Treatment of Distal Biceps Tendon Ruptures Using a Single-Incision Technique and a Bio-Tenodesis Screw

Abstract

No consensus exists in the literature on the optimal operative treatment method for distal biceps tendon ruptures. It is our hypothesis that a single-incision technique with a poly-L-lactide Bio-Tenodesis screw (Arthrex, Inc, Naples, Florida) is a safe and effective method for operative management of distal biceps tendon ruptures, with success and complication rates comparable to previous reports in the literature. This article describes a prospective case series of 29 consecutive patients (30 operations) managed by the same surgeon over 34 months. Average follow-up was 19.6 months. Two patients were lost to follow-up. Elbow range of motion (ROM) and strength; Disabilities of the Arm, Shoulder, and Hand (DASH) score; and SF-12 score were measured at various time points up to 2 years. All patients had full extension and supination. Supination and flexion strength was at least 4/5 in all patients. Mean DASH, SF-12 Physical Component (PCS), and SF-12 Mental Component (MCS) scores were 5.86 (range, 0-16.67), 50.35 (range, 30.4-60.1), and 57.15 (range, 41.7-64.4), respectively. These scores are comparable to normative values reported by the American Academy of Orthopaedic Surgeons. Complication rates were similar to those previously reported in the literature. This type of fixation allowed for early mobilization of the operative arm. Our study demonstrates that use of a tenodesis screw for distal biceps repair results in DASH and SF-12 scores comparable to the norm for the general population with complications similar to those seen in past studies. In addition, biomechanical studies suggest that the repair is strong enough to allow early ROM, and the fixation technique may allow for more anatomic positioning of the distal biceps along the ulnar border of the bicipital tuberosity.

Progressive osteolysis of the radius after distal biceps tendon repair with the bioabsorbable screw

“…41 Silva et al reported 29 patients with bio-tenodesis repair and an average DASH of 23 Similar to the results of our study, all studies obtained excellent rehabilitation of ROM and showed no significant difference in ROM of the injured side compared to the controlateral side. 23,25,41,46,52 There was no correlation between the amount of osteolysis and functional outcome in our study. This could be explained by local fibrosis or bicortical screw fixation which provided sufficient fixation.…”

“…29 The choice of a longer screw than what is reported in the literature (23 vs 12 mm) in most of our patients could have led to hardware prominence, impingement on the ulna, and toggling. 23,25,52 This could potentially trigger osteolysis or screw breakage. The frequency of the other complications that we reported, namely complex regional pain syndrome, temporary posterior interosseus nerve palsy, and minimal heterotopic ossification, were similar to the rates found in other studies.…”

“…23,25,32,52 The bioabsorbable screw has been widely used in knee surgery and, more recently, in shoulder, foot and ankle, spine, and orthopaedic trauma surgery. 1 The reported advantages of the bioabsorbable screw in distal biceps tendon repair include its facility of fixing the tendon through a 1-incision technique, its biocompatibility, and its gradual degradation with eventual replacement by bone.…”

“…Trans-osseous suture repair described by Morrey et al was the standard operative procedure to fix the distal biceps tendon. 24,44,53 Afterwards, newer fixation techniques of the distal biceps tendon have been introduced and include suture anchors, 24,35,36 bioabsorbable screws, 23,25,32,52 and button. 4 The loads to failure of these fixation techniques have only been investigated in a few biomechanical studies and the results are controversial.…”

The Biotenodesis Screw and Endobutton Technique for Repair for Acute Distal Biceps Tendon Rupture

“…Cadaveric studies have suggested that the PIN can be incarcerated by the cortical button or drill with drilling at 45 degrees distally or radially, with the mean distance nearing 2 mm. This can be improved by ulna and perpendicular drill hole placement to 11 mm [29][30][31][32][33][34]. This is a small cohort of patients with ADBR undergoing fixation with this dual technique with a 12% loss to follow up rate.…”