The Effect of Drilling Angle on Posterior Interosseous Nerve Safety During Open and Endoscopic Anterior Single-Incision Repair of the Distal Biceps Tendon

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

“…Other authors [7,13,21] performing a cadaveric study have tried to prevent the PIN lesion changing the position of the posterior cortex hole. However, in all cases, the situation of the anterior hole was in the central part of the tuberosity.…”

Use of a Bicortical Button to Safely Repair the Distal Biceps in a Two-Incision Approach: A Cadaveric Analysis

“…33 Finally, recent studies have demonstrated that, using a single anterior incision, the biceps tendon cannot be reliably repaired to the anatomic insertion. 5,22,32 Biomechanical studies have confirmed that nonanatomic placement of the biceps tendon on the insertion can have a measurable impact on supination strength, especially from neutral forearm rotation to full supination. 5,17,18 The 2-incision technique, in contrast, allows excellent access to the most ulnar aspect of the biceps tuberosity, facilitating a more anatomic repair.…”

“…Biomechanical studies have demonstrated that there are measurable consequences to nonanatomic placement of the tendon, with loss of supination power, especially with the arm in relatively more supinated positions. 5,18,32 This is likely due to loss of the "wrapping" effect of the biceps tendon around the tuberosity.…”

“…Similar to previous studies, a total of 10 specimens were used, which would seem generalizable given the average distance, and the range of distances, to at-risk structures. 30,32 Furthermore, a post hoc power analysis indicated that this study was powered to demonstrate that the pin would not contact the at-risk structures. Assuming a normal distribution, for PIN distance (mean, 11.4; SD, 2.4), 95% of values will be between 6.7 and 16.2 mm.…”

“…31 Several other studies have documented similar results, with a distance of 11 to 16 mm being recommended with single-incision distal biceps repairs, which was enabled by ulnar orientation of the guide pin trajectory. 9,32 The distal biceps was anatomically repaired to the tuberosity using the 2-incision biceps button technique. In all specimens, the biceps was repaired to the "anatomic" location as described, which is ulnar to the ridge of the biceps tuberosity.…”