A new intramedullary fixation method for distal biceps tendon ruptures: a biomechanical study

Caekebeke, Pieter; Duerinckx, Joris; Bellemans, Johan; Riet, Roger van

doi:10.1016/j.jse.2020.01.102

Cited by 10 publications

(17 citation statements)

References 26 publications

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“…7 ). 54 The biomechanical results of this intramedullar button are comparable to other currently used techniques. 47 , 55 Both load to failure (356 N) and stiffness (61 N/mm) are similar to the excellent results of the bicortical button technique.…”

Section: Treatment Of Distal Biceps Tendon Injurysupporting

confidence: 53%

Acute complete and partial distal biceps tendon ruptures: what have we learned? A review

2021

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Acute distal biceps tendon (DBT) pathology includes bicipitoradial bursitis, tendinosis, partial and complete tears. Diagnosis of complete DBT tears is mainly clinical, whereas in partial tears medical imaging is a valuable addition to the clinical diagnosis. New insights in clinical and medical imaging of partial tears may reduce time to diagnosis and may guide the treatment plan. Most complete tears are best treated with primary repair using either a single-incision or double-incision approach with good clinical outcome. The double-incision technique has a higher risk of heterotopic ossification, whereas a single-incision technique carries a higher risk of nerve-related complications. Intramedullary fixation may be a viable solution to negate the risk of posterior interosseus nerve lesions in single-incision repairs. DBT endoscopy can be used to treat low-grade partial tears and tendinosis. Cite this article: EFORT Open Rev 2021;6:956-965. DOI: 10.1302/2058-5241.6.200145

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Section: Treatment Of Distal Biceps Tendon Injurysupporting

confidence: 53%

Acute complete and partial distal biceps tendon ruptures: what have we learned? A review

2021

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“… 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 The rupture can result in the weakness of arm flexion and supination. 1 , 2 , 3 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 The restoration of functional strength following a biceps tendon rupture is possible with surgical intervention and has largely been shown to be a direct function of reattachment position relative to anatomic footprints. 2 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 15 , 17 , 18 , 19 , 21 Achieving full supination from a partially supinated orientation, an action potentially clinically relevant for the performance of activities such as using a screwdriver, has been shown to be particularly strongly related to tendon reattachment position.…”

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confidence: 99%

“…Many approaches, including single-incision anterior and double-incision posterior techniques, with various fixation methods have been described to accomplish tendon reattachment to the radial tuberosity. 1 , 2 , 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 18 , 19 , 20 , 21 , 22 Although both single-incision anterior and double-incision posterior techniques have shown significant repair success, each is associated with operative difficulties and postoperative complications that negatively impact the quality of the repair. 1 , 2 , 7 , 8 , 9 , 10 , 12 , 13 , 14 , 17 , 18 , 19 , 20 , 21 , 22 Thus, to date, there has been no consensus on the best approach to the repair.…”

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confidence: 99%

“… 1 , 2 , 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 18 , 19 , 20 , 21 , 22 Although both single-incision anterior and double-incision posterior techniques have shown significant repair success, each is associated with operative difficulties and postoperative complications that negatively impact the quality of the repair. 1 , 2 , 7 , 8 , 9 , 10 , 12 , 13 , 14 , 17 , 18 , 19 , 20 , 21 , 22 Thus, to date, there has been no consensus on the best approach to the repair. 1 , 2 , 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 20 The double-incision posterior technique consistently allows exposure for true anatomic footprint reattachment, but the extensor carpi ulnaris and, importantly, the supinator must be split to do so, potentially resulting in functionally significant decreases in the supination torque.…”

mentioning

confidence: 99%

“… 1 , 2 , 7 , 8 , 9 , 10 , 12 , 13 , 14 , 17 , 18 , 19 , 20 , 21 , 22 Thus, to date, there has been no consensus on the best approach to the repair. 1 , 2 , 3 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 20 The double-incision posterior technique consistently allows exposure for true anatomic footprint reattachment, but the extensor carpi ulnaris and, importantly, the supinator must be split to do so, potentially resulting in functionally significant decreases in the supination torque. 7 , 10 , 13 , 14 , 18 , 19 , 20 This approach has also been shown to be associated with heterotopic bone formation and muscle fatty infiltration.…”

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confidence: 99%

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Power-Optimizing Repair for Distal Biceps Tendon Rupture: Stronger and Safer

Tadevich

Bhagat

Lim

et al. 2021

Journal of Hand Surgery Global Online

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Purpose: Many approaches have been described to accomplish tendon reattachment to the radial tuberosity in a distal biceps tendon rupture, with significant success, but each is associated with potential postoperative complications, including posterior interosseous nerve (PIN) injury. To date, there has been no consensus on the best approach to the repair. The purpose of this study was to evaluate the supination strength and the distance of drill exit points from the PIN in a power-optimizing distal biceps repair method and compare the findings with those of a traditional anterior approach endobutton repair method. Methods: Cadaveric arms were dissected to allow for distal biceps tendon excision from its anatomic footprint. Each arm was repaired twice, first with the power-optimizing repair using an anterior singleincision approach with an ulnar drilling angle and biceps tendon radial tuberosity wraparound anatomic footprint attachment, then with the traditional anterior endobutton repair. Following each repair, the arm was mounted on a custom-built testing apparatus, and the supination torque was measured from 3 orientations. The PIN was then located posteriorly, and its distance from each repair exit hole was measured. Results: Five cadaveric arms, each with both the repairs, were included in the study. On average, the power-optimizing repair generated an 82%, 22%, and 13% greater supination torque than the traditional anterior endobutton repair in 45 supination, neutral, and 45 pronation orientations, respectively. On average, the power-optimizing repair produced drill hole exit points farther from the PIN (23 mm) than the traditional anterior endobutton repair (14 mm). Conclusions: The power-optimizing repair provides a significantly greater supination torque and produces a drill hole exit point significantly farther from the PIN than the traditional anterior endobutton approach.Type of study/level of evidence: Therapeutic III.

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All-suture anchors for distal biceps tendon repair: a preliminary outcome study

Lappen

Geyer

Kadantsev

et al. 2022

Arch Orthop Trauma Surg

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Introduction The aim of this study was to retrospectively evaluate the clinical outcome of double intramedullary all-suture anchors’ fixation for distal biceps tendon ruptures. Materials and methods A retrospective case series of patients who underwent primary distal biceps tendon repair with all-suture anchors was conducted. Functional outcome was assessed at a minimum follow-up of at 12 months based on the assessments of the Mayo Elbow Performance Score (MEPS), Andrews–Carson Score (ACS), Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), and the Visual Analog Scale (VAS) for pain. Maximum isometric strength test for flexion and supination as well as postoperative range of motion (ROM) were determined for both arms. Results 23 patients treated with all-suture anchors were assessed at follow-up survey (mean age 56.5 ± 11.4 years, 96% male). The follow-up time was 20 months (range Q0.25–Q0.75, 15–23 months). The following outcome results were obtained: MEPS 100 (range Q0.25–Q0.75, 100–100); ACS 200 (range Q0.25–Q0.75, 195–200); QuickDASH 31 (range Q0.25–Q0.75, 30–31); VAS 0 (range Q0.25–Q0.75, 0–0). The mean strength compared to the uninjured side was 95.6% (range Q0.25–Q0.75, 80.9–104%) for flexion and 91.8 ± 11.6% for supination. There was no significant difference in ROM or strength compared to the uninjured side and no complications were observed in any patient. Conclusion Distal biceps tendon refixation using all-suture anchors provides good-to-excellent results in terms of patient-reported and functional outcome. This repair technique appears to be a viable surgical option, although further long-term results are needed. Level of evidence Level IV (case series)

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A new intramedullary fixation method for distal biceps tendon ruptures: a biomechanical study

Cited by 10 publications

References 26 publications

Acute complete and partial distal biceps tendon ruptures: what have we learned? A review

Acute complete and partial distal biceps tendon ruptures: what have we learned? A review

Power-Optimizing Repair for Distal Biceps Tendon Rupture: Stronger and Safer

All-suture anchors for distal biceps tendon repair: a preliminary outcome study

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