS: 2.75 ± 1.32 mm; UISB: 1.45 ± .776 mm; BESB: 2.66 ± 1.18 mm (p= 0.077). Bicortical repairs displayed greater displacement after cyclic loading when compared with unicortical repairs regardless of anchor used (p= 0.007). The mean ULTF for each group was as follows: all-suture intramedullary: 200 N; all-suture extramedullary: 330 N; cortical-button intramedullary: 256 N; cortical-button extramedullary: 342 N). All-suture unicortical/intramedullary repair had a significantly lower ULTF (200 N) compared with cortical-button Bicortical/extramedullary repair (342 N) (p=0.043). CONCLUSION Bicortical/extramedullary suspensory button fixation demonstrated a greater ultimate load to failure when compared with unicortical/intramedullary all-suture anchor fixation. These findings suggest that bicortical/extramedullary suspensory cortical button fixation is a biomechanically superior construct as compared to unicortical/intramedullary all-suture anchor fixation. However, there was no significant difference in ULTF between extra-medullary, Bicortical button or Bicortical, all-suture anchor fixation.
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Wörner EA, Kodde IF, Spaans AJ, Colic N, Hilgersom N, van Oost I, The B, Eygendaal D. Three weeks of indomethacin is not superior to 1 week of meloxicam as prophylaxis for heterotopic ossifications after distal biceps tendon repair with a single-incision technique. J Shoulder Elbow Surg 2022; 31:2157-2163. [PMID: 35872167 DOI: 10.1016/j.jse.2022.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/22/2022] [Accepted: 06/05/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to assess the efficacy of 3 weeks of indomethacin, a nonselective nonsteroidal anti-inflammatory drug, in comparison to 1 week of meloxicam as prophylaxis for heterotopic ossifications (HOs) after distal biceps tendon repair. METHODS A single-center retrospective study was performed on 78 patients undergoing distal biceps tendon repair between 2008 and 2019. From 2008 to 2016, patients received meloxicam 15 mg daily for the period of 1 week as usual care. From 2016 onward, the standard protocol was changed to indomethacin 25 mg 3 times daily for 3 weeks. All patients underwent a single-incision repair with a cortical button technique. The postoperative rehabilitation protocol was similar for all patients. The postoperative radiographs at 8-week follow-up were assessed blindly by 7 independent assessors. If HOs were present, it was classified according to the Ilahi-Gabel classification for size and according to the Gärtner-Heyer classification for density. Statistical analysis was performed to analyze the difference in HO between the patients who were treated with indomethacin and with meloxicam. RESULTS Seventy-eight patients, with a mean age of 48.8 years (range 30-72) were included. The mean follow-up after surgery was 12 months (range 2-45). Indomethacin (21 days, 25 mg 3 times per day) was prescribed to 26 (33%) patients. The 52 other patients (67%) were prescribed meloxicam 15 mg daily for 7 days. HOs were seen in 19 patients 8 weeks postoperatively. Five of 26 patients treated with indomethacin developed HO, and 14 of 52 patients treated with meloxicam developed HO (P = .5). Two patients had symptomatic HO with minor restrictions in movement; neither patient was treated with indomethacin. Significantly more HOs were seen in patients with a longer time from injury to surgery (P = .01) The intraclass correlation score for reliability between assessors for HO scoring on postoperative radiographs was good to excellent for both classifications. CONCLUSION In this study, HOs were seen in 24% of postoperative radiographs. Three weeks of indomethacin was not superior to meloxicam for 1 week for the prevention of HO after single-incision distal biceps tendon repair.
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Affiliation(s)
- Elisabeth A Wörner
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Foundation for Orthopaedic Research, Care & Education (FORCE), Amphia Hospital, Breda, Netherlands.
| | - Isaak F Kodde
- Department of Orthopaedic and Trauma Surgery, Deventer Ziekenhuis, Deventer, Netherlands
| | - Anne J Spaans
- Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen/Boxmeer, Netherlands
| | - Nicola Colic
- Department of Orthopaedic Surgery, Institute for Orthopaedic Surgery, Banjica, Belgrade, Serbia
| | - Nick Hilgersom
- Foundation for Orthopaedic Research, Care & Education (FORCE), Amphia Hospital, Breda, Netherlands
| | - Iris van Oost
- Foundation for Orthopaedic Research, Care & Education (FORCE), Amphia Hospital, Breda, Netherlands
| | - Bertram The
- Foundation for Orthopaedic Research, Care & Education (FORCE), Amphia Hospital, Breda, Netherlands
| | - Denise Eygendaal
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Foundation for Orthopaedic Research, Care & Education (FORCE), Amphia Hospital, Breda, Netherlands
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Mercurio M, Castioni D, Cosentino O, Fanelli D, Familiari F, Gasparini G, Galasso O. Double-Incision Technique for the Treatment of Distal Biceps Tendon Rupture. JBJS Essent Surg Tech 2022; 12:e21.00033. [PMID: 36816526 PMCID: PMC9931040 DOI: 10.2106/jbjs.st.21.00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The double-incision technique with bone-tunnel fixation provides anatomical reattachment of a distal biceps tendon rupture to the radial tuberosity1. This technique has been described by Boyd and Anderson2 and was later modified by Morrey et al.3. The aim of the procedure is to achieve good return of elbow strength and motion with a low rate of neurological complications. Description A longitudinal antecubital incision of 3 to 4 cm allows dissection to identify and isolate the lateral antebrachial cutaneous nerve (LABCN). Supination of the forearm protects the posterior interosseus nerve, which often cannot be visualized. The distal portion of the distal biceps should be carefully identified and exposed. A high-resistance nonresorbable suture is sewn with use of a Krackow technique to whipstitch the distal 4 cm of the tendon. Alternatively, 2 sutures (4 strands) can be utilized. A curved forceps is placed in the interosseous space to identify the location for the second 4-cm incision, on the dorsal proximal forearm over the tip of the forceps with the forearm pronated. The radial tuberosity is exposed by bluntly separating the common extensor tendons, followed by transection of the supinator fibers. Two drill holes are made 5 mm apart from one another for suture passage. The tendon is passed across a loop of wire, from the anterior to the posterior incision. With the elbow at 90° of flexion and full pronation, the tendon is docked into the trough and the sutures are tied. Alternatives Alternatively, the surgical repair of the distal biceps tendon rupture can be performed through a single anterior approach4. The exposure starts with a curved longitudinal antecubital incision, exploiting the interval between the brachioradialis and pronator teres with radial (lateral) retraction of the brachioradialis and medial retraction of the pronator teres. A single anterior incision allows repair through the use of various types of fixation devices, such as suture anchors, cortical buttons, and interference screws, but seems to carry an increased risk of neurological complications, especially in terms of paresthesias in the distribution of the LABCN. Nonoperative treatment might be acceptable for elderly patients with poor functional demands. Rationale The double-incision technique with bone-tunnel fixation provides good fixation strength with an expected low rate of neurological complications1. This approach offers a useful treatment option for young and active patients with physically demanding lifestyles. Expected Outcomes The double-incision technique is an effective and safe procedure to restore elbow functionality in patients with distal biceps tendon rupture. A meta-analysis1,4-16 revealed no significant differences in postoperative functional scores following procedures performed via the single-incision compared with double-incision approach. Although the differences were smaller than the minimal clinically important difference17, the single-incision technique yielded significantly greater flexion (mean ± standard deviation, 136° ± 13°) and pronation range of motion (79° ± 10°) compared with the double-incision technique (133° ± 13° and 75° ± 14°, respectively) at 2 years postoperatively. No differences in extension and supination were observed. Rates of heterotopic ossification ranged from 0.5% to 11% for the single-incision approach and from 1% to 21.4% for the double-incision approach, with significant differences favoring the single-incision technique, although in the majority of cases the heterotopic ossification was an incidental finding. Neurological complications were found in 24.5% and 13.4% cases for the single- and double-incision techniques, respectively, with a significant difference favoring the double-incision technique. When damage to specific nerves was evaluated, the double-incision technique was associated with significantly less risk of LABCN damage. Important Tips One or 2 high-resistance nonresorbable sutures are sewn with use of a Krackow technique to whipstitch the distal 4 cm of the biceps tendon.A curved forceps is placed in the interosseous space to identify the location for the second incision, on the dorsal proximal forearm over the tip of the forceps.Pronation of the forearm protects the posterior interosseus nerve, which often cannot be visualized during volar dissection and bone fixation.Positioning the tendon more posteriorly on the radial tuberosity allows for optimal biomechanical function. Acronyms and Abbreviations ROM = range of motionCR = conventional radiologyMRI = magnetic resonance imagingUS = ultrasoundLABC = lateral antebrachial cutaneousPIN = posterior interosseous nerveHO = heterotopic ossificationCI = confidence intervalSI = single incisionDI = double incision.
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Affiliation(s)
- Michele Mercurio
- Department of Orthopedic and Trauma Surgery, Magna Graecia University and Mater Domini University Hospital, Catanzaro, Italy
| | - Davide Castioni
- Department of Orthopedic and Trauma Surgery, Magna Graecia University and Mater Domini University Hospital, Catanzaro, Italy,Email for corresponding author:
| | - Orlando Cosentino
- Department of Orthopedic and Trauma Surgery, Magna Graecia University and Mater Domini University Hospital, Catanzaro, Italy
| | - Daniele Fanelli
- Department of Orthopedic and Trauma Surgery, Magna Graecia University and Mater Domini University Hospital, Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopedic and Trauma Surgery, Magna Graecia University and Mater Domini University Hospital, Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopedic and Trauma Surgery, Magna Graecia University and Mater Domini University Hospital, Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopedic and Trauma Surgery, Magna Graecia University and Mater Domini University Hospital, Catanzaro, Italy
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KAPICIOĞLU M, PULATKAN A, UÇAN V, TEZGEL O, BİLSEL K. Comparison of Single and Double Incision Repair Techniques in Distal Biceps Tendon Rupture. BEZMIALEM SCIENCE 2022. [DOI: 10.14235/bas.galenos.2021.6479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Muscatelli S, Walley KC, Daly-Seiler CS, Greenstein JA, Sciascia A, Patterson DP, Freehill MT. Biomechanical Comparison of a Novel Multiplanar, Perpendicular Whipstitch With the Krackow Stitch and Standard Commercial Whipstitch. Orthop J Sports Med 2022; 10:23259671221107034. [PMID: 35982831 PMCID: PMC9380225 DOI: 10.1177/23259671221107034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Using alternating orthogonal suture throws with the looped whipstitch
technique may allow enhanced suture fixation. Hypothesis: It was hypothesized that this novel multiplanar, perpendicular looped
whipstitch (MP) technique would have improved biomechanical properties
compared with the standard looped whipstitch (WS) and Krackow stitch
(KS). Study Design: Controlled laboratory study. Methods: A total of 30 cadaveric tibialis anterior tendons were randomly assigned into
3 groups of 10. Tendons were secured to a custom clamp, and the other end
was sutured using 1 of 3 techniques: the KS, WS, or novel MP. The MP was
performed with alternating orthogonal throws starting right to left, then
front to back, left to right, and back to front. Each technique used 4
passes of No. 2 FiberWire spaced 5 mm apart and ending 10 mm from the tendon
end. Tendons were preloaded to 5 N, pretensioned to 50 N at 100 mm/min for 3
cycles, returned to 5 N for 1 minute, cycled from 5 to 100 N at 200 mm/min
for 100 cycles, and then loaded to failure at 20 mm/min. Elongation was
recorded after pretensioning and cycling and was measured both across the
suture-tendon interface and from the base of the suture-tendon interface to
markings on the suture limbs (construct elongation). One-way analyses of
variance were performed, with Bonferroni post hoc analysis when
appropriate. Results: There were no differences in cross-sectional area or stiffness among the 3
techniques. The ultimate load for WS (183.33 ± 57.44 N) was less compared
with both MP (270.76 ± 39.36 N) and KS (298.90 ± 25.94 N)
(P ≤ .001 for both). There was less construct
elongation for KS compared with WS and MP for total displacement, measured
from pretensioning to the end of cycling (P < .001). All
3 techniques saw a decrease in length (shortening) at the suture-tendon
interface during testing. There was more shortening at the suture-tendon
interface for WS compared with KS (P = .006). Conclusion: The KS appears superior, as it maximized strength while minimizing construct
elongation or graft shortening. The ultimate load of the MP technique was
greater than that of the standard technique but not significantly different
from that of the KS technique. Clinical Relevance: The KS is preferred. If using a WS, multiplanar, perpendicular passes should
be considered.
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Affiliation(s)
| | | | | | | | | | - David P Patterson
- University of Michigan Health System, Ann Arbor, Michigan, USA.,Ann Arbor VA Healthcare System, Ann Arbor, Michigan, USA
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Pitsilos C, Gigis I, Chitas K, Papadopoulos P, Ditsios K. Systematic review of distal biceps tendon rupture in athletes: treatment and rehabilitation. J Shoulder Elbow Surg 2022; 31:1763-1772. [PMID: 35367620 DOI: 10.1016/j.jse.2022.02.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal biceps tendon rupture is a rare injury associated with decreased elbow flexion and forearm supination strength. This impairment is not tolerated by high-demand patients like athletes. PURPOSE To review treatment and rehabilitation applied to injured athletes and study their impact in return to sports. METHODS MEDLINE, Cochrane, Web of Science, and Scopus online databases were searched. A systematic review was conducted using the PRISMA guidelines; studies published on distal biceps tendon rupture treatment and rehabilitation of athletes until June 30, 2021, were identified. A quantitative synthesis of factor related to return to preinjury sport activity was made. RESULTS Ten articles were identified, including 157 athletes. Mean age was 40.5 years, and the dominant arm was injured in 103 cases (66%). Rupture was acute in 121 athletes (77%), and the mean follow-up was 25.7 months. A hundred and fifty-three athletes (97.5%) successfully returned to sport within a mean time of 6.2 months. Surgical treatment was followed in all cases. One-incision technique was chosen in 115 (73%) and suture anchor fixation in 52 (33%) cases. No postsurgical immobilization was reported in 38 (24%) and immobilization for 2 weeks in 124 (79%) athletes. Decreased supination-pronation and flexion-extension arc was found in 63 (40%) and 27 (17%) cases, respectively. Earlier return to sport was associated with nondominant-side (P = .007) and acute (P < .001) injuries, participation in weightlifting (P = .001), double-incision approach (P = .005), cortical button fixation (P < .001), and absence of supination-pronation restriction (P = .032). Time of return to sport activity was independent of rehabilitation, including immobilization (P = .539) and strengthening (P = .155), and decreased flexion-extension arc (P = .059). CONCLUSION Athletes sustaining distal biceps tendon rupture have a high postoperative return to sport rate, independently of selected surgical technique or rehabilitation program. However, a relation between the surgical technique and time of return to sport was found. Rehabilitation did not influence time of return to sport.
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Affiliation(s)
- Charalampos Pitsilos
- 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Ioannis Gigis
- 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Chitas
- 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pericles Papadopoulos
- 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Ditsios
- 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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31
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Luokkala T, Sidharthan SK, Karjalainen TV, Paloneva J, Watts AC. Distal biceps tendon repairs and reconstructions-an analysis of demographics, prodromal symptoms and complications. Arch Orthop Trauma Surg 2022; 142:1351-1357. [PMID: 33484314 DOI: 10.1007/s00402-021-03750-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 01/01/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the demographics, complications and prodromal symptoms (any pain or unpleasant sensation in the area distal biceps tendon preceding the injury) of distal biceps tendon tears (DBTTs) of patients treated with primary repair or Achilles allograft reconstruction. MATERIALS AND METHODS 228 consecutive DBTTs in 226 patients from a single centre were evaluated. The demographic data, prodromal symptoms and postoperative adverse events were documented. RESULTS There were 225 males and 1 female patient. The age distribution showed a bimodal pattern in the whole cohort, but once the 48 (20%) elite athletes were excluded, the age was normally distributed, peaking in the 5th decade. Direct repairs were performed in 184 cases and reconstruction with Achilles tendon allograft in 45 cases. An adverse event was observed in 34 (19%) patients who underwent direct repair and in 3 (7%) cases with graft reconstruction, corresponding to RR of 0.32 (95% CI 0.1-0.96, p = 0.04). Adjusting with the potential confounders (age, occupation and smoking), the OR was 0.35; 95% CI 0.09-1.3, p = 0.11). Adverse events included 28 (12.3% of all adverse events) lateral antebrachial cutaneous nerve (LABCN) neurapraxias, 5 (2.1%) other neurapraxias, 6 (2.6%) heterotopic ossifications and 1 (0.4%) re-rupture. Twenty-three (10%) patients reported prodromal symptoms before the tear. CONCLUSIONS DBTT is a condition that affects men predominantly. The observed bimodal incidence distribution was related to elite athletes, but in the normal population the peak occurs at the age typical to tendinopathies. LABCN neurapraxia was the most common adverse event, and graft use does not seem to predispose to adverse events.
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Affiliation(s)
- Toni Luokkala
- Wrightington Hospital Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh NHS Foundation Trust, Hall Ln, Appley Bridge, Wigan, WN6 9EP, UK. .,Department of Surgery, Central Finland Central Hospital, Keski-Suomen Keskussairaala, Keskussairaalantie 19, 40620, Jyväskylä, Finland.
| | - Sijin K Sidharthan
- Wrightington Hospital Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh NHS Foundation Trust, Hall Ln, Appley Bridge, Wigan, WN6 9EP, UK
| | - Teemu V Karjalainen
- Department of Surgery, Central Finland Central Hospital, Keski-Suomen Keskussairaala, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Juha Paloneva
- Department of Surgery, Central Finland Central Hospital, Keski-Suomen Keskussairaala, Keskussairaalantie 19, 40620, Jyväskylä, Finland.,University of Eastern Finland, Kuopio, Finland
| | - Adam C Watts
- Wrightington Hospital Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh NHS Foundation Trust, Hall Ln, Appley Bridge, Wigan, WN6 9EP, UK.,University of Manchester, Manchester, UK
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Daskalakis I, Sperelakis I, Tosounidis TH, Galanakis I. Elbow heterotopic ossification after distal biceps tendon repair presenting as median nerve neuropathy: A case report. Trauma Case Rep 2022; 39:100636. [PMID: 35368721 PMCID: PMC8971613 DOI: 10.1016/j.tcr.2022.100636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
Ruptures of the distal attachment of the biceps brachii are rare injuries that typically occur in the dominant arm of men between the third and fourth decade of life. Surgical repair is indicated in active patients. Complications of surgical repair include neurovascular injury, heterotopic ossification, wound infection, elbow stiffness and re-rupture. Heterotopic ossification of the elbow is a rare complication of distal biceps tendon repair operations. It may be entirely asymptomatic or present with symptoms and signs such as swelling, erythema, pain, palpable mass, vascular and nerve compression or joint movement restriction. We present a case of heterotopic ossification presenting as median nerve neuropathy after distal biceps tendon repair using a limited volar single incision.
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Affiliation(s)
- Ioannis Daskalakis
- Department of Orthopaedic Surgery, University Hospital of Heraklion, Voutes, Heraklion, Crete, Greece
| | - Ioannis Sperelakis
- Department of Orthopaedic Surgery, University Hospital of Heraklion, Voutes, Heraklion, Crete, Greece
| | - Theodoros H. Tosounidis
- Department of Orthopaedic Surgery, University Hospital of Heraklion, Voutes, Heraklion, Crete, Greece
- University of Crete, Voutes, Heraklion, Crete, Greece
| | - Ioannis Galanakis
- Department of Orthopaedic Surgery, University Hospital of Heraklion, Voutes, Heraklion, Crete, Greece
- Corresponding author at: University Hospital of Heraklion, Voutes, Heraklion, Crete, Greece, Postal Code: 71500
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Cheng C, Bafus BT. Intramedullary, unicortical repair of distal biceps tendon rupture. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:238-242. [PMID: 37587954 PMCID: PMC10426579 DOI: 10.1016/j.xrrt.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Historically-used bicortical repair of distal biceps tendon rupture are at risk for posterior interosseous nerve palsy. Here we present a technique, and associated case report, utilizing unicortical repair with a suture cortical button device for this injury. The described technique provides robust fixation and avoids the rare, but potentially devastating complication of posterior interosseous nerve palsy.
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Affiliation(s)
- Christopher Cheng
- Department of Orthopaedic Surgery, Case Western Reserve University/University Hospitals, Cleveland, OH, USA
| | - Blaine Todd Bafus
- Department of Orthopaedic Surgery, MetroHealth Medical Center, Cleveland, OH, USA
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Operative vs. nonoperative treatment of distal biceps ruptures: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:e169-e189. [PMID: 34999236 DOI: 10.1016/j.jse.2021.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 11/22/2021] [Accepted: 12/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND HYPOTHESIS Ruptures of the distal biceps tendon are most commonly due to traumatic eccentric loading in the middle-aged male population and can result in functional deficits. Although surgical repair has been demonstrated to result in excellent outcomes, there are few comparative studies that show clear functional benefits over nonoperative management. The aim of this systematic review and meta-analysis is to compare the functional outcomes of operative and nonoperative management for these injuries. We hypothesized that operative treatment would be associated with significantly superior outcomes. METHODS According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review of the literature was performed using MEDLINE, SPORTDiscus, CINAHL (Cumulative Index to Nursing and Allied Health Literature), CENTRAL (Cochrane Central Registry of Controlled Trials), Embase, and Web of Science databases. Outcomes of interest included range of motion (ROM), strength, endurance, and patient-reported outcomes including Disabilities of the Arm, Shoulder and Hand (DASH), Mayo Elbow Performance Score (MEPS), and visual analog scale (VAS) for pain scores. Summary effect estimates of the mean difference between operative and nonoperative management for each outcome were estimated in mixed effects models. RESULTS Of an initially identified 6478 studies, 62 reported outcomes for a total of 2481 cases (2402 operative, 79 nonoperative), with an overall average age of 47.4 years (47.3 for operative, 50.3 for nonoperative). There were 2273 (98.5%) males and 35 (1.5%) females among operative cases, whereas all 79 (100%) nonoperative cases were males. Operative management was associated with a significantly higher flexion strength (mean difference, 25.67%; P < .0001), supination strength (mean difference, 27.56%; P < .0001), flexion endurance (mean difference, 11.12%; P = .0268), and supination endurance (mean difference, 33.86%; P < .0001). Patient-reported DASH and MEPS were also significantly superior in patients who underwent surgical repair, with mean differences of -7.81 (P < .0001) and 7.41 (P = .0224), respectively. Comparative analyses for ROM and pain VAS were not performed because of limited reporting in the literature for nonoperative management. CONCLUSION This study represents the first systematic review and meta-analysis to compare functional and clinical outcomes following operative and nonoperative treatment of distal biceps tendon ruptures. Operative treatment resulted in superior elbow and forearm strength and endurance, as well as superior DASH and MEPS.
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Carrazana-Suarez LF, Cooke S, Schmidt CC. Return to Play After Distal Biceps Tendon Repair. Curr Rev Musculoskelet Med 2022; 15:65-74. [PMID: 35195840 PMCID: PMC9076792 DOI: 10.1007/s12178-022-09742-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 10/30/2022]
Abstract
PURPOSE OF REVIEW Distal biceps tendon ruptures (DBTR) are uncommon injuries in 40- to 50-year-old men but occur at a younger age in the athlete population. The distal biceps tendon is an important supinator of the forearm and flexor of the elbow. A complete injury results in limiting function in the upper extremity. The current review evaluates the different options in management and the current literature on return to play in athletes. RECENT FINDINGS The distal biceps tendon inserts on the posterior aspect of the radial tuberosity as two independent heads. The long head footprint is more proximal and posterior giving it a better lever arm for supination. The short head footprint is more distal and anterior giving it a better lever arm for flexion. Surgical anatomic repair is highly recommended among the athlete population, to restore proper function of the upper extremity. There is scarce literature on return to play among athletes. The most recent studies on high-performance athletes are on National Football League (NFL) players. These studies showed that 84-94% of NFL players returned to play at least one game after distal biceps repair. Compared to matched control groups, there was no difference in the player's performance after surgery. Anatomic repair of DBTR results in excellent outcomes, high return to work, and high rate of return to play among athletes. When compared to matched control groups, NFL players have the performance score and play the same number of games after surgery.
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Affiliation(s)
- Luis F Carrazana-Suarez
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 9104 Babcock Blvd, Suite 5113, Pittsburgh, PA, 15237, USA. .,Shoulder and Elbow Mechanical Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Sean Cooke
- Shoulder and Elbow Mechanical Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christopher C Schmidt
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 9104 Babcock Blvd, Suite 5113, Pittsburgh, PA, 15237, USA.,Shoulder and Elbow Mechanical Research Laboratory, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA
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Colantonio DF, Le AH, Keeling LE, Slaven SE, Vippa TK, Helgeson MD, Chang ES. Intramedullary Unicortical Button and All-Suture Anchors Provide Similar Maximum Strength for Onlay Distal Biceps Tendon Repair. Arthroscopy 2022; 38:287-294. [PMID: 34332050 DOI: 10.1016/j.arthro.2021.06.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/03/2021] [Accepted: 06/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the biomechanical profile of onlay distal biceps repair with an intramedullary unicortical button versus all-suture anchors under cyclic loading and maximal load to failure. METHODS Twenty paired fresh-frozen human cadaveric elbows were randomized to onlay distal biceps repair with either a single intramedullary button or with two 1.35-mm all-suture anchors. A 1.3-mm high tensile strength tape was used in a Krackow stitch to suture the tendons in both groups. Specimens and repair constructs were loaded for 3,000 cycles and then loaded to failure. Maximum load to failure, mode of failure, and construct elongation were recorded. RESULTS Mean (± standard deviation) maximum load to failure for the unicortical intramedullary button and all-suture anchor repairs were 503.23 ± 141.77 N and 537.33 ± 262.13 N (P = .696), respectively. Mean maximum displacement after 3,000 cycles (± standard deviation) was 4.17 ± 2.05 mm in the button group and 2.06 ± 1.05 mm in the suture anchor group (P = .014). Mode of failure in the button group was suture tape rupture in 7 specimens, failure at the tendon-suture interface in 2 specimens, and button pullout in 1 specimen. Anchor pullout was the mode of failure in all suture anchor specimens. There were no tendon ruptures or radial tuberosity fractures in either group. CONCLUSIONS This study demonstrates that onlay distal biceps repair with 2 all-suture anchors has similar maximum strength to repair with an intramedullary button and that both are viable options for fixation. CLINICAL RELEVANCE All-suture anchors and unicortical intramedullary button have similar maximum strength at time zero. Both constructs provide suitable fixation for onlay distal biceps repair.
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Affiliation(s)
- Donald F Colantonio
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A..
| | - Anthony H Le
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A
| | - Laura E Keeling
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, U.S.A
| | - Sean E Slaven
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Tarun K Vippa
- Department of Orthopaedic Surgery, Inova Health System, Fairfax, Virginia, U.S.A
| | - Melvin D Helgeson
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, U.S.A.; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Edward S Chang
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A.; Department of Orthopaedic Surgery, Inova Health System, Fairfax, Virginia, U.S.A
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Cognetti DJ, Proffitt JM, Balldin BC, Rowland AS, Hartzler RU. Distal biceps tendon repair: cost analysis of single- versus double-incision techniques in an ambulatory surgery center. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:103-106. [PMID: 37588289 PMCID: PMC10426616 DOI: 10.1016/j.xrrt.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background The purpose of this study was to compare the cost differences for single- versus double-incision distal biceps repair at an ambulatory surgery center (ASC) given that similar clinical outcomes have been reported between these methods. Methods A retrospective review of financial and medical records was completed for patients who underwent distal biceps tendon repair over a three-year period at a single private orthopedic practice. Variables analyzed include the cost to the ASC of operative time and the cost of differential surgical supplies, specifically implants and disposable supplies. Results A total of 10 surgeons performed 104 repairs. Nine surgeons performed repairs through a single incision with use of cortical button or suture anchor fixation, and one surgeon performed transosseous suture fixation through a double-incision approach. The median tourniquet time and procedure length were 31 (interquartile range [IQR] 27-40) and 44 (IQR 39-54) minutes for single-incision repairs and 68 minutes (IQR 61-75) and 110 minutes (IQR 103-113) for double-incision repairs which were significantly different across groups (P < .001, P < .001). The total surgical cost (operative time, implants, and disposables) for single-incision repairs was a median of $758 (IQR 732-803) compared with $606 (IQR 567-629) for double-incision repairs (P < .001). However, the procedure cost with implants (not including disposables) was not significantly different for single- (median [Mdn] = $500 [IQR 475-552]) and double-incision repairs (Mdn $552 [IQR 514-564]) (P = .14) although the procedure cost with disposables (not including implant costs) favored single-incision repairs (Mdn = $478 [IQR 452-523]) over double-incision repairs (Mdn = $606 [IQR 567-629]) (P < .001). Conclusion In a single surgery center, single-incision distal biceps repairs utilizing an implant were performed more expeditiously than double-incision repairs with a transosseous technique but incurred greater surgical costs. Differences in surgical time cost between the two approaches could be consequential for ASCs and other stakeholders.
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Affiliation(s)
| | | | - B. Christian Balldin
- TSAOG Orthopaedics, San Antonio, TX, USA
- Burkhart Research Institute for Orthopaedics (BRIO), San Antonio, TX, USA
| | | | - Robert U. Hartzler
- TSAOG Orthopaedics, San Antonio, TX, USA
- Burkhart Research Institute for Orthopaedics (BRIO), San Antonio, TX, USA
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Distal Biceps Tendon Rupture Videos on YouTube: An Analysis of Video Content and Quality. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:3-7. [PMID: 35415601 PMCID: PMC8991868 DOI: 10.1016/j.jhsg.2021.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/26/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose Our purpose was to analyze the content and quality of YouTube videos related to distal biceps tendon (DBT) ruptures and repair. We aimed to compare differences between academic and nonacademic video sources. Methods The most popular YouTube videos related to DBT injuries were compiled and analyzed according to source. Viewing characteristics were determined for each video. Video content and quality were assessed by 2 reviewers and analyzed according to the Journal of the American Medical Association benchmark criteria, DISCERN criteria, and a Distal Biceps Content Score. Cohen’s kappa was used to measure interrater reliability. Results A total of 59 DBT YouTube videos were included. The intraclass correlation coefficients ranged from moderate to excellent for the content scores. The mean DISCERN score was 29, and no videos were rated as either “good” or “excellent” for content quality. With the exception of the mean Journal of the American Medical Association criteria score (1.5 vs 0.5), videos from academic sources did not demonstrate significantly higher levels of content quality. Only 4/59 videos (7%) discussed the natural history of nonsurgically treated DBT ruptures. Of the 32 videos that discussed surgical techniques, only 3/32 (9%) had a preference for 2-incision techniques. No videos discussed the association between spontaneous DBT ruptures and cardiac amyloidosis. Conclusions The overall content, quality, and reliability of DBT videos on YouTube are poor. Videos from academic sources do not provide higher-quality information than videos from nonacademic sources. Videos related to operative treatment of DBT ruptures more frequently discuss single-incision techniques. Clinical relevance Social media videos can function as direct-to-consumer marketing materials, and surgeons should be prepared to address misconceptions regarding the management of DBT tears. Patients are increasingly seeking health information online, and surgeons should direct patients toward more reliable and vetted sources of information.
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Blaeser AM, Markus DH, Hurley ET, Gonzalez-Lomas G, Strauss EJ, Jazrawi LM. Current Controversies and Decision-Making in the Management of Biceps Pathologies. JBJS Rev 2021; 9:01874474-202112000-00008. [PMID: 34962898 DOI: 10.2106/jbjs.rvw.21.00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Biceps tendon pathologies include a spectrum of injuries that range from mild tendinosis to complete tendon rupture. » Tendinosis, the most common pathology, occurs more frequently with age and is likely related to chronic degeneration. On the other side of the spectrum of severity lies a rupture of the long head of the biceps tendon (LHBT), which may be accompanied by injury to the glenoid labrum. » Superior labral anterior-posterior (SLAP) tears are frequently associated with biceps pathology. Surgical management for injuries of the bicipital-labral complex includes biceps tenodesis or tenotomy and SLAP repair. A consensus as to which of these procedures is the optimal choice has not been reached, and management may ultimately depend on patient-specific characteristics. » Due to the relatively low incidence of distal biceps tendon rupture, agreement on the optimal management strategy has not been reached. Surgical repair, or reconstruction in the case of a chronic rupture, is often chosen. However, nonoperative management has also been utilized in older, less-active patients.
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Affiliation(s)
- Anna M Blaeser
- Department of Sports Medicine, New York University Langone Health, New York, NY
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Caekebeke P, Duerinckx J, van Riet R. Acute complete and partial distal biceps tendon ruptures: what have we learned? A review. EFORT Open Rev 2021; 6:956-965. [PMID: 34760294 PMCID: PMC8559565 DOI: 10.1302/2058-5241.6.200145] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Acute distal biceps tendon (DBT) pathology includes bicipitoradial bursitis, tendinosis, partial and complete tears. Diagnosis of complete DBT tears is mainly clinical, whereas in partial tears medical imaging is a valuable addition to the clinical diagnosis. New insights in clinical and medical imaging of partial tears may reduce time to diagnosis and may guide the treatment plan. Most complete tears are best treated with primary repair using either a single-incision or double-incision approach with good clinical outcome. The double-incision technique has a higher risk of heterotopic ossification, whereas a single-incision technique carries a higher risk of nerve-related complications. Intramedullary fixation may be a viable solution to negate the risk of posterior interosseus nerve lesions in single-incision repairs. DBT endoscopy can be used to treat low-grade partial tears and tendinosis. Cite this article: EFORT Open Rev 2021;6:956-965. DOI: 10.1302/2058-5241.6.200145
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Affiliation(s)
- Pieter Caekebeke
- Ziekenhuis Oost-Limburg, Department of Orthopaedics Surgery and Traumatology, Genk, Belgium
| | - Joris Duerinckx
- Ziekenhuis Oost-Limburg, Department of Orthopaedics Surgery and Traumatology, Genk, Belgium
| | - Roger van Riet
- AZ Monica, Department of Orthopedic Surgery, Antwerp, Belgium.,University Hospital Antwerp, Department of Orthopedic Surgery, Edegem, Belgium
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Storti TM, Dias RG, Dantas GCD, Faria RSS, Simionatto JE, Paniago AF. Clinical Evaluation of the Reconstruction of the Biceps Brachii using Triceps Graft. Rev Bras Ortop 2021; 56:656-663. [PMID: 34733439 PMCID: PMC8558938 DOI: 10.1055/s-0041-1729566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 10/28/2020] [Indexed: 10/26/2022] Open
Abstract
Objective Clinical and functional evaluation of the surgical treatment for chronic injury of the distal biceps brachii applying a surgical technique with grafting of the distal triceps brachii tendon. Methods A study based on a review of the medical records and clinical evaluation of the patients submitted to surgical treatment for chronic injury to the distal insertion of the biceps brachii between February 2015 and February 2017. In a 12-month-minimum postoperative follow-up, 7 patients were evaluated regarding the range of motion of the operated and non-operated elbows, flexion, upper-limb extension and supination with a digital dynamometer, the hook test, the satisfaction index, and the Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Elbow Performance Score (MEPS) intruments. Results During the postoperative functional evaluation, no patient reported dissatisfaction with the esthetic outcome of the incisions, and all of them were satisfied/very satisfied with the range of motion and strength of the operated limb. No neurovascular complications, surgical site infection or tendon rupture were observed. On the MEPS and DASH scales, all patients scored 100 and 0 respectively. The mean flexion was of 133.5° on the operated side, versus 139.2° on the non-operated side. The mean extension was of 5° on the operated side versus 0° on the non-operated side. The supination was of 86.5° versus 90°, and the pronation, 80° versus 80°, when comparing the operated and non-operated sides respectively. The mean flexion, extension and supination corresponded respectively to 92.5%, 96.4% and 86.8% of those of the non-operated limb. Conclusion Recosntruction of the distal biceps brachii with triceps grafting seems to be an effective and safe option for the treatment of chronic distal biceps injuries.
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Affiliation(s)
- Thiago Medeiros Storti
- Instituto de Pesquisa e Ensino, Hospital Ortopédico e Medicina Especializada, Brasília, DF, Brasil
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Antonacci CL, Brown SM, O'Brien MJ, Mulcahey MK. Prophylaxis for Heterotopic Ossification Following Distal Biceps Tendon Repair. Orthopedics 2021; 44:e588-e592. [PMID: 34292837 DOI: 10.3928/01477447-20210618-22] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Heterotopic ossification (HO) is a possible complication of distal biceps tendon repair (DBTR). Several agents can prevent HO formation, although relatively few studies have investigated prophylaxis specifically after DBTR. The purposes of this study were to survey members of the American Shoulder and Elbow Surgeons (ASES) to determine (1) what percentage use HO prophylaxis after DBTR; (2) type, dosage, and duration of prophylaxis used; and (3) use of single-incision or double-incision surgical technique. An anonymous electronic survey was distributed to ASES members to determine the use of HO prophylaxis and DBTR technique. The survey included questions regarding the number of DBTRs performed annually; preferred surgical technique and implants; and type, dosage, and duration of HO prophylaxis used before, during, and after surgery. Descriptive statistics were used to analyze the results. Of 173 respondents, 98 (56.6%) performed 1 to 10 DBTRs per year, 65 (37.6%) performed 11 to 25 DBTRs per year, and 10 (5.8%) performed 26 to 50 DBTRs per year. A total of 131 (75.7%) preferred the single-incision technique, whereas 42 (24.3%) preferred the double-incision technique. A total of 94 (54.3%) performed DBTR using a metal button and interference screw, 35 (20.2%) through drill holes, 25 (14.5%) with suture anchors, and 19 (11.0%) with a metal button alone. A total of 132 (76.3%) respondents did not use HO prophylaxis, and 41 (23.7%) used nonsteroidal anti-inflammatory drugs following surgery. A total of 35 (85.4%) used indomethacin, 18 (51.4%) of whom preferred 75 mg/d for 3 to 4 weeks. Heterotopic ossification is a commonly reported complication following DBTR, especially with the double-incision technique. Prophylaxis with anti-inflammatory medications and suppressive modalities (radiation therapy) appear to reduce the incidence of HO. Despite these data, most surgeons (76.3%) do not use HO prophylaxis. Low annual volume of cases, lack of large-volume studies with outcome data, and the dominant use of the single-incision repair technique may explain this. [Orthopedics. 2021;44(4):e588-e592.].
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Cuzzolin M, Secco D, Guerra E, Altamura SA, Filardo G, Candrian C. Operative Versus Nonoperative Management for Distal Biceps Brachii Tendon Lesions: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:23259671211037311. [PMID: 34734095 PMCID: PMC8558817 DOI: 10.1177/23259671211037311] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Both nonoperative and operative treatments have been proposed to manage distal biceps brachii tendon avulsions. However, the advantages and disadvantages of these approaches have not been properly quantified. PURPOSE To summarize the current literature on both nonoperative and operative approaches for distal biceps brachii tendon ruptures and to quantify results and limitations. The advantages and disadvantages of the different surgical strategies were investigated as well. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic literature search was performed in March 2020 using PubMed Central, Web of Science, Cochrane Library, MEDLINE, Iscrctn.com, clinicaltrials.gov, greylit.org, opengrey.eu, and Scopus literature databases. All human studies evaluating the clinical outcome of nonoperative treatment as well as different surgical techniques were included. The influence of the treatment approach was assessed in terms of the Disabilities of the Arm, Shoulder and Hand (DASH) score and the Mayo Elbow Performance Index; extension, flexion, supination, and pronation range of motion (ROM); and flexion and supination strength ratio between the injured and uninjured arms. Risk of bias and quality of evidence were assessed using the Cochrane guidelines. RESULTS Of 1275 studies, 53 studies (N = 1380 patients) matched the inclusion criteria. The results of the meta-analysis comparing operative versus nonoperative approaches for distal biceps tendon avulsion showed significant differences in favor of surgery in terms of DASH score (P = .02), Mayo Elbow Performance Index (P < .001), flexion strength (94.7% vs 83.0%, respectively; P < .001), and supination strength (89.2% vs 62.6%, respectively; P < .001). The surgical approach presented 10% heterotopic ossifications, 10% transient sensory nerve injuries, 1.6% transient motor nerve injuries, and a 0.1% rate of persistent motorial disorders. Comparison of the different surgical techniques showed similar results for the fixation methods, whereas the single-incision technique led to a better pronation ROM versus the double-incision approach (81.5° vs 76.1°, respectively; P = .01). CONCLUSION The results of this meta-analysis showed the superiority of surgical management over the nonoperative approach for distal biceps tendon detachment, with superior flexion and supination strength and better patient-reported outcomes. The single-incision surgical approach demonstrated a slightly better pronation ROM compared with the double-incision approach, whereas all fixation methods led to similar outcomes.
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Affiliation(s)
- Marco Cuzzolin
- Orthopedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | - Davide Secco
- Orthopedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | - Enrico Guerra
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Giuseppe Filardo
- Orthopedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Christian Candrian
- Orthopedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
- Facoltà di Scienze Biomediche, USI–Università della Svizzera Italiana, Lugano, Switzerland
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Di Stefano M, Sensi L, di Bella L, Tucci R, Bazzucchi E, Zanna L. Acute distal biceps tendon rupture: retrospective analysis of two different approaches and fixation techniques. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1543-1551. [PMID: 34596749 PMCID: PMC9587971 DOI: 10.1007/s00590-021-03132-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/23/2021] [Indexed: 11/07/2022]
Abstract
Purpose The 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. Methods A 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. Results Of 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). Conclusion Both techniques provide a reliable and strong repair with an optimal recovery of ROM returning to preinjury activity with substantially overlapping timelines.
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Affiliation(s)
- Marco Di Stefano
- Department of Shoulder and Elbow, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Lorenzo Sensi
- Department of Shoulder and Elbow, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Leonardo di Bella
- Department of Shoulder and Elbow, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Raffaele Tucci
- Department of Shoulder and Elbow, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Efisio Bazzucchi
- Department of Shoulder and Elbow, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy
| | - Luigi Zanna
- Department of Shoulder and Elbow, University of Florence, A.O.U. Careggi CTO - Largo Palagi 1, 50139, Florence, Italy.
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Ritsch M. Bizeps- und Trizepssehnenrupturen im Kraftsport. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00486-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gowd AK, Liu JN, Maheshwer B, Garcia GH, Beck EC, Cohen MS, Nicholson GP, Cole BJ, Verma NN. Return to sport and weightlifting analysis following distal biceps tendon repair. J Shoulder Elbow Surg 2021; 30:2097-2104. [PMID: 33667641 DOI: 10.1016/j.jse.2021.01.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/16/2021] [Accepted: 01/31/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rupture of the distal biceps tendon is an increasingly frequent injury sustained predominantly by middle-aged men. Despite the prevalence of sport in this age group, little is known regarding return to sport outcomes following surgery. METHODS Patients undergoing distal biceps tendon repair (DBR) between January 2015 and January 2017 were contacted electronically via e-mail and via telephone to administer a previously validated and standard return to sport survey. Patients self-reported preinjury and current level of sport and activity as well as preinjury and current level of select weightlifts. RESULTS A total of 77 of 124 patients were available for follow-up (62.1%). Of these patients, 61 endorsed preoperative sport and were included for analysis. Average follow-up was 38.7 ± 6.7 months. The mean age at surgery was 47.5 ± 8.8 years, and the mean body mass index was 30.3 ± 5.1. The dominant side was affected in 25 of 61 cases. Of the 61 included patients, 57 (93.4%) were able to return to sport at any level (lower, same, or higher intensity than preinjury activity level). Forty of the patients (65.6%) were able to return to sport at same or higher intensity. Mean time to return to sport was 6.0 ± 2.8 months. Days from injury to surgery (odds ratio [OR] 0.999, 95% confidence interval [CI] 0.998-0.999), suture anchor fixation in comparison to suture button (OR 0.602, 95% CI 0.427-0.850), and dominant-side surgery (OR 0.749, 95% CI 0.582-0.963) were associated with a decreased likelihood to return to sport at same or higher level of duty. Single-sided incision in comparison to double (OR 5.209, 95% CI 1.239-20.903) and dominant-side surgery (OR 6.370, 95% CI 1.639-24.762) were associated with increased duration to return to sport. CONCLUSION Distal biceps tendon rupture is a significant injury; however, patients can expect high levels of return to sport following DBR with some residual impairment compared with baseline. It is important to counsel patients on their expectations while taking into account the results of this study: that there will be a small but appreciable decrease in strength compared with preinjury levels.
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Affiliation(s)
- Anirudh K Gowd
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Joseph N Liu
- Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | | | - Edward C Beck
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Mark S Cohen
- Rush University Medical Center, Chicago, IL, USA
| | | | - Brian J Cole
- Rush University Medical Center, Chicago, IL, USA
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Distal biceps ruptures repair: Experience with 80 cases. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recote.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Carter TH, Karunaratne BJ, Oliver WM, Murray IR, White TO, Reid JT, Duckworth AD. Acute distal biceps tendon repair using cortical button fixation results in excellent short- and long-term outcomes : a single-centre experience of 102 patients. Bone Joint J 2021; 103-B:1284-1291. [PMID: 34192926 DOI: 10.1302/0301-620x.103b7.bjj-2020-2246.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Acute distal biceps tendon repair reduces fatigue-related pain and minimizes loss of supination of the forearm and strength of flexion of the elbow. We report the short- and long-term outcome following repair using fixation with a cortical button techqniue. METHODS Between October 2010 and July 2018, 102 patients with a mean age of 43 years (19 to 67), including 101 males, underwent distal biceps tendon repair less than six weeks after the injury, using cortical button fixation. The primary short-term outcome measure was the rate of complications. The primary long-term outcome measure was the abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Secondary outcomes included the Oxford Elbow Score (OES), EuroQol five-dimension three-level score (EQ-5D-3L), satisfaction, and return to function. RESULTS Eight patients (7.8%) had a major complication and 34 (33.3%) had a minor complication. Major complications included re-rupture (n = 3; 2.9%), unrecovered nerve injury (n = 4; 3.9%), and surgery for heterotopic ossification (n = 1; 1.0%). Three patients (2.9%) overall required further surgery for a complication. Minor complications included neurapraxia (n = 27; 26.5%) and superficial infection (n = 7; 6.9%). A total of 33 nerve injuries occurred in 31 patients (30.4%). At a mean follow-up of five years (1 to 9.8) outcomes were available for 86 patients (84.3%). The median QuickDASH, OES, EQ-5D-3L, and satisfaction scores were 1.2 (IQR 0 to 5.1), 48 (IQR 46 to 48), 0.80 (IQR 0.72 to 1.0), and 100/100 (IQR 90 to 100), respectively. Most patients were able to return to work (81/83, 97.6%) and sport (51/62,82.3%). Unrecovered nerve injury was associated with an inferior outcome according to the QuickDASH (p = 0.005), OES (p = 0.004), EQ-5D-3L (p = 0.010), and satisfaction (p = 0.024). Multiple linear regression analysis identified an unrecovered nerve injury to be strongly associated with an inferior outcome according to the QuickDASH score (p < 0.001), along with infection (p < 0.001), although re-rupture (p = 0.440) and further surgery (p = 0.652) were not. CONCLUSION Acute distal biceps tendon repair using cortical button fixation was found to result in excellent patient-reported outcomes and health-related quality of life. Although rare, unrecovered nerve injury adversely affects outcome. Cite this article: Bone Joint J 2021;103-B(7):1284-1291.
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Affiliation(s)
- Thomas H Carter
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh and the University of Edinburgh, Edinburgh, UK
| | - Bevin J Karunaratne
- University of Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - William M Oliver
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh and the University of Edinburgh, Edinburgh, UK
| | - Iain R Murray
- Department of Sports Medicine, Stanford University, Redwood City, California, USA
| | - Timothy O White
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh and the University of Edinburgh, Edinburgh, UK
| | - Jeffrey T Reid
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh and the University of Edinburgh, Edinburgh, UK
| | - Andrew D Duckworth
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh and the University of Edinburgh, Edinburgh, UK.,Usher Institute, University of Edinburgh, Edinburgh, UK
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Albishi W, Agenor A, Lam JJ, Elmaraghy A. Distal Biceps Tendon Tears: Diagnosis and Treatment Algorithm. JBJS Rev 2021; 9:01874474-202107000-00002. [PMID: 34260471 DOI: 10.2106/jbjs.rvw.20.00151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Distal biceps tendon (DBT) tears occur most commonly in middle-aged men after a sudden, forced eccentric contraction of the flexed elbow. » An understanding of the multiple risk factors, mechanisms, and pathophysiological causes is essential for proper and timely diagnosis. » High clinical suspicion and routine physical examination with appropriate special examination tests, including the hook test, the passive forearm pronation test, the biceps crease interval test, and the bicipital aponeurosis flex test, can help with rapid and accurate diagnosis and guide appropriate and timely management. » Treatment for DBT tears depends on the extent (complete versus incomplete) and timing (acute versus chronic) of the injury, and options include nonoperative management, repair, and reconstruction with or without repair of the bicipital aponeurosis.
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Affiliation(s)
- Waleed Albishi
- Department of Orthopedic Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Aouod Agenor
- Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jason J Lam
- Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amr Elmaraghy
- Department of Orthopaedic Surgery, Unity Health, St. Joseph's Health Centre, Toronto, Ontario, Canada
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