Factors that determine supination strength following distal biceps repair

Schmidt, Christopher C.; Brown, Brandon T.; Qvick, Lars M.; Stachowicz, Rafal Z.; Latona, Carmen R.; Miller, Mark Carl

doi:10.1016/j.jse.2016.07.049

Cited by 4 publications

(5 citation statements)

References 3 publications

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“…More recently, use of the double-incision technique has been questioned because it damages the supinator muscle, thus jeopardizing supination strength. 29 This study, based on an MRI quantification of fat fraction, has partially confirmed this hypothesis. An overall increase in fat fraction from 14% to 19% was observed in our cohort of patients.…”

Section: Discussionsupporting

confidence: 69%

“…This is in accordance with other reports. 18,29 The reason for this difference is probably multifactorial, and limited damage of the supinator muscle secondary to the posterolateral approach is, according to our study, a marginal factor. Other variables could have played a more relevant role.…”

Section: Discussionmentioning

confidence: 59%

“…The effect of the double-incision technique on supinator muscles has been reported by a single study that described worrisome fatty infiltration of the supinator muscle. 29 According to the authors, fatty infiltration was commonly observed after the double-incision technique, affecting supination strength. This new finding could clarify some unexplained cases of supination weakness after the double-incision technique.…”

mentioning

confidence: 99%

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Minimal Damage to the Supinator Muscle After the Double-Incision Technique for Distal Biceps Tendon Repair

Blonna¹,

Olivero

Galletta

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The effect of the double-incision technique on the supinator muscle is unclear. Purpose: The aim of this study was to quantify fatty atrophy of the supinator muscle and map the area of muscle damage. Study Design: Case series; Level of evidence, 4. Methods: A total of 19 male patients (median age, 43 years) who underwent distal biceps tendon repair were included in the analysis. Patients with a minimum of 12 months of follow-up were included. The following variables were analyzed: range of motion; shortened version of Disabilities of the Arm, Shoulder and Hand (QuickDASH) score; Summary Outcome Determination (SOD) score; and isokinetic peak force and endurance in supination. Quantitative analysis and mapping of fatty infiltration of the supinator muscle were based on the calculation of proton density fat fraction on magnetic resonance imaging scans of both elbows using the IDEAL (Iterative Decomposition of Echoes of Asymmetrical Length) sequence. Results: At an average follow-up of 24 months (range, 12-64 months), the median SOD score was 9.0 (95% CI, 7.8-9.4), and the mean QuickDASH score was 6.7 (95% CI, 0.0-14.1). A difference of 17% in peak torque was measured between repaired and nonrepaired elbows (repaired elbow: 9.7 N·m; nonrepaired elbow: 11.7 N·m; P = .11). Endurance was better in the repaired elbow than the nonrepaired elbow (8.4% vs 14.9% work fatigue, respectively; P = .02). The average fat fraction of the supinator muscle was 19% (95% CI, 16%-21%) in repaired elbows and 14% (95% CI, 13%-16%) in contralateral elbows ( P = .04). The increase in fat fraction was located in a limited area between the radius and ulna at the level of the bicipital tuberosity. Conclusion: The assessment of the supinator muscle showed a limited increase in fat fraction between the radius and ulna at the level of the bicipital tuberosity. No significant effect on supination strength was highlighted.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 59%

mentioning

confidence: 99%

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Minimal Damage to the Supinator Muscle After the Double-Incision Technique for Distal Biceps Tendon Repair

Blonna¹,

Olivero

Galletta

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Acute anatomic surgical repair of distal biceps brachii tendon has been shown to improve functional outcomes, strength, and muscle endurance after distal biceps rupture. 1,16,22,23 Cortical button fixation has been shown to outperform bone tunnels, intraosseous screws, and suture anchors in biomechanical studies. 7,12,16,19 As noted previously, the most common major complication following surgery is PIN palsy, and unicortical button fixation may have the advantage of avoiding inadvertent injury to the PIN.…”

Section: Discussionmentioning

confidence: 99%

No Significant Difference Between Intramedullary and Extramedullary Button Fixation for Distal Biceps Brachii Tendon Rupture After Cyclic Loading in a Cadaver Model

Majumdar

Salas

Chavez

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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To biomechanically compare intramedullary (IM) versus extramedullary (EM) distal biceps button fixation under cyclic loading conditions, which is most representative of postoperative physiologic status. Methods: This controlled laboratory study used 13 fresh-frozen matched paired cadaver elbows. One specimen from each pair was randomized to either IM (unicortical) or EM (bicortical) distal biceps button fixation via onlay technique. A servohydraulic actuator was used to cycle each specimen from full extension to 90 of flexion at 0.5 Hz for 3,000 cycles. All specimens were subsequently loaded to failure to simulate an acute postoperative load. Results: During cyclic loading, the mean change in force from cycle 5 to cycle 3000 was 2.1 AE 3.2 N for the IM group and 0.6 AE 4.2 N for the EM group (P ¼ .19). The increase in tendon gap for the IM group was 1.02 mm and for the EM group was 1.83 mm (P ¼ .37). During failure loading, the IM group had a mean failure load of 154.9 AE 44.5 N and the EM group a mean failure load of 191.1 AE 62.6 N (P ¼ .16). Conclusions: No significant differences exist between the IM and EM techniques in loss of force and tendon gap formation under cyclic loading or load to failure conditions. Thus, IM fixation may adequately facilitate optimal bonetendon apposition, with less risk of iatrogenic injury to the posterior interosseous nerve that can be seen with bicortical extramedullary fixation. Clinical Relevance: The most common major complication following distal biceps repair is PIN palsy. IM fixation may be sufficient in facilitating optimal bone-tendon apposition and healing with onlay technique, while minimizing risk of iatrogenic PIN injury associated with EM fixation.

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“…El uso de implantes para aproximar el tendón al hueso sin violar la tuberosidad bicipital podría ser beneficioso, al preservar la ventaja de la leva y, aunque existen dudas sobre la capacidad de cicatrización del tendón sobre hueso cortical, esta se ha demostrado en ensayos animales y en humanos (11,12) . Desde el punto de vista biomecánico, preservar la tuberosidad radial aumenta el momento de supinación un 27%, aunque la relevancia clínica de este dato es desconocida (13) .…”

Section: Anatomía Y Conceptos Biomecánicos Del Tendón Y La Tuberosidaunclassified

Reinserción del tendón distal del bíceps

Laakso¹

2018

REACA

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RESUMEN Objetivo: el desarrollo de nuevos conocimientos y nuevos implantes ha renovado el interés por la reparación quirúrgica del bíceps distal. El presente capítulo repasa los aspectos más relevantes de la reinserción quirúrgica del tendón distal del bíceps. Métodos: se ha realizado una revisión de bibliografía reciente y relevante sobre aspectos básicos de la lesión y su reparación quirúrgica. Resultados: la reparación quirúrgica del tendón es un procedimiento eficaz con una recuperación de una movilidad funcional y una vuelta a la actividad laboral en la mayor parte de los casos. Algunos pacientes pueden sufrir una limitación de la supinación y una limitación leve de la fuerza. La tasa de rerrotura es menor del 2% y la tasa de complicaciones es del 20%, siendo las lesiones del nervio cutáneo antebraquial cutáneo lateral en el abordaje anterior y la osificación heterotópica en la doble incisión las más frecuentes. Conclusión: la reparación quirúrgica del tendón es una técnica eficaz pero no exenta de complicaciones. La atención a algunos detalles técnicos intraoperatorios puede ayudar a reducir el índice de complicaciones.

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Factors that determine supination strength following distal biceps repair

Cited by 4 publications

References 3 publications

Minimal Damage to the Supinator Muscle After the Double-Incision Technique for Distal Biceps Tendon Repair

Minimal Damage to the Supinator Muscle After the Double-Incision Technique for Distal Biceps Tendon Repair

No Significant Difference Between Intramedullary and Extramedullary Button Fixation for Distal Biceps Brachii Tendon Rupture After Cyclic Loading in a Cadaver Model

Reinserción del tendón distal del bíceps

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