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Calderazzi F, Lucchetta L, Donelli D, Costantino C, Vaienti E. Surgically treated acute distal biceps tendon injuries: What results do they have in comparison with the contralateral healthy arm? A systematic review and meta-analysis. Orthop Traumatol Surg Res 2023:103785. [PMID: 38070732 DOI: 10.1016/j.otsr.2023.103785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/23/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Surgical repair of distal biceps tendon injury restores flexion and supination strength, resulting in good functional outcome. There are few studies that consider clinical results of the operated arm compared to the healthy contralateral arm, whereas there are many articles examining the results of different surgical techniques. We carried out a systematic review with meta-analysis of the studies that consider this comparison. The aim was to evaluate if there are significative differences in terms of functional results between the operated arm and the non-injured contralateral arm. In fact, we believe that this comparison is useful for assessing patient true satisfaction. PATIENTS AND METHODS In accordance with the PRISMA and QUORUM statements, a comprehensive search on PubMed, Scopus, Embase, Cochrane, Google Scholar and Web of Science databases was conducted to identify studies reporting comparative functional results of the operated arm with healthy contralateral arm from January 1985 until November 2022. Criteria for inclusion were acute complete injury of the distal biceps' tendon operated within 30days; range of motion (ROM), isokinetic and isometric strength measurements; minimum patients follow-up of 24months; studies written in English language. Then a DerSimonian and Laird meta-analysis was conducted to compare the functional outcomes of the operated arm to the non-injured arm. RESULTS Of the 588 initial studies, 18 studies met the inclusion criteria; methodological quality was assessed using the Newcastle-Ottawa scale. A total of 272 surgically treated distal biceps ruptures were included in the study. The mean follow-up time was of 39.6months (24 to 72months). ROM flexion, pronation, and supination of the operated elbows were significantly decreased, with mean differences of -1.24̊ (p=0.004), -7.95̊ (p=0.003), and -9.27̊ (p=0.004) respectively, compared to the non-injured healthy elbows. The difference of ROM extension was not-statistically significant (+0.21̊; p=0.66). The Isokinetic data showed a statistically significant reduction in the flexion strength (-4.56Nm; p=0.0004) and a statistical significative reduction in the supination strength (-1.18 Nm; p=0.02) of the injured operated arm compared with the healthy one. The forest-plot table of the isometric data was not elaborated due to the small number of studies eligible for the meta-analysis. DISCUSSION This study represents the first systematic review and meta-analysis to compare functional and clinical outcomes following operative treatment of distal biceps tendon ruptures with the contralateral healthy arm. Significant differences in ROM flexion, supination, and pronation and in isokinetic and isometric data were found between the operated and non-operated unaffected arm, demonstrating that, as expected, the unaffected arm performed better than the operated one. However, the functional differences between the data of the operated and healthy arm were slight and lead us to overall consider surgery as good functional result. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Filippo Calderazzi
- Department of Medicine and Surgery, Orthopaedic Clinic, Maggiore Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy.
| | - Lorenzo Lucchetta
- Department of Medicine and Surgery, Orthopaedic Clinic, University Hospital of Perugia, 06156 Perugia, Italy
| | - Davide Donelli
- Department of Cardiothoracic and Vascular Diseases, Cardiology Unit, Maggiore Hospital, University of Parma, 43126 Parma, Italy
| | - Cosimo Costantino
- Department of Biomedical, Biotechnological and Translational Sciences, Maggiore Hospital, University of Parma, 43126 Parma, Italy
| | - Enrico Vaienti
- Department of Medicine and Surgery, Orthopaedic Clinic, Maggiore Hospital, University of Parma, Via Gramsci 14, 43126 Parma, Italy
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Ribas LHBV, Schor B, Filho GDRM, Belangero PS. Acute Distal Biceps Tendon Injury: Diagnosis and Treatment. Rev Bras Ortop 2023; 58:e689-e697. [PMID: 37908533 PMCID: PMC10615608 DOI: 10.1055/s-0043-1771488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 04/12/2023] [Indexed: 11/02/2023] Open
Abstract
Acute distal biceps injuries clinically present with sudden pain and acute loss of flexion and supination strength. The main injury mechanism occurs during the eccentric load of the biceps. The hook test is the most significant examination test, presenting the highest sensibility and specificity for this lesion. Magnetic resonance imaging, the gold standard imaging test, can provide information regarding integrity and identify partial and/or complete tears. The surgical treatment uses an anterior or double approach and several reattachment techniques. Although there is no clinical evidence to recommend one fixation method over the other, biomechanical studies show that the cortical button resists better to failure. Although surgical treatment led to an 89% rate of return to work in 14 weeks, the recovery of high sports performance occurred in 1 year, with unsustainable outcomes.
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Affiliation(s)
- Luiz Henrique Boraschi Vieira Ribas
- Aluno do Programa de Pós-Graduação do Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
- Médico ortopedista, especialista em Ombro e Cotovelo, Instituto Vita, São Paulo, SP, Brasil
| | - Breno Schor
- Médico ortopedista, especialista em Ombro e Cotovelo, Instituto Vita, São Paulo, SP, Brasil
| | - Geraldo da Rocha Motta Filho
- Médico ortopedista, especialista em Ombro e Cotovelo, Instituto Nacional de Traumatologia e Ortopedia (INTO), Rio de Janeiro, RJ, Brasil
| | - Paulo Santoro Belangero
- Cirurgião ortopçdico, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
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3
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Wörner EA, Nagel M, Kodde IF, Eygendaal D, The B. Return to sports following distal biceps tendon repair: A current concepts review. J ISAKOS 2023; 8:227-231. [PMID: 36924828 DOI: 10.1016/j.jisako.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/07/2023] [Accepted: 02/19/2023] [Indexed: 03/17/2023]
Abstract
Distal biceps tendon ruptures are relatively rare injuries but tend to occur in active and athletic populations, especially in weightlifting and contact sports. The distal biceps tendon is an important supinator of the forearm and flexor of the elbow, thus an injury to this ligament can be invalidating for athletes. The aim of this review was to determine the ability and the time to return to sports following distal biceps tendon repair in athletes and the level of performance. The literature is scarce about the return to sports among athletes. Most studies include athletes are National Football League (NFL) players, others are weightlifters and a few recreational athletes. The return to play rate after distal biceps tendon repair is high. The performances of the returned players were similar to matched players and most players returned to the same level. Most players-depending on the sport-were not able to return to competition within the same season. In order to manage expectations, it should be discussed preoperatively with the athlete (and their coach) that the return to sports rate is high, but the return will probably be the following season.
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Affiliation(s)
- E A Wörner
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands; Department of Orthopaedic Surgery, Amphia Hospital, Molengracht 21, 4818 CK Breda, Netherlands.
| | - M Nagel
- Department of Orthopaedic Surgery, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - I F Kodde
- Department of Orthopaedic and Trauma Surgery, Deventer Hospital, Nico Bolkesteinlaan 75, 7416 SE Deventer, Netherlands
| | - D Eygendaal
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - B The
- Department of Orthopaedic Surgery, Amphia Hospital, Molengracht 21, 4818 CK Breda, Netherlands
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4
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Bartlett LE, Klein BJ, Daley A, Goodwillie A, Cohn RM. Functional Considerations in Bilateral, Simultaneous Tendon Injuries of the Upper Extremity: A Narrative Review of Current Literature. JBJS Rev 2023; 11:01874474-202306000-00008. [PMID: 37307343 DOI: 10.2106/jbjs.rvw.23.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
» Bilateral, simultaneous same-tendon injuries of the upper extremity are rarely encountered, yet their unique complexity poses a substantial challenge for treating orthopaedic surgeons.» In general, extremities with more tendon retraction should be repaired acutely while contralateral injuries can be treated in a staged or simultaneous manner depending on injury morphology, location, and anticipated functional impairment.» Combinations of accelerated and conventional rehabilitation protocols can be used for individual extremities to minimize the length of functional impairment.
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Affiliation(s)
- Lucas E Bartlett
- Department of Orthopedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington Hospital, Huntinton, New York
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5
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Baldwin MJ, Watts AC, Peach CA, Phadnis J, Singh H, Gwilym SE. Treatment of acute distal biceps tendon ruptures - A survey of the British Elbow and Shoulder Society surgical membership. Shoulder Elbow 2022; 14:555-561. [PMID: 36199515 PMCID: PMC9527480 DOI: 10.1177/17585732211032960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 01/17/2023]
Abstract
Background Acute distal biceps tendon ruptures result in weakness and deformity. While in other jurisdictions the rate of surgical repair has outpaced rises in incidence, UK practice for distal biceps tendon ruptures is unknown. The aim of this survey was to characterise current UK clinical practice. Methods An online survey was sent to the surgeon members of the British Elbow and Shoulder Society. Questions covered respondent demographics, clinical decision making, surgical experience and willingness to be involved in future research. Results A total of 242 surgeons responded; 99% undertook acute distal biceps tendon repairs with 83% repairing at least half of all distal biceps tendon ruptures, and 84% of surgeons would have their own, hypothetical, acute distal biceps tendon rupture repaired in their dominant arm and 67% for their non-dominant arm. Patient age, occupation and restoration of strength were the commonest factors underpinning a recommendation of surgical fixation. Most surgeons (87%) supported a national trial to study operative and non-operative treatments. Conclusions UK upper limb surgeons currently advise surgical repair of acute distal biceps tendon ruptures for the majority of their patients. This is despite a paucity of evidence to support improved outcomes following surgical, rather than non-operative, management. There is a clear need for robust clinical evaluation in this area.
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Affiliation(s)
- MJ Baldwin
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - AC Watts
- Upper Limb Unit, Wrightington Hospital, Wigan, UK
| | - CA Peach
- Manchester Shoulder and Elbow Unit, Manchester University Foundation NHS Trust, Manchester, UK
| | - J Phadnis
- Brighton & Sussex Medical School, Brighton & Sussex University Hospitals, Brighton, UK
| | - H Singh
- Leicester Shoulder & Elbow Unit, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - SE Gwilym
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
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Pitsilos C, Gigis I, Chitas K, Papadopoulos P, Ditsios K. Systematic review of distal biceps tendon rupture in athletes: treatment and rehabilitation. J Shoulder Elbow Surg 2022; 31:1763-1772. [PMID: 35367620 DOI: 10.1016/j.jse.2022.02.027] [Citation(s) in RCA: 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: 12/18/2021] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal biceps tendon rupture is a rare injury associated with decreased elbow flexion and forearm supination strength. This impairment is not tolerated by high-demand patients like athletes. PURPOSE To review treatment and rehabilitation applied to injured athletes and study their impact in return to sports. METHODS MEDLINE, Cochrane, Web of Science, and Scopus online databases were searched. A systematic review was conducted using the PRISMA guidelines; studies published on distal biceps tendon rupture treatment and rehabilitation of athletes until June 30, 2021, were identified. A quantitative synthesis of factor related to return to preinjury sport activity was made. RESULTS Ten articles were identified, including 157 athletes. Mean age was 40.5 years, and the dominant arm was injured in 103 cases (66%). Rupture was acute in 121 athletes (77%), and the mean follow-up was 25.7 months. A hundred and fifty-three athletes (97.5%) successfully returned to sport within a mean time of 6.2 months. Surgical treatment was followed in all cases. One-incision technique was chosen in 115 (73%) and suture anchor fixation in 52 (33%) cases. No postsurgical immobilization was reported in 38 (24%) and immobilization for 2 weeks in 124 (79%) athletes. Decreased supination-pronation and flexion-extension arc was found in 63 (40%) and 27 (17%) cases, respectively. Earlier return to sport was associated with nondominant-side (P = .007) and acute (P < .001) injuries, participation in weightlifting (P = .001), double-incision approach (P = .005), cortical button fixation (P < .001), and absence of supination-pronation restriction (P = .032). Time of return to sport activity was independent of rehabilitation, including immobilization (P = .539) and strengthening (P = .155), and decreased flexion-extension arc (P = .059). CONCLUSION Athletes sustaining distal biceps tendon rupture have a high postoperative return to sport rate, independently of selected surgical technique or rehabilitation program. However, a relation between the surgical technique and time of return to sport was found. Rehabilitation did not influence time of return to sport.
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Affiliation(s)
- Charalampos Pitsilos
- 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Ioannis Gigis
- 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Chitas
- 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Pericles Papadopoulos
- 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Ditsios
- 2nd Orthopaedic Department, "G. Gennimatas" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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7
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Abdel Khalik H, Lameire DL, Rubinger L, Ekhtiari S, Khanna V, Ayeni OR. Return to Sport and Work Following Distal Femoral Varus Osteotomy: A Systematic Review. HSS J 2022; 18:297-306. [PMID: 35645636 PMCID: PMC9096991 DOI: 10.1177/15563316211051295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022]
Abstract
Background: Distal femoral varus osteotomy (DFVO) is an effective surgical intervention for the management of symptomatic valgus malalignment of the knee. Because it preserves the native knee joint and its ligamentous stability, DFVO is preferred to total knee arthroplasty (TKA) in the young, active population. Purpose: We sought to assess return to work (RTW) and return to sport (RTS) rates following DFVO for valgus malalignment of the knee. Methods: For this systematic review, we searched EMBASE, MEDLINE, and Web of Science from inception through December 31, 2020. English language studies of all levels of evidence explicitly reporting on RTS and RTW rates following DFVO for valgus malalignment of the knee were eligible for inclusion. Results: Seven studies and 127 patients were included in our analysis. Mean age was 32.4 ± 8.8 years with men comprising 46.7% ± 22.3% of study populations. The mean RTS rate was 87.2% ± 10.7%, with a return to preoperative activity levels rate of 65.4% ± 26.8%. The mean RTW rate was 81.8% ± 23.3%, with a return to preoperative activity levels of 72.8% ± 18.1%. The mean reoperation rate was 35.6% ± 18.8% within a mean follow-up period of 5.5 ± 1.9 years. Conclusions: This systematic review of low-level studies found DFVO to be a safe and effective procedure for the management of genu valgum in young, active populations, with most patients returning to sport and/or work, although not all at their preoperative activity levels. A paucity of data surrounds RTS and RTW rates following DFVO. Future studies should explicitly report both return to activity rates and whether patients returned to their preoperative activity levels.
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Affiliation(s)
- Hassaan Abdel Khalik
- Michael G. DeGroote School of Medicine,
McMaster University, Hamilton, ON, Canada,Hassaan Abdel Khalik, BSc, MMI, Michael G.
DeGroote School of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada.
| | - Darius L. Lameire
- Michael G. DeGroote School of Medicine,
McMaster University, Hamilton, ON, Canada
| | - Luc Rubinger
- Division of Orthopaedic Surgery,
McMaster University, Hamilton, ON, Canada
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery,
McMaster University, Hamilton, ON, Canada
| | - Vickas Khanna
- Division of Orthopaedic Surgery,
McMaster University, Hamilton, ON, Canada
| | - Olufemi R. Ayeni
- Division of Orthopaedic Surgery,
McMaster University, Hamilton, ON, Canada
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8
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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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9
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Bergman JW, Silveira A, Chan R, Lapner M, Hildebrand KA, Le ILD, Sheps DM, Beaupre LA, Lalani A. Is Immobilization Necessary for Early Return to Work Following Distal Biceps Repair Using a Cortical Button Technique?: A Randomized Controlled Trial. J Bone Joint Surg Am 2021; 103:1763-1771. [PMID: 34166263 DOI: 10.2106/jbjs.20.02047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Improvements in surgical fixation to repair distal biceps tendon ruptures have not fully translated to earlier postoperative mobilization; it is unknown whether earlier mobilization affords earlier functional return to work. This parallel-arm randomized controlled trial compared the impact of early mobilization versus 6 weeks of postoperative immobilization following distal biceps tendon repair. METHODS One hundred and one male participants with a distal biceps tendon rupture that was amenable to a primary repair with use of a cortical button were randomized to early mobilization (self-weaning from sling and performance of active range of motion as tolerated during first 6 weeks) (n = 49) or 6 weeks of immobilization (splinting for 6 weeks with no active range of motion) (n = 52). Follow-up assessments were performed by a blinded assessor at 2 and 6 weeks and at 3, 6, and 12 months. At 12 months, distal biceps tendon integrity was verified with ultrasound. The primary outcome was return to work. Secondary outcomes were pain, range of motion, strength, shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) score, and tendon integrity. Intention-to-treat analysis was performed. A linear mixed model for repeated measures was used to compare pain, range of motion, strength, and QuickDASH between the groups over time; return to work was assessed with use of independent t tests. RESULTS The groups were similar preoperatively (p ≥ 0.16). The average age (and standard deviation) was 44.7 ± 8.6 years. Eighty-three participants (82%) were followed to 12 months. There were no differences between the groups in terms of return to work (p ≥ 0.83). Participants in the early mobilization group had significantly more passive forearm supination (p = 0.04), with passive forearm pronation (p = 0.06) and active extension and supination (p = 0.09) trending toward significantly greater range of motion in the early mobilization group relative to the immobilization group. Participants in the early mobilization group had significantly better QuickDASH scores over time than those in the immobilization group (p = 0.02). There were no differences between the groups in terms of pain (p ≥ 0.45), active range of motion (p ≥ 0.09), or strength (p ≥ 0.70). Two participants (2.0%, 1 in each group) had full-thickness tears on ultrasound at 12 months (p = 0.61). Compliance was not significantly different between the groups (p = 0.16). CONCLUSIONS Early motion after distal biceps tendon repair with cortical button fixation is well tolerated and does not appear to be associated with adverse outcomes. No clinically important group differences were seen. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joseph W Bergman
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Western Upper Limb Facility, Sturgeon Community Hospital, St. Albert, Alberta, Canada
| | - Anelise Silveira
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Chan
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Western Upper Limb Facility, Sturgeon Community Hospital, St. Albert, Alberta, Canada
| | - Michael Lapner
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Western Upper Limb Facility, Sturgeon Community Hospital, St. Albert, Alberta, Canada
| | - Kevin A Hildebrand
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ian L D Le
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David M Sheps
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Western Upper Limb Facility, Sturgeon Community Hospital, St. Albert, Alberta, Canada
| | - Lauren A Beaupre
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Aleem Lalani
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Western Upper Limb Facility, Sturgeon Community Hospital, St. Albert, Alberta, Canada
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10
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Gowd AK, Liu JN, Maheshwer B, Garcia GH, Beck EC, Cohen MS, Nicholson GP, Cole BJ, Verma NN. Return to sport and weightlifting analysis following distal biceps tendon repair. J Shoulder Elbow Surg 2021; 30:2097-2104. [PMID: 33667641 DOI: 10.1016/j.jse.2021.01.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/16/2021] [Accepted: 01/31/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rupture of the distal biceps tendon is an increasingly frequent injury sustained predominantly by middle-aged men. Despite the prevalence of sport in this age group, little is known regarding return to sport outcomes following surgery. METHODS Patients undergoing distal biceps tendon repair (DBR) between January 2015 and January 2017 were contacted electronically via e-mail and via telephone to administer a previously validated and standard return to sport survey. Patients self-reported preinjury and current level of sport and activity as well as preinjury and current level of select weightlifts. RESULTS A total of 77 of 124 patients were available for follow-up (62.1%). Of these patients, 61 endorsed preoperative sport and were included for analysis. Average follow-up was 38.7 ± 6.7 months. The mean age at surgery was 47.5 ± 8.8 years, and the mean body mass index was 30.3 ± 5.1. The dominant side was affected in 25 of 61 cases. Of the 61 included patients, 57 (93.4%) were able to return to sport at any level (lower, same, or higher intensity than preinjury activity level). Forty of the patients (65.6%) were able to return to sport at same or higher intensity. Mean time to return to sport was 6.0 ± 2.8 months. Days from injury to surgery (odds ratio [OR] 0.999, 95% confidence interval [CI] 0.998-0.999), suture anchor fixation in comparison to suture button (OR 0.602, 95% CI 0.427-0.850), and dominant-side surgery (OR 0.749, 95% CI 0.582-0.963) were associated with a decreased likelihood to return to sport at same or higher level of duty. Single-sided incision in comparison to double (OR 5.209, 95% CI 1.239-20.903) and dominant-side surgery (OR 6.370, 95% CI 1.639-24.762) were associated with increased duration to return to sport. CONCLUSION Distal biceps tendon rupture is a significant injury; however, patients can expect high levels of return to sport following DBR with some residual impairment compared with baseline. It is important to counsel patients on their expectations while taking into account the results of this study: that there will be a small but appreciable decrease in strength compared with preinjury levels.
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Affiliation(s)
- Anirudh K Gowd
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Joseph N Liu
- Loma Linda University Medical Center, Loma Linda, CA, USA
| | | | | | - Edward C Beck
- Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Mark S Cohen
- Rush University Medical Center, Chicago, IL, USA
| | | | - Brian J Cole
- Rush University Medical Center, Chicago, IL, USA
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11
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Carter TH, Karunaratne BJ, Oliver WM, Murray IR, White TO, Reid JT, Duckworth AD. Acute distal biceps tendon repair using cortical button fixation results in excellent short- and long-term outcomes : a single-centre experience of 102 patients. Bone Joint J 2021; 103-B:1284-1291. [PMID: 34192926 DOI: 10.1302/0301-620x.103b7.bjj-2020-2246.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Acute distal biceps tendon repair reduces fatigue-related pain and minimizes loss of supination of the forearm and strength of flexion of the elbow. We report the short- and long-term outcome following repair using fixation with a cortical button techqniue. METHODS Between October 2010 and July 2018, 102 patients with a mean age of 43 years (19 to 67), including 101 males, underwent distal biceps tendon repair less than six weeks after the injury, using cortical button fixation. The primary short-term outcome measure was the rate of complications. The primary long-term outcome measure was the abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Secondary outcomes included the Oxford Elbow Score (OES), EuroQol five-dimension three-level score (EQ-5D-3L), satisfaction, and return to function. RESULTS Eight patients (7.8%) had a major complication and 34 (33.3%) had a minor complication. Major complications included re-rupture (n = 3; 2.9%), unrecovered nerve injury (n = 4; 3.9%), and surgery for heterotopic ossification (n = 1; 1.0%). Three patients (2.9%) overall required further surgery for a complication. Minor complications included neurapraxia (n = 27; 26.5%) and superficial infection (n = 7; 6.9%). A total of 33 nerve injuries occurred in 31 patients (30.4%). At a mean follow-up of five years (1 to 9.8) outcomes were available for 86 patients (84.3%). The median QuickDASH, OES, EQ-5D-3L, and satisfaction scores were 1.2 (IQR 0 to 5.1), 48 (IQR 46 to 48), 0.80 (IQR 0.72 to 1.0), and 100/100 (IQR 90 to 100), respectively. Most patients were able to return to work (81/83, 97.6%) and sport (51/62,82.3%). Unrecovered nerve injury was associated with an inferior outcome according to the QuickDASH (p = 0.005), OES (p = 0.004), EQ-5D-3L (p = 0.010), and satisfaction (p = 0.024). Multiple linear regression analysis identified an unrecovered nerve injury to be strongly associated with an inferior outcome according to the QuickDASH score (p < 0.001), along with infection (p < 0.001), although re-rupture (p = 0.440) and further surgery (p = 0.652) were not. CONCLUSION Acute distal biceps tendon repair using cortical button fixation was found to result in excellent patient-reported outcomes and health-related quality of life. Although rare, unrecovered nerve injury adversely affects outcome. Cite this article: Bone Joint J 2021;103-B(7):1284-1291.
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Affiliation(s)
- Thomas H Carter
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh and the University of Edinburgh, Edinburgh, UK
| | - Bevin J Karunaratne
- University of Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - William M Oliver
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh and the University of Edinburgh, Edinburgh, UK
| | - Iain R Murray
- Department of Sports Medicine, Stanford University, Redwood City, California, USA
| | - Timothy O White
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh and the University of Edinburgh, Edinburgh, UK
| | - Jeffrey T Reid
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh and the University of Edinburgh, Edinburgh, UK
| | - Andrew D Duckworth
- Edinburgh Orthopaedics - Trauma Royal Infirmary of Edinburgh and the University of Edinburgh, Edinburgh, UK.,Usher Institute, University of Edinburgh, Edinburgh, UK
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Vishwanathan K, Soni K. Distal biceps rupture: Evaluation and management. J Clin Orthop Trauma 2021; 19:132-138. [PMID: 34099972 PMCID: PMC8167284 DOI: 10.1016/j.jcot.2021.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022] Open
Abstract
Injury to the distal biceps occurs in certain high risk groups. Anatomical continuity of the lacertus fibrosus has bearing on the extent of retraction of the torn tendon stump. The objective of clinical and imaging evaluation is to discriminate between tendinosis, partial tear, acute complete tear and chronic complete tear. A complete tear of the distal biceps tendon can be diagnosed clinically with the Hook test. The traditional Hook test and the resisted Hook test are useful clinical tests. Though x-rays are routinely done, MRI remains the investigation of choice. Non-operative treatment has a role in selected patients with partial tear or patients with complete tear who have low functional demands. Operative treatment is the recommended treatment for complete tear of the distal biceps and is associated with good functional outcome and patient satisfaction.
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Affiliation(s)
- Karthik Vishwanathan
- Professor and Head, Department of Orthopaedics, Parul Institute of Medical Sciences and Research, Parul University, Vadodara, India,Corresponding author. Professor and Head of the Department, Department of Orthopaedics, Parul Institute of Medical Sciences and Research, Faculty of Medicine, Parul University, P.O Limda, Waghodia, Vadodara, 391760, India.
| | - Krishna Soni
- Medical Student, Parul Institute of Medical Sciences and Research, Parul University, Vadodara, India
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Agarwalla A, Gowd AK, Jan K, Liu JN, Garcia GH, Naami E, Wysocki RW, Fernandez JJ, Cohen MS, Verma NN. Return to work following distal triceps repair. J Shoulder Elbow Surg 2021; 30:906-912. [PMID: 32771606 DOI: 10.1016/j.jse.2020.07.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the rate and duration of return to work in patients undergoing distal triceps repair (DTR). METHODS Consecutive patients undergoing DTR from 2009 to 2017 at our institution were retrospectively reviewed at a minimum of 1 year postoperatively. Patients completed a standardized and validated work questionnaire; a visual analog scale for pain; the Mayo Elbow Performance Score; the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire; and a satisfaction survey. RESULTS Of 113 eligible patients who underwent DTR, 81 (71.7%) were contacted. Of these patients, 74 (91.4%) were employed within 3 years prior to surgery (mean age, 46.0 ± 10.7 years; mean follow-up, 5.9 ± 3.9 years). Sixty-nine patients (93.2%) returned to work by 2.2 ± 3.2 months postoperatively. Sixty-six patients (89.2%) were able to return to the same level of occupational intensity. Patients who held sedentary-, light-, medium-, and high-intensity occupations were able to return to work at a rate of 100.0%, 100.0%, 80.0%, and 76.9%, respectively, by 0.3 ± 0.5 months, 1.8 ± 1.5 months, 2.5 ± 3.6 months, and 4.8 ± 3.9 months, respectively, postoperatively. Of the workers' compensation patients, 15 (75%) returned to work by 6.5 ± 4.3 months postoperatively, whereas 100% of non-workers' compensation patients returned to work by 1.1 ± 1.6 months (P < .001). Seventy-one patients (95.9%) were at least somewhat satisfied, with 50 patients (67.6%) reporting excellent satisfaction. Seventy-two patients (97.3%) would undergo the operation again if presented the opportunity. A single patient (1.4%) required revision DTR. CONCLUSIONS Approximately 93% of patients who underwent DTR returned to work by 2.2 ± 3.2 months postoperatively. Patients with higher-intensity occupations had an equivalent rate of return to work but took longer to return to their preoperative level of occupational intensity. Information regarding return to work is imperative in preoperative patient consultation to manage expectations.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Kyleen Jan
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, CA, USA
| | | | - Edmund Naami
- School of Medicine, University of Illinois, Chicago, IL, USA
| | - Robert W Wysocki
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - John J Fernandez
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Mark S Cohen
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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