A Simple Grafting Method to Repair Irreparable Distal Biceps Tendon

Abstract

Irreparable distal biceps tendon tears typically are treated using a free tendon graft. We asked whether our new method to fix the graft-using two suture anchorsyields similar results to our previous bone canal method. We compared the two methods for strength, endurance, and clinical findings. There were two groups, the suture anchor group (Group A, seven patients) and the bone canal group operated on before suture anchors (Group B, seven patients). The patients were males with a mean age at surgery of 44.9 years. The operative delay from primary trauma to index surgery averaged 5.9 months. The minimum followup was 2 years (mean, 11.1 years; range, 2-23 years). The mean arc of elbow motion was 0°to 132°, pronation 83°, and supination 80°. Compared with the contralateral side, the maximal peak torque was 84% in supination and 91% in pronation, and the maximal static elbow flexion strength was 94%. The Mayo elbow score averaged 99 in Group A and 100 in Group B. There were no major differences between the two groups. Our novel modification to fix a tendon graft yields equal clinical outcomes compared with the bone canal method for treatment of irreparable distal biceps tendon injuries.

Magnetic resonance imaging of the elbow

“…Surgical debridement and reattachment is only warranted in patients who fail to respond to conservative management (24,30,34,35). The majority of patients with complete tears require immediate surgical reattachment of the biceps tendon to the bicipital tuberosity (36), as delayed reconstruction of the tendon can be more challenging and have a poorer functional outcome (24,30,(37)(38)(39).…”

Elbow Tendinopathy and Tendon Ruptures: Epicondylitis, Biceps and Triceps Ruptures

“…Vastamäki and Vastamäki retrospectively reported on 14 patients treated with allograft reconstruction (7 with suture anchor fixation and 7 with transosseous suture fixation) a mean 5.9 months after injury. 53 At minimum 2-year follow-up, there was no difference in elbow flexion strength between the groups (93% of uninjured [63 of 68] versus 97% [59 of 61]), but there was a trend toward lower supination strength with suture anchors (73% [8 of 11] of uninjured versus 94% [11 of 12], p ϭ .16). One patient in the suture anchor group developed considerable motion-limiting heterotopic ossification.…”

Treatment of Chronic Biceps Tendon Ruptures

“…Cain et al [12] noted a 3 % rate of symptomatic heterotopic ossification regardless of when surgery was performed. Vastamaki and Vastamaki [70] reported on two patients fixed with a tendon graft through an anterior approach that developed heterotopic ossification, including one with a substantial loss of motion resulting in a motion arc of 25-120°. In the absence of heterotopic ossification, loss of motion, both with elbow extension [17,68] and rotation [9], has been reported as well in patients undergoing surgery in the chronic setting.…”

“…Since first described in the English literature in 1977 by Hovelius and Josefsson [35], multiple techniques for chronic reconstruction utilizing a graft have been described, with no technique appearing superior. Published reports have examined using semitendinosis autograft [30, 32, 50, 72], flexor carpi radialis autograft [45], Achilles tendon allograft [17, 31, 59, 66, 73], tensor fascia lata autograft [7, 35, 38, 64], lacertus fibrosis [31], palmaris longus autograft [64, 70], plantaris longus autograft [70], and long extensors of the second and third toes [70] (Table 1).…”

“…When treating chronic ruptures, it is not unusual to immobilize the affected extremity for a minimum of 10–14 days, with several authors advocating the use of a brace with an extension block for several weeks after removal from the splint [17, 38, 45, 50, 59, 66, 68, 72]. Others approach these repairs with more caution, immobilizing patients in a plaster splint for 6 weeks [67, 70]. Following this, it is usual to start formal strengthening at 3 months, with delaying return to vigorous lifting at no sooner than 6 months following surgery.…”