A comparative clinical and functional assessment of cortical button versus suture anchor in distal biceps brachii tendon repair

Reichert, Paweł; Królikowska, Aleksandra; Kentel, Maciej; Witkowski, Jarosław; Gnus, Jan; Satora, Wojciech; Czamara, Andrzej

doi:10.1016/j.jos.2018.08.007

Cited by 12 publications

(9 citation statements)

References 23 publications

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“…10 In their retrospective sample of 28 patients with a mean follow-up of 3 years, Reichart et al report mean DASH scores of 14.39 in the cortical button group and 23.01 in the suture anchor group. 5 Similarly, in a case series of 46 patients, 93% were satisfied with the results and more than 80% of patients had regained their premorbid function in both recreational and occupational activities. 11 This article adds further evidence that surgical repair of ruptured distal biceps reliably restores upper limb function.…”

Section: Discussionmentioning

confidence: 89%

“…These functional results are in line with other papers comparing similar groups of patients. 5,11,12 The mean DASH score in this cohort was 4.9; a DASH score ranging from 0 to 29 is considered to be the point where patients were no longer considered their upper limb disorder a problem. 10 In their retrospective sample of 28 patients with a mean follow-up of 3 years, Reichart et al report mean DASH scores of 14.39 in the cortical button group and 23.01 in the suture anchor group.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous techniques are described in the literature, with no true consensus regarding the optimal method of fixation. 5 Commonly reported methods include suture anchors and cortical buttons, with many studies reporting comparable outcomes. 6 –8…”

Section: Introductionmentioning

confidence: 99%

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Mid-term clinical and functional outcomes of distal biceps tendon repair: A comparative study of two surgical fixation techniques

Poyser

Abdul

Mehta

2020

Journal of Orthopaedics, Trauma and Rehabilitation

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Objective: Acute rupture of the distal biceps tendon is relatively uncommon, and surgical repair is advocated for acute injuries to restore strength and function. Numerous techniques are described in the literature, with no true consensus regarding the optimal method of fixation. The aim of this study was to evaluate patient-reported outcome measures, clinical outcomes and complications for patients undergoing distal biceps tendon repair using two fixation techniques: cortical button and suture anchor. Methods: A retrospective single-unit case series of 51 cases (50 patients) underwent distal biceps tendon repair, comprising 19 cortical button and 32 suture anchor fixations. Patients were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and overall satisfaction. Clinical outcomes and complications were reviewed from patient records. Results: Thirty-eight (76.5%) patients responded to DASH questionnaires with a mean follow-up of 189 weeks (11.5–425 weeks). Mean DASH scores for cortical button and suture anchor groups were 6.2 (0–30.8) and 3.3 (0–16.7), respectively ( p = 0.21). Eight patients (16%) reported lateral cutaneous neuropraxia in the early post-operative period. All but two of these patients experienced complete resolution at the final follow-up. One patient had heterotrophic ossification, which did not require any further intervention. There was one re-rupture (suture anchor), but the patient declined further surgical intervention. Conclusion: There were no statistically significant differences in the patient-reported outcome measures, overall satisfaction and complication rate between patients undergoing either method of fixation. Level of evidence: III

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Mid-term clinical and functional outcomes of distal biceps tendon repair: A comparative study of two surgical fixation techniques

Poyser

Abdul

Mehta

2020

Journal of Orthopaedics, Trauma and Rehabilitation

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“…However, they found no difference in reoperation rates among suture anchor, cortical button, and cortical button with interference screw repairs. Reichert et al 21 also found no significant differences in clinical and functional outcomes between cortical button and suture anchor fixation 3 years after DBT repair. van der Vis et al 28 reported no differences in physical function and quality of life 8 to 100 months after repair.…”

Section: Discussionmentioning

confidence: 95%

Optimizing Fixation for Distal Biceps Tendon Repairs: A Systematic Review and Meta-regression of Cadaveric Biomechanical Testing

et al. 2021

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Background: Various surgical techniques can be used to repair acute distal biceps tendon (DBT) tears; however, it is unknown which type of repair or implant has the greatest biomechanical strength and presents the lowest risk of type 2 failure. Purpose: To identify associations between the type of implant or construct used and the biomechanical performance of DBT repairs in a review of human cadaveric studies. Study Design: Systematic review and meta-regression. Methods: We systematically searched the EMBASE and Medline (PubMed) databases for biomechanical studies that evaluated DBT repair performance in cadaveric specimens. Two independent reviewers extracted data from 14 studies that met our inclusion criteria. The pooled data set was subjected to meta-regression with adjusted failure load (AFL) as the primary outcome variable. Procedural parameters, such as number of sutures, cortices, locking stitches, and whipstitches, served as covariates. Adjusted analysis was performed to determine the differences among implant types. The alpha level was set at .05. Results: When using no implant (bone tunnels) as the referent, no fixation type or procedural parameter was significantly better at predicting AFL. Cortical button fixation had the highest AFL (370 N; 95% CI, −2 to 221). In an implant-to-implant comparison, suture anchor alone was significantly weaker than cortical button (154 N; 95% CI, 30 to 279). Constructs using a cortical button and interference screw were not stronger (as measured by AFL) than those using a cortical button alone. The presence of a locking stitch added 113 N (95% CI, 29 to 196) to the AFL. The use of cortical button instead of interference screws or bone tunnels was associated with lower odds of type 2 failure. Avoiding locking stitches and using more sutures in the construct were also associated with lower odds of type 2 failure. Conclusion: Cortical button fixation is associated with greater construct strength than is suture anchor repair and a lower risk of type 2 failure compared with interference screw fixation or fixation without implants. The addition of an interference screw to cortical button fixation was not associated with increased strength. The presence of a locking stitch added 113 N to the failure load but also increased the odds of type 2 failure.

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“…This construct was shown to be biomechanically superior over traditional bone-tunnel repair, suture anchors, and tenodesis screws regarding pullout strength [ 18 ]. The other techniques place stress on the sutures in various ways [ 18 , 19 ]. The bone tunnel places stress on the sutures against sharp cortical bone, allowing for suture failure at the edges [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Successful Surgical Repair of Acute Quadriceps Tendon Rupture Utilizing Cortical Button Fixation: A Case Report

et al. 2021

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Patient: Male, 69-year-old Final Diagnosis: Quadriceps tendon rupture Symptoms: Knee pain Medication:— Clinical Procedure: Surgery Specialty: Orthopedics and Traumatology Objective: Unusual setting of medical care Background: Timely diagnosis and surgical treatment are often needed to restore function of the extensor mechanism after rupture of the quadriceps tendon. Several techniques for quadriceps tendon repair have been reported, including suture anchors and bone tunnels. Cortical button fixation, or the use of an adjustable cortical fixation device, is a local and biomechanically strong internal brace technique used to treat ligament and tendon injuries. This report is of a 69-year-old man who experienced a quadriceps tendon rupture while golfing and underwent a successful surgical repair using cortical button fixation. Case Report: A 69-year-old man sustained an injury after slipping while golfing. He had immediate left knee pain and inability to bear weight. Radiographs demonstrated patella baja with an acute superior pole avulsion fracture of the patella, consistent with rupture of the quadriceps tendon. Surgical repair was discussed. Technique: After soft tissue debridement, the quadriceps tendon was debrided from the frayed and edematous edges. Two Krackow-type stitches were placed with #2 Fibertape and passed through 2 cortical buttons. Two bone tunnels were drilled from the superior to the inferior poles of the patella, bicortically. The cortical button was passed and appropriately tensioned. Conclusions: Although acute quadriceps tendon rupture is commonly treated with transosseous suture repair and suture anchor repair, this report demonstrates that cortical button fixation was a successful procedure with strong biomechanical properties, resulting in the early return of function and range of motion.

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A comparative clinical and functional assessment of cortical button versus suture anchor in distal biceps brachii tendon repair

Cited by 12 publications

References 23 publications

Mid-term clinical and functional outcomes of distal biceps tendon repair: A comparative study of two surgical fixation techniques

Mid-term clinical and functional outcomes of distal biceps tendon repair: A comparative study of two surgical fixation techniques

Optimizing Fixation for Distal Biceps Tendon Repairs: A Systematic Review and Meta-regression of Cadaveric Biomechanical Testing

Successful Surgical Repair of Acute Quadriceps Tendon Rupture Utilizing Cortical Button Fixation: A Case Report

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