Complications of distal biceps tendonrepairs

Distal biceps tendon rupture: Is surgery the best course of treatment? Two case reports

STUDY DESIGN

Repeated case study.

INTRODUCTION

Complete rupture of the distal biceps tendon occurs mostly within the middle-aged male population. Surgical repair is traditionally recommended. Given the potential for complications, questions remain whether surgical repair is indicated.

PURPOSE

To explore non-operative management for full distal biceps tendon ruptures.

CASES

Two participants with complete tears of the distal biceps tendon confirmed with magnetic resonance imaging/ultrasound had chosen to not undergo surgical repair. First, a 48-year-old police officer was an avid weight lifter and recreational athlete. Second, a 43-year-old detailer has minimal physical activity participation other than work duties and light recreational sports. Strength testing was performed immediately after rupture and at 24 weeks after a structured physical therapy program focused on strengthening and stretching the elbow flexors and supinator.

OUTCOMES

Initial strength deficits of 17/21% in flexion and 13/19% for supination were detected. In both patients, flexion and supination strength returned to normal limits when compared with the opposite upper extremity. After intervention, functional and disability scores were normal in both cases, and both patients reported return to preinjury repetitive work and weight training.

DISCUSSION

Although patients are typically counseled that a reason for surgical repair after biceps rupture is substantial loss of flexion and supination strength, these cases indicate that full recovery of strength and function is possible through rehabilitation.

CONCLUSION

These cases question the traditional wisdom that a surgical repair is needed for all distal biceps ruptures.

LEVEL OF EVIDENCE

Therapy, level 5. ICD-10 Code: M66.3.

Anatomic reinsertion of the distal biceps tendon rupture through a single anterior approach: extensile or mini-invasive approach? A retrospective study at mean 45-month follow-up

PURPOSE

To evaluate and compare clinical results and complication rate of a standard and mini-invasive reconstruction technique for distal biceps tendon rupture.

METHODS

Twenty-eight cases of biceps tendon rupture were evaluated at mean 45-month follow-up. A standard anterior approach was used in 19 cases, and a less invasive anterior approach was used in nine cases. Suture anchors were used for tendon reconstruction in all cases. Elbow range of motion (ROM), subjective strength recovery, time to return to work and sports activities, and complications were recorded. Disability of the Arm, Shoulder and Hand Score (DASH) the Oxford Elbow Score (OES), and the Mayo Elbow Performance Score (MEPS) were obtained for all patients.

RESULTS

Mean ROM recovery was almost complete. Mean subjective strength recovery allowed full return to sports and work in 93 % of cases, within mean 3-month postoperative. Mean DASH, OES, and MEPS scores were good. The clinically relevant complications rate was 17.8 %, all associated with the standard extensile approach group (Group A). Asymptomatic heterotopic ossifications were detected in four cases (14.3 %), not affecting functional recovery.

CONCLUSIONS

Clinical results and complications rate of anatomical reconstruction of the distal biceps tendon rupture were comparable to the literature. Comparison between Group A and B showed no significant differences in terms of ROM, and OES and MEPS scores. Strength recovery, time to return to sports and work, and DASH score showed a positive trend in Group B. The clinically relevant complications rate was 0 % in Group B and 26 % in Group A.

Distal biceps tendon insertion: an anatomic study

Knowledge of the exact location of the distal biceps brachii insertion is crucial when performing tendon reconstruction or repair. To quantitatively describe the morphology of the distal biceps brachii insertion, 20 cadaveric arms were examined. Linear and angular measurements, including the footprint dimensions and shape, radial tuberosity dimensions and irregularities, and the rotational position of the tuberosity and footprint, were obtained. The axial and transverse dimensions of the radial tuberosity and distal biceps tendon footprint measured 24.2 x 12 mm and 18.7 x 3.7 mm, respectively. The insertion footprint is on the posterior/ulnar aspect of the radial tuberosity centered at approximately 30 degrees anterior to the lateral/coronal plane with the forearm fully supinated. This explains why any preoperative limitation in supination may make an anatomic repair difficult through a single anterior incision. To our knowledge, this is the first study to quantitatively describe the angular location of the radial tuberosity and the relationship of the distal biceps tendon on the tuberosity.