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Butler K, Almigdad A, Kim J, Dodson E, Malhas A. Outcomes of distal biceps repair at two-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:989-993. [PMID: 37821629 DOI: 10.1007/s00590-023-03756-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE This single-centre study aimed to review the postoperative outcomes of distal biceps avulsion repair using a single incision with the endo-button technique. METHODS A retrospective cohort study was performed of a single surgeon series of distal biceps repairs performed consecutively from September 2016 to September 2020. At two years, outcome measures included Oxford Elbow Score (OES), range of movement (ROM), complications and ongoing issues. RESULTS Forty-five distal biceps tendon repairs were performed on 43 patients with a mean follow-up of 3.2 years (1.1-5.3). The average OES was 46 (11-48), and 90% of patients recovered a comparable range of movement to the contralateral side. Two patients developed re-rupture (4%) on days 0 and 9 of surgery, but there were no late re-ruptures of the repair. CONCLUSION Short-term outcomes from distal biceps tendon repair show low complication rates, high patient satisfaction and good functional outcomes. The results would support acute surgical treatment of active, working-age, patients with distal biceps tendon ruptures.
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Affiliation(s)
- Kathrine Butler
- Department of Orthopaedic, Royal Berkshire Foundation Trust Hospital, Reading, UK
| | - Ahmad Almigdad
- Department of Orthopaedic, Royal Berkshire Foundation Trust Hospital, Reading, UK
| | - Jaewoo Kim
- Department of Orthopaedic, Royal Berkshire Foundation Trust Hospital, Reading, UK
| | - Ellen Dodson
- Department of Orthopaedic, Royal Berkshire Foundation Trust Hospital, Reading, UK
| | - Amar Malhas
- Department of Orthopaedic, Royal Berkshire Foundation Trust Hospital, Reading, UK.
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Schmidt GJ, Dmochowski JM, Gudeman AS, Cage ES, Greenberg JA, Hoyer RW. Primary Repair of Chronic Distal Biceps Tendon Tears. Hand (N Y) 2024; 19:38-43. [PMID: 35815641 PMCID: PMC10786113 DOI: 10.1177/15589447221107691] [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] [Indexed: 02/10/2023]
Abstract
BACKGROUND This study reports the clinical results following primary repair of distal biceps tendon ruptures more 6 weeks after injury. METHODS A retrospective review of distal biceps tendon repairs performed by 8 different hand surgeons from January 1, 2015 to October 15, 2020 was performed. Patients with complete tears surgically treated ≥6 weeks after injury without tendon graft were included. Thirty patients qualified and underwent chart review for complication and range of motion (ROM) data. They were contacted for final patient-reported outcome measures (PROMs) using Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Patient Reported Elbow Evaluation (PREE) scores. Final PROMs were obtained from 21 patients with an average follow-up of 31.3 months (range: 4-71 months). RESULTS Average time from injury to repair was 71 days (range: 42-204). The average QuickDASH score was 6.6 (±6.2) and PREE score was 7.8 (±8.0). The amount of elbow flexion necessary to complete the repair was documented in 21 patients and averaged 64º (±10º). Postoperatively, patients achieved an average extension/flexion of 1º (±1º) to 138º (±2º) and pronation/supination of 76º (±4º) to 77º (±3º). Complications were reported in 14 patients (47%) and included 2 re-ruptures, 1 adhesive scar formation, 1 superficial infection, 1 intraoperative lateral antebrachial cutaneous nerve laceration, 12 neuropraxias, and 1 case of heterotopic ossification (HO). CONCLUSIONS Primary repair of chronic distal biceps tendon tears greater than 6 weeks from injury demonstrated excellent PROMs and elbow ROM. However, the complication rate may be higher than early repair.
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Carlier Y, Pierreux PA. Primary repair of acute versus chronic ruptures of the distal biceps tendon. Comparison of functional results in a case-control study. Orthop Traumatol Surg Res 2023; 109:103559. [PMID: 36690325 DOI: 10.1016/j.otsr.2023.103559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/18/2022] [Accepted: 01/02/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND In the event of a rupture of the distal tendon of the biceps brachii, most authors recommend early reinsertion to recover optimal elbow function. However, these ruptures are not always diagnosed or promptly referred to surgeons, thus creating a delay in treatment. Studies reporting functional results in cases of chronic repair (greater than 21 days) of the distal biceps brachii tendon show an increased rate of complications. HYPOTHESIS Primary repairs of chronic ruptures (treatment delayed for more than 21 days) and acute ruptures of the distal biceps give the same functional results and the same rate of complications. MATERIAL AND METHODS We conducted a retrospective study between January 2017 and December 2021 comparing chronic primary repair of the distal biceps at the elbow (experimental group, comprising 75 patients) and acute (control group, comprising 135 patients) by endobutton. We analyzed the time between trauma and surgery, and assessed short- and long-term functional recovery by measuring residual pain (VAS), a collection of the following functional scores: Mayo Elbow Performance Score (MEPS), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) and Patient-Rated Elbow Evaluation (PREE), as well as a measure of strength (as a percentage of the healthy side). We evaluated the rate of complications and radiographically analyzed the rate of heterotopic ossification. RESULTS The mean time between trauma and surgery was 73±66 days (experimental group) versus 11.2±5 days (control group). In the short-term (4.79±2.09 months), there was no significant difference in the MEPS, Q-DASH and PREE functional scores between the two groups (p=0.354, p=0.412 and p=0.958, respectively). In the long-term (28.9±17.9 months), the functional evolution remained similar. The recovery of strength in flexion and supination was 89.19±13.43% and 77.48±16.68%, respectively, and similar in the two cohorts (p=0.476 and p=0.395). There was no difference in the rate of complications; however, the rate of heterotopic ossification was higher in the control group (p=0.006). DISCUSSION The functional results and the recovery of strength did not change according to the time until surgery. Although the overall complication rate was similar, repairs of the biceps in less than 21 days led to more heterotopic ossification. LEVEL OF EVIDENCE III; retrospective case-control study.
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Affiliation(s)
- Yacine Carlier
- Centre de l'arthrose de Mérignac, clinique du sport Bordeaux-Mérignac, 6, rue Georges-Nègrevergne, 33700 Mérignac, France.
| | - Pieter Antoine Pierreux
- Centre de l'arthrose de Mérignac, clinique du sport Bordeaux-Mérignac, 6, rue Georges-Nègrevergne, 33700 Mérignac, France; Department of Orthopaedics and Traumatology, Orthoclinic Brugge, AZ Sint-Jan AV, Brugge - Ruddershove 10, 8000 Brugge, Belgium
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Moriya K, Maki Y, Koda H, Tsubokawa N. A Novel Reconstruction Technique for Chronic Distal Biceps Tendon Rupture: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00039. [PMID: 37556579 DOI: 10.2106/jbjs.cc.23.00184] [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: 08/11/2023]
Abstract
CASE A 71-year-old otherwise healthy man presented with an 8-week history of elbow pain and weakness in both elbow flexion and forearm supination. Magnetic resonance imaging revealed complete rupture of the distal biceps tendon insertion associated with 65 mm of proximal retraction. At 10 weeks after initial injury, the patient underwent a novel reconstruction technique using a periosteal flap from the iliac crest; subsequently, all symptoms resolved. CONCLUSION Chronic distal biceps tendon injuries can be reconstructed safely and effectively using a periosteal flap from the iliac crest that allows not only rigid but also biological graft attachment.
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Cognetti DJ, McDermott ER, Song DJ, Tennent DJ. Minimally Invasive Distal Biceps Tendon Reconstruction With Semitendinosus Allograft and Dual Unicortical Button Fixation. Arthrosc Tech 2023; 12:e943-e949. [PMID: 37424649 PMCID: PMC10323917 DOI: 10.1016/j.eats.2023.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/12/2023] [Indexed: 07/11/2023] Open
Abstract
Complete rupture of the distal biceps tendon is routinely treated with direct repair; however, chronic, mid-substance, or musculotendinous tears are challenging clinical scenarios for surgeons. Although attempts at direct repair should be considered, in cases of severe retraction or tendon deficiency, a reconstruction may be warranted. Herein the authors describe a technique for distal biceps reconstruction using allograft with a Pulvertaft weave via a standard anterior incision, similar to primary repair, with a small catchment incision more proximally for tendon retrieval. Use of this technique with dual unicortical buttons allows for early range of motion, restoration of the distal footprint, and improved biomechanical construct strength, which has proven invaluable in a population of elite and highly active military servicemembers.
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Affiliation(s)
- Daniel J. Cognetti
- Department of Orthopaedic Surgery and Rehabilitation, San Antonio Military Medical Center, San Antonio, Texas
| | - Emily R. McDermott
- Department of Orthopaedic Surgery and Rehabilitation, San Antonio Military Medical Center, San Antonio, Texas
| | - Daniel J. Song
- Department of Orthopaedic Surgery, Evans Army Community Hospital, Fort Carson, Colorado, U.S.A
| | - David J. Tennent
- Department of Orthopaedic Surgery, Evans Army Community Hospital, Fort Carson, Colorado, U.S.A
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Tzeuton S, Johns W, Campbell B, Hammoud S, Ciccotti MG, Namdari S. Outcomes and Patient Satisfaction of Delayed Distal Biceps Repairs without Graft Augmentation: A Systematic Review. JBJS Rev 2023; 11:01874474-202305000-00001. [PMID: 37141425 DOI: 10.2106/jbjs.rvw.22.00185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Distal biceps tendon tears are responsible for 3% to 10% of all biceps ruptures. Treated nonoperatively, these injuries result in poor endurance, loss of supination strength, and loss of flexion strength compared with those treated operatively with repair or reconstruction. When presenting in a chronic fashion, operative management can involve graft reconstruction or primary repair. When there is adequate tendon excursion and quality, primary repair is preferred. The purpose of this systematic review was to investigate the literature regarding outcomes of direct surgical repair of chronic distal biceps tendon ruptures. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to perform this systematic review and for the presentation of results. A search of the literature was performed on the electronic database Medline, Scopus, and the Cochrane Library. Included studies evaluated subjective and objective outcomes after delayed treatment (≥4 weeks postinjury) for chronic distal biceps tendon ruptures, without use of graft augmentation. Subjective and objective outcome metrics such as functional scores, range of motion, strength, pain level, and return to employment were collected. RESULTS Eight studies were reviewed. The studies included 124 patients with chronic distal biceps tendon tears, treated surgically after a mean delay to surgery of 121.8 days. Four studies included comparison of patients with acute and chronic tears, whereas the other 4 studies assessed chronic tears only. The findings of these 4 studies suggest that direct repair of chronic tears is correlated with a mildly higher rate of lateral antebrachial cutaneous nerve (LABCN) injury palsy (10/82 [12.1%] chronic vs. 3/38 [7.9%] acute, p = 0.753); however, this complication was overwhelmingly transient. There were only 3 reported reruptures (3.19%) across 5 studies reporting this complication. Overall, patients who had undergone direct repair of chronic distal biceps tears had good patient satisfaction, outcomes, and range of motion. CONCLUSION Direct repair of chronic distal biceps tendon tears without the use of graft reconstruction is associated with acceptable patient satisfaction, range of motion, and functional outcome scores, although transient LABCN palsy rates may be slightly higher. When sufficient residual tendon is present in the setting of chronic distal biceps rupture, direct repair is a viable treatment option. However, the existing literature regarding direct repair of chronic distal biceps repair is limited, and further prospective assessment directly comparing primary repair vs. reconstruction of chronic distal biceps ruptures is warranted. LEVEL OF EVIDENCE Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Serge Tzeuton
- The University of Maryland Medical Center, Baltimore, Maryland
| | - William Johns
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Benjamin Campbell
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sommer Hammoud
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael G Ciccotti
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Surena Namdari
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Tovar-Bazaga M, Llaneras MPC, Badia A. Reconstruction of chronic distal biceps ruptures by dermal matrix. HAND SURGERY AND REHABILITATION 2023; 42:243-249. [PMID: 37004984 DOI: 10.1016/j.hansur.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES Distal biceps tear is uncommon, with well-recognized risk factors and typical clinical presentation. Delays in surgical treatment lead to several challenges, such as tendon retraction and tendon degeneration. We present a surgical technique using a sterilized acellular dermal matrix, which provides a solution for a challenging pathology. MATERIAL AND METHODS We present a detailed surgical technique of distal biceps reconstruction with acellular dermal matrix, performed in 4 patients, with an average time to diagnosis of 36 days (range, 28-45 days). Demographics, clinical data, range of motion and subjective satisfaction were collected. RESULTS At a mean follow-up of 18 months, all 4 patients showed full range of motion and strength, complete recovery and previous work resumed without pain. No complications appeared during this time. CONCLUSIONS Delayed distal biceps tear reconstruction by acellular dermal matrix showed promising results. Meticulous surgical technique using this matrix provided excellent reconstruction, with very solid anatomical repair and exceptionally good fixation, good clinical outcome and satisfied patients. LEVEL OF EVIDENCE IV.
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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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9
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Synovec JD, Traven SA, Griffith AT, Novikov D, Li X, Woolf SK, Eichinger JK, Slone HS. Outcomes and complications after different surgical techniques for the treatment of chronic distal biceps tendon ruptures: a systematic review and quantitative synthesis. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:323-331. [PMID: 37588857 PMCID: PMC10426634 DOI: 10.1016/j.xrrt.2022.02.007] [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] [Indexed: 08/18/2023]
Abstract
Hypothesis The purpose of this study was to perform a systematic review of the available literature evaluating surgical outcomes after chronic distal biceps tendon rupture. Surgical techniques, including primary repair, autograft reconstruction, and allograft reconstruction, were compared, as well as subjective and objective clinical outcomes and complication rates. Methods A systematic literature search of Level I-IV studies reporting outcomes of surgically treated chronic distal biceps tendon ruptures were performed via PubMed, Cochrane Collaboration, Science Direct, and Google Scholar databases. Twenty-two papers were identified in the review, with 236 patients. A Modified Coleman Methodological Score (CMS) was determined for every article to assess study quality. Patient-reported outcomes, postoperative range of motion, flexion and supination strength, and postoperative complications were recorded. MAYO elbow scores (MEPS) were reported more consistently than the other outcome tools. Results No Level I or level II studies were identified in our search, and the heterogeneity of outcome measures precluded meta-analysis. Studies demonstrated mean MEPS scores ranging between 86 and 100, regardless of the surgical technique utilized. All studies reported a mean flexion-extension arc equal to or greater than 5-130°. The reported mean postoperative flexion strength was within 10% of the unaffected contralateral side. The most common complication for both direct repair and reconstruction groups was paresthesia of the lateral antebrachial cutaneous nerve [direct repair: 18-16.8%; reconstruction: 8-6.2% (allograft: 4-6%; autograft: 4-7%)]. Rerupture was uncommon and occurred in three patients who had undergone direct repair and in one patient after autograft reconstruction. Conclusions Surgical treatment of chronic distal biceps injuries yields favorable objective and subjective outcomes. Currently, available evidence suggests that direct repair, autograft reconstruction, or allograft reconstruction are all viable treatment options with similar outcomes.
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Affiliation(s)
| | | | | | | | - Xinning Li
- Boston University Medical Center, Boston, MA, USA
| | - Shane K. Woolf
- Medical University of South Carolina, Charleston, SC, USA
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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: 1.5] [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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Metikala S, Portnoff B, Herickhoff P. Staged Achilles Allograft Reconstruction of Chronic Bilateral Simultaneous Tears of the Retracted Distal Biceps Tendon Using a Novel Fixation Technique. Cureus 2022; 14:e25172. [PMID: 35747037 PMCID: PMC9206879 DOI: 10.7759/cureus.25172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 11/05/2022] Open
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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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Boonrod A, Harasymczuk M, Ramazanian T, Boonrod A, Smith J, O’Driscoll SW. The Turtle Neck Sign: Identification of Severe Retracted Distal Biceps Tendon Rupture. Orthop J Sports Med 2022; 10:23259671211065030. [PMID: 35071656 PMCID: PMC8777348 DOI: 10.1177/23259671211065030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Chronic tendon retraction subsequent to distal biceps tendon rupture significantly increases repair difficulty and potential for tendon grafting. Biceps tendons that appear short or absent with magnetic resonance imaging (MRI) or that cannot be readily identified at surgery may erroneously be classified as irreparable. These apparent “absent” biceps tendons may actually be retracted and curled up inside the muscle, visually resembling the head-neck of a turtle retracted inside its shell (the “turtle neck sign”). When located, these tendons could be unfolded and repaired primarily. This type of tendon retraction seems to be associated with high-degree ruptures and larcertus fibrosus tears. Purpose: To test the hypothesis that tendon retractions with a turtle neck sign on MRI are more associated with high-degree ruptures and larcertus fibrosus tears versus tendon tears with simple linear retraction. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Retracted distal biceps tendon ruptures on sagittal MRI were categorized as linear retraction or curled-up (turtle neck) retraction. Retraction length, injury severity, and lacertus fibrosus tears were analyzed. Results: The authors retrospectively analyzed the patient records of 85 consecutive traumatic distal biceps tendon ruptures from 2003 to 2019; the final study cohort was 37 patients. Injury-to-surgery timing was as follows: <3 weeks, 43% (16 cases); 3 weeks to 3 months, 32% (12 cases); and >3 months, 24% (9 cases). Overall, 19 patients had linear retraction <7 cm (mean, 3.3 ± 1.9 cm) and 18 patients had a turtle neck retraction ≥7 cm (mean, 9.1 ± 1.6 cm). The injury-to-surgery time (median [± interquartile range]) was 27 days (±90 days) in the linear retraction group and 23 days (±65 days) in the turtle neck retraction group. The turtle neck retraction group had a significantly higher occurrence of abnormal hook test findings, complete distal biceps tendon rupture, and lacertus fibrosus tears compared with the linear retraction group (100% vs 58%, 100% vs 68%, and 100% vs 37%, respectively; P ≤ .02). However, significant repairability differences were not found. Conclusion: Highly retracted distal biceps turtle neck sign tendon ruptures occur frequently in association with high-degree ruptures and lacertus fibrosus tears. The presence of a turtle neck retraction did not affect reparability. Surgeons should be aware of this curled-up retraction to avoid mistaking it for an absent tendon or a muscle-tendon disruption.
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Affiliation(s)
- Artit Boonrod
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopaedics, Khon Kaen University, Khon Kaen, Thailand
| | - Michal Harasymczuk
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Traumatology, Orthopedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - Taghi Ramazanian
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Arunnit Boonrod
- Department of Radiology, Srinagarind Hospital, Khon Kaen, Thailand
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
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Bajwa A, Simon MJK, Leith JM, Moola FO, Goetz TJ, Lodhia P. Surgical Results of Chronic Distal Biceps Ruptures: A Systematic Review. Orthop J Sports Med 2022; 10:23259671211065772. [PMID: 35005052 PMCID: PMC8738885 DOI: 10.1177/23259671211065772] [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: 08/02/2021] [Accepted: 09/10/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Distal biceps tendon tears can cause weakness and fatigue with activities requiring elbow flexion and supination. Surgical management of chronic tears (>21 days) is not well described in the literature. Purpose: To determine the clinical outcomes of chronic distal biceps repairs and reconstructions. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a search of Medline (PubMed and Ovid), EMBASE, CINAHL physical therapy, Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, and PubMed Central from inception until September 29, 2020, to identify articles on chronic distal biceps ruptures. The inclusion criteria were studies with at least 1 outcome measure and 10 patients with chronic distal biceps ruptures treated surgically. The quality of the included studies was assessed with the methodological index for nonrandomized studies (MINORS) score. Functional outcomes and complications were reviewed. Results: A total of 12 studies were included after systematic database screenings. The MINORS scores ranged from 5 to 19. There were a total of 1704 distal biceps ruptures, of which 1270 were acute and 434 were chronic. Average follow-up time was 12 months to 5.1 years. Single-incision (n = 3), 2-incision (n = 2), or both (n = 6) surgical techniques were used in these studies. Four studies described the use of autografts, and 4 articles used allografts in the chronic repair. Range of motion, function, and strength outcomes were similar when compared with the contralateral arm. Pain was reduced to minimal levels. Main postoperative complications were of paresthesia (specifically to the lateral antebrachial cutaneous nerve), which were temporary in 69.1% of cases. Conclusion: The results of this review indicate that surgical management of chronic distal biceps ruptures demonstrates improvement in outcomes including pain reduction and functional ability. Although there may be a slightly higher immediate complication rate, the functional outcomes remain comparable with those seen in the patient population with acute distal biceps.
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Affiliation(s)
- Arpun Bajwa
- Gray's Harbor Medical Group, Gray's Harbor Orthopedics, Aberdeen, Washington, USA
| | - Maciej J K Simon
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Orthopaedics and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jordan M Leith
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Footbridge Clinic for Integrated Orthopaedic Care, Vancouver, British Columbia, Canada
| | - Farhad O Moola
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Fraser Orthopaedic Institute, New Westminster, British Columbia, Canada
| | - Thomas J Goetz
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Parth Lodhia
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Fraser Orthopaedic Institute, New Westminster, British Columbia, Canada
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15
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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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16
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Beeler S, Hecker A, Bouaicha S, Meyer DC, Wieser K. Indirect markers for length adjustment in distal biceps tendon allograft reconstruction. PLoS One 2021; 16:e0257057. [PMID: 34473790 PMCID: PMC8412371 DOI: 10.1371/journal.pone.0257057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 08/21/2021] [Indexed: 11/27/2022] Open
Abstract
Chronic musculotendinous retraction, shortening and fibrosis after distal biceps tendon tears makes a primary reconstruction often difficult or even impossible. Interposition reconstruction with allograft provides a solution, however there is no consensus about appropriate intraoperative graft length adjustment. Therefore, the purpose of this study was to find a practical reference value for distal biceps tendon length adjustment. Three-dimensional surface models of healthy distal biceps tendons were created based on 85 MRI scans. The tendon length was measured from the myotendinous junction to the insertion on the bicipital tuberosity. Inter-epicondylar distance (IED) and radial head diameter (RHD) were measured on antero-posterior radiographs as a surrogate for patient size. Correlations between the tendon length and IED, RHD and patient’s height (PH) were calculated. Mean length of the external part of the distal biceps tendon was 69mm (female 64mm, male 71mm). The tendon length in mm was on average 1.1 times of the IED (mm), 3 times of the RHD (mm) and 0.4 times of PH (cm). Herewith, the tendon length could be predicted within a narrow range of +/-1cm in 84% by using IED, 82% by using RHD and 80% by using PH. Intra- and inter-reader reliabililty of IED and RHD was excellent (R2 = 0.938–0.981). The distal biceps tendon length can be best predicted within 1cm with an accuracy of 82–84% using the IED and RHD with an excellent intra- and inter-reader reliability.
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Affiliation(s)
- Silvan Beeler
- Balgrist University Hospital, Zurich, Switzerland
- * E-mail:
| | | | | | | | - Karl Wieser
- Balgrist University Hospital, Zurich, Switzerland
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17
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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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18
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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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19
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Morrey B. Why the elbow? My experience and perspective. J Clin Orthop Trauma 2021; 20:101474. [PMID: 34194971 PMCID: PMC8220003 DOI: 10.1016/j.jcot.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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20
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Jiménez-Martín A, Santos-Yubero FJ, Najarro-Cid FJ, Navarro-Martínez S. Distal biceps ruptures repair: Experience with 80 cases. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [PMID: 33903025 DOI: 10.1016/j.recot.2020.11.006] [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: 11/25/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Rupture of distal biceps has a frequency of 1.2 cases per 100,000 population. Conservative treatment presents a loss in supination of 40% and flexion of 30%, like transfers to the brachialis. Our goal is to review our experience with anatomical reattachment. MATERIAL AND METHODS Cohorts study. We analized an historic cohort, although recent, treated with double approach (Boyd-Anderson) compared to another prospective cohort (treated with single and double approach). Sample size of 80 patients. Mean age of 48.9±5.9years. We analyzed laterality, time to diagnosis, presurgery time, surgery time, approach, type of reintegration, rehabilitation time, Mayo Elbow Performance Score (MEPS), biomechanical study and complications. Follow up from 2 years to 7years. RESULTS Time for diagnosis was about 4days. Preoperative time: 12.2±6.4 days. Surgical time: 61.9±15.7minutes. We used the two-way surgical approach (Boyd-Anderson-Morrey) in 78.8% of patients, and the anterior surgical approach (Henry) in 21.2% of cases. Transosseous reinsertion was made in 45% of cases, with screw anchor in 40% and with cortical button in 15%. Rehabilitation time: 91±29.7 days. MEPS: 88±11.7 points. There was loss of flexor strength of 28±16.6%. COMPLICATIONS 1case of proximal radioulnar synostosis, 2 radial transient paralysis and 5 cases with residual stiffness. Hypothesis contrast: We reached best results in MEPS with double surgical approach (P=.009), with fewer complications (P=.008). We observed increased pain with cortical buttons (P<.05) and less surgical time if patient was operated before 1week (P=.03). Relative risk of 0.2 when we compared type of approach with radial nerve lesion risk, considering that double approach had less cases, what it would be consider as a protective factor. CONCLUSIONS In our experience, we believe that anatomic reattachment is an effective treatment. Double surgical approach presents best result in MEPS, with fewer complications than with anterior approach.
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Affiliation(s)
- A Jiménez-Martín
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Fremap, Sevilla, España.
| | - F J Santos-Yubero
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Fremap, Sevilla, España
| | - F J Najarro-Cid
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Fremap, Sevilla, España
| | - S Navarro-Martínez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Fremap, Sevilla, España
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21
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Litowski ML, Purnell J, Hildebrand KA, Bois AJ. Surgical outcomes and complications following distal biceps tendon reconstruction: a systematic review and meta-analysis. JSES Int 2020; 5:24-30. [PMID: 33554159 PMCID: PMC7846700 DOI: 10.1016/j.jseint.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Primary repair of chronic distal biceps tendon ruptures may not be possible because of tendon retraction, and there remains no clear consensus on the type of reconstruction technique used. The purpose of this study was to report the clinical outcomes and complication rates following reconstruction of chronic distal biceps tendon ruptures. Methods A systematic review was performed following PRISMA guidelines. The following databases were searched: Embase, MEDLINE, and Cochrane Central Register of Controlled Trials. The primary outcomes of interest included range of motion, strength, and functional outcome scores. Secondary outcomes included complication, reoperation, and revision rates. Outcomes and complication rates of each graft type and fixation technique were aggregated and compared with nonparametric Wilcoxon signed rank and rank sum tests. Spearman rank coefficients were calculated for time from injury to surgery on all outcomes. Results There were no significant differences found between the graft type or fixation technique for postoperative range of motion, strength, and patient-reported outcomes. Postoperative complications were substantially higher in the autograft group (34%) as compared to the allograft group (14%). The fixation technique used also demonstrated a significantly increased complication rate in the weave group compared with the onlay group (34% and 9%, respectively). Conclusion Our results do not reveal any statistically significant differences between groups in the primary outcomes. However, substantially higher complication rates were observed in the autograft and weave cohorts; more than half of the complications related to the use of autograft were associated with donor site morbidity. No specific graft type was identified as superior, although this may be due to the small patient numbers included within this study.
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Affiliation(s)
- Madison L Litowski
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Jennifer Purnell
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Kevin A Hildebrand
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Aaron J Bois
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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22
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Hinckel BB, Baumann CA, Ejnisman L, Cavinatto LM, Martusiewicz A, Tanaka MJ, Tompkins M, Sherman SL, Chahla JA, Frank R, Yamamoto GL, Bicos J, Arendt L, Fithian D, Farr J. Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic. J Am Acad Orthop Surg Glob Res Rev 2020; 4:e20.00083. [PMID: 33986224 PMCID: PMC7537824 DOI: 10.5435/jaaosglobal-d-20-00083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/16/2020] [Indexed: 01/08/2023]
Abstract
Orthopaedic practices have been markedly affected by the emergence of the COVID-19 pandemic. Despite the ban on elective procedures, it is impossible to define the medical urgency of a case solely on whether a case is on an elective surgery schedule. Orthopaedic surgical procedures should consider COVID-19-associated risks and an assimilation of all available disease dependent, disease independent, and logistical information that is tailored to each patient, institution, and region. Using an evidence-based risk stratification of clinical urgency, we provide a framework for prioritization of orthopaedic sport medicine procedures that encompasses such factors. This can be used to facilitate the risk-benefit assessment of the timing and setting of a procedure during the COVID-19 pandemic.
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Affiliation(s)
- Betina B Hinckel
- From the Oakland University, Rochester (Dr. Hinckel, and Dr. Cavinatto); Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak (Dr. Hinckel, Dr. Cavinatto), MI; the University of Missouri-School of Medicine, Columbia, MO (Mr. Baumann); the Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, BR (Dr. Ejnisman); the Shoulder and Elbow Surgery, Beaumont Orthopaedic Associates, Beaumont Health (Dr. Martusiewicz); the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Dr. Tanaka); the Department of Orthopedic Surgery, TRIA Orthopedic Center, University of Minnesota, Gillette Children's Specialty Healthcare, MN (Dr. Tompkins); the Department of Orthopedic Surgery, Stanford University, CA (Dr. Sherman); the Rush University Medical Center, Chicago, IL (Dr. Chahla); the Division of Sports Medicine and Shoulder Surgery, Department of Orthopedics, Aurora, CO (Dr. Frank); the Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA (Dr. Yamamoto); CEGH-CEL, Instituto de Biociências, Universidade de São Paulo (Dr. Yamamoto); DASA Laboratories, Sao Paulo, Brazil (Dr. Yamamoto); the Michigan Orthopedic Surgeons, Fellowship Director William Beaumont Sports Medicine Fellowship, Assistant Professor Oakland University William Beaumont School of Medicine, MI (Dr. Bicos); the Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN (Dr. Arendt); the Southern California Permanente Medical Group and Torrey Pines Orthopaedic Medical Group, San Diego, CA (Dr. Fithian); and the Knee Preservation, Cartilage Regeneration and OrthoBiologics, Department of Orthopedic Surgery, Indiana University School of Medicine, OrthoIndy and OrthoIndy Hospital, Greenwood and Indianapolis, IN (Dr. Farr)
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23
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Zeman CA, Mueller JD, Sanderson BR, Gluck JS. Chronic distal biceps avulsion treated with suture button. J Shoulder Elbow Surg 2020; 29:1548-1553. [PMID: 32381475 DOI: 10.1016/j.jse.2020.01.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/25/2020] [Accepted: 01/28/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal biceps tendon avulsions account for 3%-10% of all biceps ruptures. Treated nonoperatively, these injuries lead to a loss of endurance, supination strength, and flexion strength compared with operative repair or reconstruction. Operative management of chronic injury has classically been with graft tissue to augment the contracted muscle. We present our results for chronic distal biceps avulsions secured with suture button through a single transverse incision in high flexion without the need for allograft augmentation. MATERIALS AND METHODS This was a retrospective review of 20 patients with 21 injuries who underwent primary surgical repair of chronic distal biceps tendon avulsions at an average of 10 weeks (range 4-42 weeks). All patients were treated with a single transverse incision with a suture button armed with nonabsorbable no. 2 core sutures. Postoperatively patients were found to have 50°-90° flexion contracture. All patients were placed in a simple sling postoperatively with gentle extension to gravity as tolerated immediately and no formal physical therapy. Patients were surveyed regarding pre- and postoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, visual analog scale (VAS) score, Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and overall satisfaction. Range of motion (ROM), flexion, and supination strength compared to the contralateral uninjured extremity were evaluated at final follow-up. RESULTS Mean clinical follow-up was 26 months. All patients regained full ROM and 5/5 flexion and supination strength at final follow-up. MEPSs were 100 for all responding patients compared with an average 47.5 preoperatively (P < .0001). The mean postoperative ASES score was 97.2 compared with 41.9 preoperatively (P < .0001). Mean OESs pre- and postoperatively were 24.2 and 48, respectively (P < .0001). The mean VAS score was 4.4 preoperatively and was reported as 0 by all patients at final follow-up (P < .0001). Two patients had transient sensory radial nerve neuropathy, and 1 patient has persistent palsy. No synostoses occurred. Four patients reported supination fatigue postoperatively compared with the uninjured extremity. CONCLUSION Given these results, we feel that chronic distal biceps tendon ruptures can be repaired successfully with a single incision using suture button technique without the use of a graft. Though the flexion contracture is significant postoperatively, all patients regained full ROM and had excellent postoperative functional outcome scores.
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Affiliation(s)
- Craig A Zeman
- Ventura Orthopedics, Clinical Faculty at Community Memorial Health System Orthopedic Residency, Ventura, CA, USA
| | - Joseph D Mueller
- Department of Orthopedic Surgery, Community Memorial Health System, Ventura, CA, USA.
| | - Brent R Sanderson
- Department of Orthopedic Surgery, Community Memorial Health System, Ventura, CA, USA
| | - Joshua S Gluck
- Ventura Orthopedics, Clinical Faculty at Community Memorial Health System Orthopedic Residency, Ventura, CA, USA
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24
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Luokkala T, Siddharthan SK, Karjalainen TV, Watts AC. Distal biceps hook test - Sensitivity in acute and chronic tears and ability to predict the need for graft reconstruction. Shoulder Elbow 2020; 12:294-298. [PMID: 32788933 PMCID: PMC7400716 DOI: 10.1177/1758573219847146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/07/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study was to assess the sensitivity of distal biceps hook test - O'Driscoll hook test - in a retrospective series of acute and chronic distal biceps tendon tears and investigate the ability of the test to predict the need for graft reconstruction. METHODS We retrospectively evaluated 234 consecutive distal biceps tendon tears operated in a single centre. The result of O'Driscoll hook test and perioperative findings of distal biceps were documented in standard fashion. RESULTS The perioperative and O'Driscoll hook test data were available in 202 cases. The sensitivity for the distal biceps hook test was 78% in all tears and 83% in complete tears. The sensitivity was significantly lower in partial tears (30%) and in cases where lacertus fibrosus was found to be intact (45 %). When O'Driscoll hook test was positive and the delay from initial injury to operative intervention was eight weeks or more, there was over 75% probability of achilles tendon allograft reconstruction. When O'Driscoll hook test was negative, the probability of reconstruction even after 12 weeks' delay was only 20%. DISCUSSION O'Driscoll hook test is useful when establishing distal biceps tendon tear diagnosis, but a negative test does not exclude rupture. In delayed cases, a positive test may predict the need for reconstruction.
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Affiliation(s)
- Toni Luokkala
- Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK,Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland,Toni Luokkala, Keski-Suomen Keskussairaala, Keskussairaalantie 19, 40620 Jyväskylä, Finland.
| | - Sijin K Siddharthan
- Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | | | - Adam C Watts
- Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
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25
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Freislederer F, Papillo D, Glanzmann M, Scheibel M. Distale Bizepssehnen- und Trizepssehnenrupturen. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2020; 158:663-682. [DOI: 10.1055/a-0999-8250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ZusammenfassungRupturen der distalen Bizeps- und Trizepssehne sind selten, treten jedoch gehäuft bei männlichen, sportlichen und körperlich schwer arbeitenden Patienten auf. Dieser Übersichtsartikel beschreibt Ätiologie und Pathogenese sowie Diagnostik, Behandlungsmöglichkeiten, das zu erwartende Outcome dieser Verletzungen und gibt Einblicke in das eigene Vorgehen.
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26
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Return to work following a distal biceps repair: a systematic review of the literature. J Shoulder Elbow Surg 2020; 29:1002-1009. [PMID: 32147339 DOI: 10.1016/j.jse.2019.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/07/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Among an active aging population, distal biceps tendon ruptures are becoming increasingly common. Typically, they are the result of an acute heavy eccentric load being placed on an already contracted muscle, and surgery is the gold standard treatment for optimal clinical and functional outcomes. Although improved strength has been shown after operative repair, there is little evidence available regarding a timeframe for return to work-related activity. The purpose of this study was to conduct a systematic review of the literature to provide guidance for return to work after a distal biceps repair. METHODS The authors searched online databases (EMBASE, MEDLINE) from inception until October 11, 2018, for literature pertaining to functional outcomes after distal biceps repair. Study inclusion and exclusion criteria were established a priori and applied in duplicate independently by 2 reviewers. RESULTS Of the 480 initial studies, 40 papers satisfied full text inclusion criteria (19 case control studies, 12 retrospective reviews, 9 prospective reviews). A total of 1270 patients with 1280 distal bicep ruptures were included in the study. The mean age of patients was 45.38 years, and 97% (n = 1067) of reported patients were male. The mean follow-up time was 30 months (range, 6-84 months). After distal biceps repair, 1128 (89%) of patients were able to fully return to work without any modification of duties. Time to return to work was reported in 17 of the included studies with a mean of 14.37 ± 0.52 weeks. DISCUSSION The average time to return to work after distal biceps repair in the literature was just beyond 14 weeks. Patients and employers may be given a range between 3 and 4 months, with variation dependent on job demands. Further studies are needed to establish whether the surgical approach or repair technique has any impact on time to return to work.
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27
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Samra I, Mati W, Blundell C, Lane S, Charalambous CP. Distal biceps tendon ruptures - the relation of radiological retraction and chronicity to the ability of tendon reattachment and long-term functional outcomes. J Orthop 2019; 20:111-118. [PMID: 32042237 DOI: 10.1016/j.jor.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 12/08/2019] [Indexed: 11/16/2022] Open
Abstract
Aims To assess whether the degree of radiological retraction and chronicity of distal biceps tendon ruptures are related to the ability to reattach the tendon and long-term functional outcomes. Methods Analysis of consecutive patients undergoing surgery for distal biceps tendon ruptures by a single surgeon. Measurements regarding the site and degree of tendon retraction in relation to anatomical landmarks following rupture were correlated with intraoperative findings. Postoperative functional outcomes were assessed in cases with >12 months follow-up. Results 24 cases of distal biceps tendon ruptures treated surgically were identified. Mean tendon retraction was 6.0 cm (range 1.2-9.5) from the radial tuberosity. 22 cases were reattached successfully. 2 required ligament augmentation/bridging using a synthetic ligament. In 2 cases the tendon could not be reattached due to poor quality of the tendon stump. Ability to reattach the tendon was unrelated to degree of radiological retraction or chronicity of rupture. Degree of retraction was not related to rupture chronicity. All reattachments healed with no re-rupture at follow-up with no substantial motion loss. In 17 cases >12months follow-up the DASH and OES were not related to retraction or chronicity of rupture. Conclusions Radiological retraction and chronicity are not related to the ability to reattach distal biceps tendon ruptures or their clinical outcomes, hence should not discourage surgical exploration and attempted reattachment. Substantial tendon retractions can occur acutely and reattachment in considerable flexion did not produce any significant motion loss. Some cases will need augmentation or gap bridging and augmentation devices need to be available at surgery. Level of evidence Level IV Retrospective Study Defined.
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Affiliation(s)
- Inderpaul Samra
- Department of Trauma and Orthopaedic Surgery, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Wael Mati
- Department of Radiology, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Clare Blundell
- Department of Trauma and Orthopaedic Surgery, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Suzanne Lane
- Department of Trauma and Orthopaedic Surgery, Blackpool Victoria Hospital, Blackpool, United Kingdom
| | - Charalambos P Charalambous
- School of Medicine, University of Central Lancashire, United Kingdom.,Department of Trauma and Orthopaedic Surgery, Blackpool Victoria Hospital, Blackpool, United Kingdom
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28
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Riesner HJ, Hackenbroch C, Lang P, Achatz G, Palm HG, Friemert B. Surgical Reconstruction Options in Chronic Distal Biceps Tendon Ruptures - Case Report and Literature Review. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 159:75-82. [PMID: 31683328 DOI: 10.1055/a-1014-3703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Chronic distal biceps tendon ruptures are rare and conservative or operative treatment options are suitable. There is a consensus in the literature in case of acute traumatic ruptures the operative refixation should be preferred. Disagreement exists in the best way of care of old ruptures (> 4 weeks) of distal biceps tendon. Several kinds of refixation possibilities up to tendon grafts are described. Aim of this publication is showing an overview of the literature of the approved methods in reconstruction of the distal biceps tendon using autogenous and allogenic grafts, comparing the outcomes and transferring them on an own case. MATERIAL AND METHODS A literature research was carried out using the online medical database "PubMed" with the following keywords "chronic rupture distal biceps tendon, surgical techniques". 59 citations were found concerning the topic, 37 publications were relevant for this work. RESULTS There is consensus that even in chronic ruptures the operative management of the distal biceps tendon generates the best results. Consistently the experiences and results of only little patient collectives are reported. Numerous techniques of surgery are described without predominance of one method. Reinsertions of the tendon butts are reported in different techniques: with achilles, palmaris longus, fascia lata, triceps, quadriceps and semitendinosus tendon grafts. All together they showed postoperative satisfactory results. CONCLUSION With surgical treatment of chronic ruptured distal biceps tendons comparable outcomes can be achieved by primary refixation and graft augmentations. In case of graft augmentations several tissue options are available which showed in all cases satisfactory functional results in the end.
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Affiliation(s)
- Hans-Joachim Riesner
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm
| | | | - Patricia Lang
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm
| | - Gerhard Achatz
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm
| | - Hans-Georg Palm
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm
| | - Benedikt Friemert
- Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm
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Holt J, Preston G, Heindel K, Preston H, Hill G. Diagnosis and Management Strategies for Distal Biceps Rupture. Orthopedics 2019; 42:e492-e501. [PMID: 31355900 DOI: 10.3928/01477447-20190723-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 12/12/2018] [Indexed: 02/03/2023]
Abstract
Rupture of the distal biceps tendon most commonly is secondary to mechanical overload during eccentric muscle contraction. Due to deficits of strength and endurance, surgical repair usually is recommended. Although both single- and double-incision approaches have been described, double-incision techniques have been shown to better re-create the native anatomic insertion. However, excellent and comparable clinical outcomes have been demonstrated with both techniques. Fixation with a cortical button and interference screw has been shown to be the strongest construct biomechanically; however, several modern constructs provide adequate strength. Surgical technique should focus on restoration of anatomy, early range of motion, and prevention of complications. [Orthopedics. 2019; 42(6):e492-e501.].
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Lenz R, Bonacker J, Mittelmeier W, Ellenrieder M, Tischer T. [What do orthopedic and trauma surgeons expect from radiologists when interpreting imaging of the elbow?]. Radiologe 2019; 58:968-975. [PMID: 30225771 DOI: 10.1007/s00117-018-0456-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
CLINICAL ISSUE The elbow is a complex joint with a multitude of acute and chronic pathologies. In addition to the clinical examination, radiological diagnostics play a decisive role in the further therapeutic management. DIAGNOSTIC WORK-UP/PERFORMANCE While acute traumatic injuries often present with obvious structural changes and the need for rapid treatment decisions, chronic processes can present with less evident alterations. Especially in these cases there is a need for clear communication between the treating physician and the radiologist with respect to managing optimal imaging as the basis for a certain diagnosis and therefore optimal treatment. Basic prerequisites on both sides are detailed knowledge of all elbow pathologies, classifications and the spectrum of radiological diagnostic imaging. ACHIEVEMENTS/PRACTICAL RECOMMENDATIONS From the point of view of orthopedic surgeons the radiologist is responsible for the correct performance and interpretation of the necessary imaging procedures. The aim of this article is to give an overview of important aspects in the imaging of typical orthopedic/traumatic pathologies.
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Affiliation(s)
- R Lenz
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland.
| | - J Bonacker
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland
| | - W Mittelmeier
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland
| | - M Ellenrieder
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland
| | - T Tischer
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, 18057, Rostock, Deutschland
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Frank T, Seltser A, Grewal R, King GJW, Athwal GS. Management of chronic distal biceps tendon ruptures: primary repair vs. semitendinosus autograft reconstruction. J Shoulder Elbow Surg 2019; 28:1104-1110. [PMID: 30935824 DOI: 10.1016/j.jse.2019.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/24/2018] [Accepted: 01/06/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Delayed presentation of distal biceps tendon ruptures can make primary repair difficult, in which case reconstruction using a tendon graft is an option. The aim of this study was to compare outcomes and complications between delayed distal biceps tendon ruptures managed with repair vs. semitendinosus autograft reconstruction. METHODS Nineteen delayed distal biceps tendon rupture cases treated with a tendon reconstruction were compared with 16 delayed primary repair cases (>21 days). The reconstructions were performed using a semitendinosus autograft looped through a transosseous tunnel in the bicipital tuberosity and secured with a Pulvertaft weave to the remnant distal biceps tendon. The patient groups were reviewed and completed functional outcomes testing including range of motion, isometric elbow flexion and supination strength, Disabilities of the Arm, Shoulder, and Hand, Patient-Rated Elbow Evaluation, Single Assessment Numeric Evaluation, and Mayo Elbow Performance Index. RESULTS Mean patient age (49 ± 9 vs. 46 ± 8 years, P = .65) and follow-up (47 ± 25 vs. 45 ± 27 months, P = .45) were similar between delayed primary repair and reconstruction groups. Range of motion (P = .62), supination strength (P = .26), elbow flexion strength (P = .93), Disabilities of the Arm, Shoulder, and Hand (P = .08), and Single Assessment Numeric Evaluation (P = .22) were not significantly different between groups. The Patient-Rated Elbow Evaluation (P = .02) and Mayo Elbow Performance Index (P = .04), however, were better in the delayed repair group compared with the reconstruction group. Complications were similar between groups (P = .87). CONCLUSION Delayed reconstruction of irreparable distal biceps tendon ruptures with semitendinosus autograft produces similar strength, range of motion, and complication rates but slightly worse functional outcome scores compared with delayed primary repair. This suggests that when possible direct repair is preferred, however, if not possible, reconstruction with an autologous tendon graft results in predictably good outcomes.
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Affiliation(s)
- Tym Frank
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, ON, Canada
| | - Anna Seltser
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, ON, Canada
| | - Ruby Grewal
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, ON, Canada
| | - Graham J W King
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, ON, Canada
| | - George S Athwal
- Roth
- McFarlane Hand and Upper Limb Center, St Joseph's Health Care, London, ON, Canada.
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Morrell NT, Hammond TL, Lemos DF. Reconstruction of a chronic, isolated, myotendinous rupture of the short-head component of the distal biceps tendon. J Shoulder Elbow Surg 2019; 28:e182-e186. [PMID: 30987789 DOI: 10.1016/j.jse.2018.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/12/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Nathan T Morrell
- Department of Orthopaedics and Rehabilitation, University of Vermont Medical Center, Burlington, VT, USA.
| | - Tracie L Hammond
- Department of Orthopaedics and Rehabilitation, University of Vermont Medical Center, Burlington, VT, USA
| | - Diego F Lemos
- Department of Radiology, University of Vermont Medical Center, Burlington, VT, USA
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Alech-Tournier F, Elkholti K, Locquet V, Ninou M, Gibert N, Pozzetto M, Breden F, Rostoucher P, Marc A, Erhard L, Vogels J. Outcomes of distal biceps tendon reattachment using the ToggleLoc™ fixation device with ZipLoop™ technology with single mini-open technique. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:925-931. [DOI: 10.1007/s00590-019-02376-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 01/04/2019] [Indexed: 11/28/2022]
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Cerciello S, Santagada A, Mazzocca AD. Distal Biceps Rupture—Achilles Augmentation Technique. OPER TECHN SPORT MED 2018. [DOI: 10.1053/j.otsm.2018.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mirzayan R, Sethi PM. Distal Biceps Repair With Acellular Dermal Graft Augmentation. OPER TECHN SPORT MED 2018. [DOI: 10.1053/j.otsm.2018.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Management of proximal and distal biceps tendon pathology is evolving. The long head of the biceps tendon, if inflamed, may be a pain-producing structure. In appropriately indicated patients, a symptomatic long head of the biceps tendon can be surgically managed via tenotomy, tenodesis, and/or superior labrum anterior to posterior repair. In some patients, primary superior labrum anterior to posterior pathology can be managed via biceps tenodesis. Determining which procedure is most appropriate and which technique and implant are preferred for a given patient with biceps tendon pathology is controversial. Less debate exists with regard to the timing of distal biceps tendon repair; however, considerable controversy exists with regard to selection of an appropriate surgical technique and implant. In addition, the treatment of patients with a chronic and/or retracted distal biceps tendon tear and patients in whom distal biceps tendon repair fails is extremely challenging. Orthopaedic surgeons should understand the anatomy of, nonsurgical and surgical treatment options for, and outcomes of patients with proximal or distal biceps tendon pathology.
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Beazley JC, Lawrence TM, Drew SJ, Modi CS. Distal Biceps and Triceps Injuries. Open Orthop J 2017; 11:1364-1372. [PMID: 29290876 PMCID: PMC5721327 DOI: 10.2174/1874325001711011364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 01/26/2023] Open
Abstract
Background: Rupture of the distal biceps and triceps tendons are relatively uncommon injuries typically occurring in middle-aged males as a result of eccentric loading of the tendon. Methods: A literature search was performed and the authors’ personal experiences reported. Results: This review discusses the diagnosis, indications and guidelines for management of these injuries and provides a description of the authors’ preferred operative techniques. Conclusion: Whilst non-operative treatment may be appropriate for patients with low functional demands, surgical management is the preferred option for the majority of patients. We have described a cortical button technique and osseous tunnel technique utilised at our institution for distal biceps and triceps tendon fixation respectively. For biceps or triceps tendon injuries, those receiving an early diagnosis and undergoing surgical intervention, an excellent functional outcome can be expected.
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Affiliation(s)
- James C Beazley
- Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Thomas M Lawrence
- Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Steven J Drew
- Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Chetan S Modi
- Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
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Schmidt CC, Styron JF, Lin EA, Brown BT. Distal Biceps Tendon Anatomic Repair. JBJS Essent Surg Tech 2017; 7:e32. [PMID: 30233967 DOI: 10.2106/jbjs.st.16.00057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Distal biceps injuries, which usually occur in active middle-aged men, can result in chronic pain and loss of supination and flexion strength3,4. Surgical repair of a ruptured distal biceps tendon can reliably decrease pain and improve strength compared with nonoperative management3,4. However, even following successful healing and rehabilitation of a surgically repaired biceps tendon, full supination strength is rarely restored5-7. The expected outcome following distal biceps repair using a traditional anterior approach is a measurable loss of rotational strength, especially from neutral to supinated positions5,7. This deficit can lead to difficulty with occupational and recreational activities5,8. The center of an uninjured biceps tendon inserts into the radial tuberosity 6.7 mm anterior to its apex9,10. This posterior location forces the biceps tendon to wrap around the radial protuberance during pronation, thus utilizing the protuberance as a mechanical cam during forceful forearm supination10,11. The distal biceps tendon comprises a medial short head and lateral long head; the 2 heads are continuations of the proximal muscles2,20,21. The short head inserts distal to the long head on their radial attachment site2,20,21. Performing a distal biceps repair via an anterior approach typically places the center of the reattachment site 12.9 mm anterior to its apex or approximately 6 mm anterior to an uninjured control tendon9. This shifts the repair site from its anatomic location (posterior to the radial protuberance) to a new nonanatomic location (on top of the protuberance). This anterior reattachment location decreases the cam effect of the radial protuberance, resulting in an average supination loss of 10% in neutral rotation and 33% in 60° of supination7,10. A posterior approach to the radial tuberosity using 2 separate intramedullary buttons for the short and long heads reliably positions the distal biceps insertion at its anatomic footprint, which is posterior to the radial protuberance9,10,11. This technique has been named the distal biceps tendon anatomic repair. Not only does it restore the normal supination cam effect of the radial protuberance, but it also provides superior initial fixation strength, with load to failure strength similar to the native tendon1. The distal biceps anatomic repair can be divided into the following 9 key steps: Step 1: Preoperative planning; Step 2: Positioning; Step 3: Identifying and retrieving the tendon; Step 4: Preparing the 2 heads of the tendon; Step 5: Posterior exposure of tendon footprint; Step 6: Drilling the short and long-head drill holes; Step 7: Passage of the tendon; Step 8: Unicortical button fixation; Step 9: Alternative fixation: cortical trough; and Step 10: Postoperative management.
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Affiliation(s)
- Christopher C Schmidt
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Joseph F Styron
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Edward A Lin
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Brandon T Brown
- Department of Biomechanical Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
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Conroy C, Sethi P, Macken C, Wei D, Kowalsky M, Mirzayan R, Pauzenberger L, Dyrna F, Obopilwe E, Mazzocca AD. Augmentation of Distal Biceps Repair With an Acellular Dermal Graft Restores Native Biomechanical Properties in a Tendon-Deficient Model. Am J Sports Med 2017; 45:2028-2033. [PMID: 28419811 DOI: 10.1177/0363546517701426] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The majority of distal biceps tendon injuries can be repaired in a single procedure. In contrast, complete chronic tears with severe tendon substance deficiency and retraction often require tendon graft augmentation. In cases with extensive partial tears of the distal biceps, a human dermal allograft may be used as an alternative to restore tendon thickness and biomechanical integrity. HYPOTHESIS Dermal graft augmentation will improve load to failure compared with nonaugmented repair in a tendon-deficient model. STUDY DESIGN Controlled laboratory study. METHODS Thirty-six matched specimens were organized into 1 of 4 groups: native tendon, native tendon with dermal graft augmentation, tendon with an attritional defect, and tendon with an attritional defect repaired with a graft. To mimic a chronic attritional biceps lesion, a defect was created by a complete tear, leaving 30% of the tendon's width intact. The repair technique in all groups consisted of cortical button and interference screw fixation. All specimens underwent cyclical loading for 3000 cycles and were then tested to failure; gap formation and peak load at failure were documented. RESULTS The mean (±SD) load to failure (320.9 ± 49.1 N vs 348.8 ± 77.6 N, respectively; P = .38) and gap formation (displacement) (1.8 ± 1.4 mm vs 1.6 ± 1.1 mm, respectively; P = .38) did not differ between the native tendon groups with and without graft augmentation. In the tendon-deficient model, the mean load to failure was significantly improved with graft augmentation compared with no graft augmentation (282.1 ± 83.8 N vs 199.7 ± 45.5 N, respectively; P = .04), while the mean gap formation was significantly reduced (1.2 ± 1.0 mm vs 2.7 ± 1.4 mm, respectively; P = .04). The mean load to failure of the deficient tendon with graft augmentation (282.1 N) compared with the native tendon (348.8 N) was not significantly different ( P = .12). This indicates that the native tendon did not perform differently from the grafted deficient tendon. CONCLUSION In a tendon-deficient, complete distal biceps rupture model, acellular dermal allograft augmentation restored the native tendon's biomechanical properties at time zero. The grafted tissue-deficient model demonstrated no significant differences in the load to failure and gap formation compared with the native tendon. As expected, dermal augmentation of attritional tendon repair increased the load to failure and stiffness as well as decreased displacement compared with the ungrafted tissue-deficient model. Tendons with their native width showed no statistical difference or negative biomechanical consequences of dermal augmentation. CLINICAL RELEVANCE Dermal augmentation of the distal biceps is a biomechanically feasible option for patients with an attritionally thinned-out tendon.
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Affiliation(s)
- Christine Conroy
- Orthopaedic & Neurosurgery Specialists, Greenwich, Connecticut, USA
| | - Paul Sethi
- Orthopaedic & Neurosurgery Specialists, Greenwich, Connecticut, USA
| | - Craig Macken
- Orthopaedic & Neurosurgery Specialists, Greenwich, Connecticut, USA
| | - David Wei
- Orthopaedic & Neurosurgery Specialists, Greenwich, Connecticut, USA
| | - Marc Kowalsky
- Orthopaedic & Neurosurgery Specialists, Greenwich, Connecticut, USA
| | | | - Leo Pauzenberger
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Felix Dyrna
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Elifho Obopilwe
- University of Connecticut Health Center, Farmington, Connecticut, USA
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Alentorn-Geli E, Assenmacher AT, Sánchez-Sotelo J. Distal biceps tendon injuries: A clinically relevant current concepts review. EFORT Open Rev 2017; 1:316-324. [PMID: 28461963 PMCID: PMC5367534 DOI: 10.1302/2058-5241.1.000053] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Distal biceps tendon (DBT) conditions comprise a spectrum of disorders including bicipitoradial bursitis, partial tears, acute and chronic complete tears. In low-demand patients with complete DBT tears, non-operative treatment may be entertained provided the patient understands the potential for residual weakness, particularly in forearm supination. Most acute tears are best treated by primary repair using either single-incision or double-incision techniques with good clinical outcomes. Single-incision techniques may carry a higher risk of nerve-related complications, whereas double-incision techniques have historically been considered to carry a higher risk of heterotopic ossification, particularly if the ulna is exposed. Various fixation techniques, including bone tunnels, cortical buttons, suture anchors, interference screws or a combination seem to provide different fixation strength but similar clinical outcomes. Some chronic tears may be repaired primarily, provided tendon tissue can be identified; alternatively, autograft or allograft reconstruction can be considered, and good outcomes have been reported with both techniques.
Cite this article: Alentorn-Geli E, Assenmacher AT, Sanchez-Sotelo J. Distal biceps tendon injuries: a clinically relevant current concepts review. EFORT Open Rev 2016;1:316-324. DOI: 10.1302/2058-5241.1.000053.
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Clinical Faceoff: Distal Biceps Rupture: Operative Versus Nonoperative Treatment. Clin Orthop Relat Res 2017; 475:324-327. [PMID: 27380277 PMCID: PMC5213928 DOI: 10.1007/s11999-016-4956-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 06/21/2016] [Indexed: 01/31/2023]
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Fontana M, Trimarchi A, Colozza A. Lacertus fibrosus augmentation for distal biceps brachii rupture repair: surgical technique. Musculoskelet Surg 2016; 100:85-88. [PMID: 27900711 DOI: 10.1007/s12306-016-0435-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 11/03/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Repair of distal biceps tendon ruptures has become widely accepted. Unfortunately, care of retracted-degenerated injuries remains a challenge for orthopedic surgeons. Complication rates appear to increase when surgery is performed in chronic cases compared to those operated acutely. Multiple techniques for chronic reconstruction with the use of grafts have been described. Recently Morrey, from the Mayo Clinic, proposed a direct anatomic repair of retracted distal biceps tendon ruptures in extreme flexion (60°-90°) to avoid grafting. MATERIALS AND METHODS The authors propose and describe a new surgical technique using the lacertus fibrosus (LF) as augmentation-elongation for retracted-degenerated distal biceps tendon tears. We present four cases with chronic ruptures with 2-year follow-up. The mean age was 45 years old (33-51), the time of surgery was 13 weeks (4-24) after the trauma, dominant arm was involved in two cases. RESULTS The mean MEPS was 95/100 at 2-year follow-up. With this technique we increase the length of the tendon up to 2.5 cm. The major complication in our study was transient sensitive radial nerve paresthesia. We did not have any hardware mobilization or muscular herniation. CONCLUSION With this study we want to present our experience in the treatment of retracted distal biceps tendon tear with lacertus fibrosus augmentation. Our surgical technique is an effective and cheap option for chronic-retracted distal biceps tendon lesions. Recovery time is quicker, and integration is faster due to the use of an autologous vascularized graft. Preoperative ultrasound scan is mandatory in order to evaluate LF integrity, thickness and size.
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Marshall NE, Keller RA, Okoroha K, Guest JM, Yu C, Muh S, Moutzouros V. Radiostereometric Evaluation of Tendon Elongation After Distal Biceps Repair. Orthop J Sports Med 2016; 4:2325967116672620. [PMID: 27928546 PMCID: PMC5131736 DOI: 10.1177/2325967116672620] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Operative repair of distal biceps tendon ruptures has shown successful outcomes. However, little is known about the amount of tendon or repair site lengthening after repair. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate distal biceps tendon repair via intratendinous radiostereometric analysis to analyze tendon lengthening at different time intervals of healing. The hypothesis was that there is significant lengthening after repair. STUDY DESIGN Case series; Level of evidence, 4. METHODS Eleven patients with distal biceps ruptures requiring operative repair were recruited. During repair, two 2-mm tantalum beads with laser-etched holes were sutured to the distal biceps tendon. Beads were evaluated via computed tomography scans immediately postoperatively and at 16 weeks. Radiographs were obtained at time 0 and then at 4, 8, and 16 weeks postoperatively. Measurements were made using the button-to-bead and bead-to-bead distances to assess repair site elongation as well as tendon elongation over time. After final follow-up, patients filled out the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and underwent ultrasound to confirm the integrity of the tendon. RESULTS Ten patients had complete ruptures, with 1 having a partial rupture that underwent completion of the tear and subsequent repair. All patients showed statistically significant lengthening after surgery. The mean amount of tendon lengthening after surgery was 22.8 mm (range, 11.2-30.9 mm; P < .05), and the repair site lengthened a mean 17.0 mm (range, 9.6-30.6 mm; P < .05) from surgery to final follow-up. The greatest change in lengthening was noted between time 0 and week 4 (mean, 11.3 mm; P < .05), with the least amount of lengthening between weeks 8 and 16 (mean, 2.6 mm; P < .05). The mean DASH score was 11.2. Final ultrasound evaluations found all tendons to be in continuity. CONCLUSION All patients undergoing distal biceps tendon repair have significant elongation after surgery, with the greatest amount of lengthening seen in the early postoperative period.
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Affiliation(s)
- Nathan E Marshall
- Orthopedic Surgery Department, Henry Ford Hospital, Detroit, Michigan, USA
| | - Robert A Keller
- Orthopedic Surgery Department, Henry Ford Hospital, Detroit, Michigan, USA
| | - Kelechi Okoroha
- Orthopedic Surgery Department, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Charles Yu
- Orthopedic Surgery Department, Henry Ford Hospital, Detroit, Michigan, USA
| | - Stephanie Muh
- Orthopedic Surgery Department, Henry Ford Hospital, Detroit, Michigan, USA
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Schmidt CC, Savoie FH, Steinmann SP, Hausman M, Voloshin I, Morrey BF, Sotereanos DG, Bero EH, Brown BT. Distal biceps tendon history, updates, and controversies: from the closed American Shoulder and Elbow Surgeons meeting-2015. J Shoulder Elbow Surg 2016; 25:1717-30. [PMID: 27522340 DOI: 10.1016/j.jse.2016.05.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/10/2016] [Accepted: 05/26/2016] [Indexed: 02/01/2023]
Abstract
Understanding of the distal biceps anatomy, mechanics, and biology during the last 75 years has greatly improved the physician's ability to advise and to treat patients with ruptured distal tendons. The goal of this paper is to review the past and current advances on complete distal biceps ruptures as well as controversies and future directions that were discussed and debated during the closed American Shoulder and Elbow Surgeons meeting in 2015.
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Affiliation(s)
- Christopher C Schmidt
- Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Felix H Savoie
- Department of Orthopaedics, Tulane University, New Orleans, LA, USA
| | | | - Michael Hausman
- Department of Orthopaedics, Mount Sinai Hospital, New York, NY, USA
| | - Ilya Voloshin
- Department of Orthopaedics, University of Rochester, Rochester, NY, USA
| | - Bernard F Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dean G Sotereanos
- Department of Orthopaedic Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emily H Bero
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brandon T Brown
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
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Abstract
Mainly males in their 40s and 50s suffer from distal biceps tendon rupture. The diagnosis is made by clinical evaluation and is usually confirmed by magnetic resonance imaging. Different approaches and reconstruction techniques have been described in the past, and the clinical results are mostly good and excellent. Thereby the decision regarding which technique to use lies with the surgeon. However, specific complications have been described and should be considered.
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Caputo AE, Cusano A, Stannard J, Hamer MJ. Distal biceps repair using the lacertus fibrosus as a local graft. J Shoulder Elbow Surg 2016; 25:1189-94. [PMID: 27066965 DOI: 10.1016/j.jse.2016.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 02/01/2016] [Accepted: 02/12/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND We report a case series of 15 patients who underwent a new surgical technique that uses a transfer of the lacertus fibrosus to augment the repair of the distal biceps tendon. This technique seeks to minimize the need for and potential complications associated with autogenous or allograft tendon reconstruction in this clinical scenario. METHODS We reviewed the clinical outcomes of patients who both underwent a lacertus transfer for biceps tendon reconstruction during a 10-year period and had at least 6 months of follow-up. Their clinical outcomes, including success of tendon repair, functional performance, and associated surgical complications, were evaluated. RESULTS During a 10-year period, 244 patients underwent surgery for repair or reconstruction of the distal biceps tendon. During this time, 15 patients met the criteria for use of the lacertus transfer technique. When direct repair was not possible because of tendon retraction and attrition, although a tendon graft was considered, the intact lacertus fibrosus was used to augment the biceps repair. Of these 15 patients, 12 met study inclusion criteria. At latest follow-up, all 12 patients were successfully treated by the lacertus transfer without complication, had regained elbow flexion and forearm supination strength, and had no lacertus harvest complications. CONCLUSIONS When operative treatment is chosen for biceps tendon injuries and if the lacertus fibrosus is intact, transfer of the lacertus to augment repair of the distal biceps provides predictable outcomes without the potential complications associated with allograft or autograft tendon reconstruction.
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Abstract
Distal biceps tendon ruptures are relatively rare. Patients are usually middle-aged men involved in heavy labor. Patients usually present with the history of a pop and a proximal migration of the biceps muscle belly. Clinical exam should be sufficient to diagnose a complete rupture. Several specific tests have been described. Ultrasound scanning or MRI can help confirm the diagnosis. Radiographs are not needed to diagnose distal biceps tendon rupture but may show typical findings. Imaging, more specifically the flexion-abduction-supination (FABS) view MRI, is particularly helpful in the case of a partial rupture or chronic rupture of the distal biceps tendon. Results of surgical reinsertion of the distal biceps have been shown to be superior to conservative treatment. Different techniques and approaches have been described with specific advantages and disadvantages. Primary repair of the tendon is preferred. If this is no longer possible in chronic tears, an augmentation can be done using tendon graft. Results of surgical treatment are good in the vast majority of patients. Reruptures are rare but minor complications are common. Major complications may include posterior interosseous nerve palsy or radioulnar synostosis, but the risk of these complications may be decreased by meticulous attention to detail during surgery.
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Affiliation(s)
- Melanie Vandenberghe
- Department of Orthopedic Surgery, AZ Monica Hospital, Stevenslei 20, 2100, Deurne, Belgium
| | - Roger van Riet
- Department of Orthopedic Surgery, AZ Monica Hospital, Stevenslei 20, 2100, Deurne, Belgium. .,Department of Orthopedic Surgery, University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium. .,Department of Orthopedic Surgery, Erasme University Hospital, Route De Lennik 808, Brussels, Belgium.
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Phadnis J, Flannery O, Watts AC. Distal biceps reconstruction using an Achilles tendon allograft, transosseous EndoButton, and Pulvertaft weave with tendon wrap technique for retracted, irreparable distal biceps ruptures. J Shoulder Elbow Surg 2016; 25:1013-9. [PMID: 27039674 DOI: 10.1016/j.jse.2016.01.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/25/2015] [Accepted: 01/07/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal biceps ruptures can result in ongoing pain and weakness when treated nonoperatively. If retraction of the tendon renders primary repair impossible, reconstruction using a graft is recommended. The current literature includes a variety of techniques with studies reporting small patient numbers. The aim of this study was to report the results of a larger cohort of patients using a technique modified from those previously described in the literature. METHODS Twenty-one consecutive male patients underwent distal biceps reconstruction through 2 small anterior incisions using an Achilles tendon allograft that was fixed distally using a transosseous EndoButton and secured proximally using a Pulvertaft weave and tendon wrap. The mean age was 44 years, and the mean time to surgery was 25 months (range, 2-96 months). Functional outcomes were collected prospectively. RESULTS The mean preoperative Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score (11 patients) was 1.9 (range, 0-4.5). The mean postoperative Oxford Elbow Score, QuickDASH score, and Mayo Elbow Performance Score were 44.7 (range, 35-48), 4 (range, 0-20.5), and 92.9 (range, 70-100), respectively, at a mean follow up of 15 months (range, 6-35 months). The mean postoperative QuickDASH score was significantly improved compared with preoperatively (P < .001). All patients were satisfied and all returned to their previous level of activity. There were 2 transient lateral antebrachial cutaneous nerve paresthesias, and 2 patients had a 5° extension lag. There were no other complications. CONCLUSION Achilles allograft reconstruction of retracted irreparable distal biceps ruptures provides consistently good results with few complications using this technique.
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Affiliation(s)
- Joideep Phadnis
- Upper Limb Unit, Wrightington Hospital, Wigan, UK; Brighton and Sussex University Hospitals, Brighton, UK.
| | | | - Adam C Watts
- Upper Limb Unit, Wrightington Hospital, Wigan, UK
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Abstract
Modern techniques to repair the distal biceps tendon include one-incision and 2-incision techniques that use transosseous sutures, suture anchors, interference screws, and/or cortical buttons to achieve a strong repair of the distal biceps brachii. Repair using these techniques has led to improved functional outcomes when compared with nonoperative treatment. Most complications consist of neuropraxic injuries to the lateral antebrachial cutaneous nerve, posterior interosseous nerve, stiffness and weakness with forearm rotation, heterotopic ossification, and wound infections. Although complications certainly affect outcomes, patients with distal biceps repairs report a high satisfaction rate after repair.
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Affiliation(s)
- Mark Tyson Garon
- Indiana Hand to Shoulder Center, 8501 Harcourt Road, Indianapolis, IN 46260, USA
| | - Jeffrey A Greenberg
- Indiana Hand to Shoulder Center, 8501 Harcourt Road, Indianapolis, IN 46260, USA.
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Refixation techniques and approaches for distal biceps tendon ruptures: a systematic review of clinical studies. J Shoulder Elbow Surg 2016; 25:e29-37. [PMID: 26709017 DOI: 10.1016/j.jse.2015.09.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 09/10/2015] [Accepted: 09/15/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical fixation is the preferred method of treatment for the ruptured distal biceps tendon in active patients. To date, no fixation technique has been proven superior in a clinical setting. The purpose of the study was to systematically review the available literature on approach and fixation methods for distal biceps tendon repair in a clinical setting and to determine the optimal fixation methods of the distal biceps tendon on the radial tuberosity. Our hypothesis was that the outcomes would not be significantly different among the various fixation techniques and approaches. METHODS A systematic review of the available literature on anatomic reconstruction methods for distal biceps tendon ruptures was performed. The outcome measures evaluated were postoperative range of motion, elbow flexion and supination strength, and complication rates and types. RESULTS Forty articles were included, representing 1074 patients divided into 4 fixation groups: suture anchors, bone tunnels, interference screws, and cortical buttons. There was no significant difference in range of motion and strength between the different approaches and fixation techniques. Complications were significantly less common after the double-incision approach with bone tunnel fixation (P < .0005). CONCLUSIONS There were significantly fewer complications after the double-incision approach with bone tunnel fixation. The double-incision approach had significantly fewer complications than the single-incision anterior approach, and the bone tunnel fixation had significantly fewer complications than the other 3 fixation techniques. However, as the double-incision approach was used with bone tunnel fixation in 84% of cases, there was a strong interrelationship between these variables.
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