Repair of the torn distal biceps tendon by endobutton fixation

Abstract

Background:A number of techniques have been described to reattach the torn distal biceps tendon to the bicipital tuberosity. We report a retrospective analysis of single incision technique using an endobutton fixation in sports persons.Materials and Methods:The present series include nine torn distal biceps tendons in eight patients, fixed anatomically to the radial tuberosity with an endobutton by using a single incision surgical technique; seven patients had suffered the injuries during contact sports. The passage of the endobutton was facilitated by using a blunt tipped pin in order to avoid injury to the posterior interosseous nerve. The patients were evaluated by Disabilities of the Arm, Shoulder and Hand (DASH) score and Mayo elbow score.Results:The average age of the patients was 27.35 years (range 21–42 years). Average follow-up was 41.5 months (range 24–102 months). The final average flexion extension arc was 0°–143°, while the average pronation and supination angles were 77° (range 70°–82°) and 81° (range 78°–85°), respectively at the last followup. All the patients had a Disabilities of the Arm, Shoulder and Hand (DASH) score of 0 and a Mayo elbow score of 100 each. All the seven active sports persons were able to get back to their respective game. There was no nerve injury or any other complication.Conclusions:The surgical procedure used by us is a simple, safe and reproducible technique giving minimal morbidity and better cosmetic results.

Repair Techniques for Acute Distal Biceps Tendon Ruptures

“…These results were in contrast to those in the present study, which indicated bone tunnel and cortical button fixation to have lower complication rates compared with the other methods. Although the present study included only a small percentage of patients treated with intramedullary cortical buttons for fixation 24,26,28 , no complications occurred in any of those patients.…”

“…Surgical repair is performed with use of either a one-incision approach, originally described by Dobbie 3 , or a two-incision approach, described by Boyd and Anderson 4 . Multiple fixation methods have been developed, including bone tunnels [5][6][7][8][9][10][11][12][13][14][15][16] , suture anchors 2,5,7,9,11,15,[17][18][19][20][21][22] , intraosseous (biotenodesis) screws 5,16,23 , and suspensory cortical buttons 16,[24][25][26][27][28] . The complications of this procedure include lateral antebrachial cutaneous nerve injury, radial sensory nerve injury, superficial infection, deep infection, heterotopic ossification, posterior interosseous nerve palsy, radioulnar synostosis, limited elbow motion, and tendon rerupture 29 .…”

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

“…Several surgical options have been described in literature: one incision-approach, using suture anchors, endobutton, biotenodesis screw for fixation, and a double-incision approach, using bone tunnels [8, 15, 19, 21, 22]. Standard and modified double incision approach differ one to each other in ulnar periosteum exposure, avoided by the Morrey’s muscle-splitting technique that reduces risk of synostosis [23, 24].…”

Ultrasonography of Complications in Surgical Repair of the Distal Biceps Brachii Tendon

“…Their frequency varies according to the surgical procedure performed. For example, tendon rerupture is more frequent with procedures involving anchors or transosseous screws; lateral antebrachial cutaneous nerve lesions are more frequent when a single anterior incision is made; posterior interosseous nerve lesions are more frequent in techniques involving the Endobutton; and heterotopic ossification is more frequent for a double‐incision technique …”

“…The occurrence of tears of the distal biceps brachii tendon (DBBT) was previously estimated at 3% of all DBBT ruptures, but their frequency recently increased to 10%, probably due to multifactorial causes, such as increased use of body building, contacts sports, anabolic steroids, and smoking, but also due to increased imaging opportunities, such as ultrasonography (US) and magnetic resonance (MRI) . The most common pathologic mechanism leading to DBBT rupture is simultaneous powerful contraction of the muscle and passive extension of the elbow.…”