Distal biceps tendon rupture: advantages and drawbacks of the anatomical reinsertion with a modified double incision approach

Abstract

BackgroundDistal biceps tendon rupture occurs more often in middle-aged male population, involving the dominant arm. In this retrospective study, it’s been described the occurrence of the most frequent adverse events and the clinical outcomes of patients undergoing surgical repair of distal biceps tendon rupture with the modified Morrey’s double-incision approach, to determine better indications for patients with acute tendon injury.MethodsSixty-three patients with acute distal biceps tendon rupture treated with a modified double-incision technique between 2003 and 2015 were retrospectively evaluated at a mean 24 months of follow-up. Clinical evaluation including range of motion (ROM) and isometric strength recovery compared to the healthy contralateral side assessment, together with documentation of nerve injury, was performed. Patients were asked to answer DASH, OES and MEPS scores.ResultsThe ROM recovery showed excellent results compared to the healthy contralateral side.The reported major complications included: one case of proximal radio-ulnar synostosis, 3 cases of posterior interosseous nerve (PIN) palsy and one case of a-traumatic tendon re-rupture. Concerning minor complications, intermittent pain, ROM deficiency < 30° in flexion/extension and pronation/supination, isometric flexion strength deficiency < 30% and isometric supination strength deficiency < 60%, lateral antebrachial cutaneous nerve (LACBN) injury, were observed. The average DASH score was 8.5; the average OES was 41.5 and the MEPS was 96.3.ConclusionThe Morrey modified double-incision technique finds its indication in young and active patients if performed within 2 weeks from injury. If performed by experienced surgeons, the advantages can exceed the drawbacks of possible complications.

Clinical and Functional Comparison between Anatomical and Non-Anatomical Acute Repair of Tears of the Distal Tendon of Biceps Brachii

“…Even though the surgical treatment is now considered the treatment of choice, there is not a general agreement on which is the best surgical approach. Some authors prefer the single anterior approach (16)(17)(18); while others prefer the Boyd and Anderson double-incision technique (1,10,11,19). Even though the two-incision technique limits the volar surgical dissection, it has been associated with important complications including proximal radio-ulnar synostosis (20), formation of proximal radio-ulnar calcifications and lesions on the posterior interosseous nerve (21).…”

No functional differences in anatomic reconstruction with one vs. two suture anchors after non-simultaneous bilateral distal biceps brachii tendon rupture: a case report and review of the literature

“…According to Kodde et al [20] the double-incision approach had significantly fewer complications than the single-incision anterior approach in their latest systematic review of 40 studies. However, the clinical outcome remains controversial [21,22], as some authors reported a significantly greater proportion of unsatisfactory results than with single-incision repair [23]. In the only randomized controlled trial to this topic, no significant differences in outcomes between the single-and doubleincision distal biceps repair techniques other than a 10% advantage in final flexion strength with the latter could be shown [9].…”

Anatomical variations of the biceps brachii insertion: a proposal for a new classification

“…(47) Broken tendons are subject to several treatment techniques: one cut technique (use of seam anchors), two-cut technique (using bone tunnels), biotendinosis screw for fixation and endobuttons. [4,9,10,17,27,41,42]. Different methods of double incision (standard and modified) are characterized by a different dimension of showing the ulnar periosteum.…”

“…It turned out that against the induction of nerve palsy (radial or lateral antebrachial cutaneous nerve) nor the heterotopic ossification does not protect the anterior small incision of the cubital fossa with the execution of muscle splitting technique. [42].…”