Bicipital tuberosity bone characteristics in surgical reattachment of the distal biceps: anatomical and radiological study

Abstract

Based on the results of this anatomic study which have demonstrated that anterior cortex and anterior trabecular bone of the medial and distal regions of the bicipital tuberosity are thicker than proximal part, we postulate that these segments could give better pulling out resistance to monocortical implants. Our findings suggest that the strongest parts of the bicipital tuberosity are the proximal and medial parts of the posterior cortex. We can afford them drilling across the radius using a bicortical implant in the proximal and medial section of the radial tuberosity. Furthermore, we suggest that an increased margin of safety could be achieved to prevent injury to the posterior interosseous nerve, drilling the cortical hole in the proximal part of the radial tuberosity without losing resistance properties.

Radial tuberosity anatomy in intramedullar repair of distal biceps tendon ruptures. A radiological study

“…Prior studies regarding radial tuberosity anatomy used microCT images while standard CT images where used for this study. Similar results between measurements on microCT and standard CT have been reported (8). As the thickness of the anterior and posterior cortex in present study are comparable to previous mentioned results, we assumed that standard CT is indeed as proficient to measure cortical thickness.…”

“…We opted for standard CT images to obtain a large measurement cohort which significantly surpasses the number required in the power analysis. Finally, the measurement of the posterior and anterior cortex at the radial tuberosity is comparable to previous microCT measurements (8). Second, given that the CT scans were taken for different indications on a non-standardized manner we manually aligned the plane of the radial tuberosity by using the sagittal and coronal planes to have standardized measurements.…”

“…There is a need to place two buttons as the anterior cortex of the radial tuberosity is markedly thinner than the posterior cortex. This has been shown in small series evaluating the cortex thickness and density at the radial tuberosity (8).…”

“…There is little known regarding the anterior cortex anatomy around the radial tuberosity, its thickness in different sections and its possible importance in assuring a good resistance to pulling out of the implants use in surgical reinsertion of the DBT. The few studies that describe the anterior cortex are small series (8).…”