//

Repair of distal biceps rupture using Arthrex Biceps Button

    Overview

    Learn the Repair of distal biceps rupture using Arthrex Biceps Button surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Repair of distal biceps rupture using Arthrex Biceps Button surgical procedure.
    The distal biceps tendon attaches onto the radial tuberosity, which is located on the posteromedial aspect of the proximal radius, where it is at risk of injury. The biceps itself comprises of two anatomically distinct portions, each with separate origin and insertion:
    – The short head origin is from the coracoid and inserts distally and anteriorly on the radial tuberosity.
    – The long head origin is from the supraglenoid tubercle of the scapula and inserts more proximally and posteriorly with an oval footprint on the radial tuberosity. It acts as a better supinator as it attaches to the apex of the radial tuberosity.
    Rupture of the distal biceps tendon tends to occur in a working age population, with over 95% occurring in males. There is also an association with anabolic steroid use.
    Non-operative management can result in almost a 50% decrease in supination endurance and up to a 40% drop in supination strength, and a 30% drop drop in flexion strength. Therefore in the working population, repair of the distal biceps is recommended to optimise function, flexion and supination strength.
    Operative repair using a cortical button technique, as demonstrated here, has been demonstrated to restore flexion and supination strength to over almost 80% of the contralateral sides strength, which is a significant improvement on conservative management.
    I tend to repair acute ruptures of the distal biceps tendon primarily using a one-incision technique, which helps minimise the risk of synostosis formation. I fix the tendon back using a cortical button and interference screw fixation with the Arthrex distal biceps tendon repair kit. The cortical button provides a robust fixation and has been shown to have the highest load to failure of the commonly used fixation methods. The Arthrex distal biceps button also allows early mobilisation, which helps reduce the chance of a loss of range of movement. The interference screw has also been show to induce direct tendon to bone healing which adds to the robustness of the construct.

    Kelly MP, Perkinson SG, Ablove RH, Tueting JL. Distal Biceps Tendon Ruptures: An Epidemiological Analysis Using a Large Population Database. Am J Sports Med. 2015 Aug;43(8):2012-7. doi: 10.1177/0363546515587738. Epub 2015 Jun 10.

    Indications

    INDICATIONS
    Surgical repair of a complete distal biceps rupture is indicated in young, active, healthy patients, who do not want to accept a decreased level of function. This is particularly important in those who work in manual jobs and require sustained prono-supination strength and endurance. Acute ruptures are best repaired within 3 weeks of injury to optimise the chances of a straightforward repair.
    Symptomatic partial tendon tears that involve over 50% of the tendon tend to remain symptomatic with conservative management. Therefore, surgical management with completion of the tear and repair is also a relative indication.
    SYMPTOMS & EXAMINATION
    Patients often complain of a painful ‘pop’ when the elbow is involved in an eccentric muscle contraction against a heavy load in a semi-flexed position. Most injuries occur as an avulsion of the radial tuberosity, but can occur at the myotendinous junction.
    There is initial pain at the time of injury but tends to fade over the intervening days. Patients can complain of pain and weakness particularly on supination.
    Clinically, there is an obvious asymmetry when comparing the upper limbs, with a ‘reverse Popeye’ sign depending on the level of retraction. There may be bruising and ecchymoses over the medial aspect of the elbow. There is usually a palpable defect, and if there is any doubt, the limb can be compared with the contralateral side.
    Clinical tests to confirm the rupture include:
    Hook or coat-hanger test :The patient actively flexes the elbow to 90 degrees and supinates the forearm. This accentuates the biceps tendon and allows to examiner to ‘hook’ around the lateral aspect of the biceps tendon using their index finger. In the intact tendon, the hook test is negative. In a positive test, the tendon is less distinct. Note that with a ruptured biceps tendon, the bicipital aponeurosis can become taut and mimic the biceps tendon. The aponeurosis can be differentiated from the tendon as it attaches more medially to the deep fascia.
    Ruland biceps squeeze test : The elbow is held in 60-80 degrees of flexion with the forearm pronated. One hand is used to stabilise the elbow while the other squeezes the biceps muscle belly. A positive test is where there is failure to observe supination of the patient’s forearm when squeezing the biceps muscle belly.
    IMAGING
    A distal biceps rupture is a clinical diagnosis. Any imaging is used to confirm the clinical suspicion of a distal biceps rupture.
    For any patient presenting with elbow pain, an AP and lateral radiograph of the elbow is useful in excluding other bony injuries. It helps to clarify if there is any bony avulsion of the radial tuberosity, although this is uncommon.
    The lead author tends to prefer an ultrasound of the biceps rupture to confirm the level of rupture and to clarify how far the tendon has retracted. This is because an ultrasound can be sought quickly and does not add significant delay to any potential surgery.
    In cases where the ultrasound report is equivocal or there is any doubt regarding the diagnosis, an MRI can be sought. As patients can present with a delay from the time of injury, MRI is not usually the imaging modality of choice as it is less easily accessible.
    ALTERNATIVE OPERATIVE TREATMENT
    Surgical repair of the distal biceps tendon vary in terms of whether the rupture is acute (less than 3 weeks) or chronic (over 6 weeks).
    For acute ruptures, the biceps tendon tends to be repaired primarily. The variations in this technique to be considered include:
    Approach – One or two incision technique
    The approach is usually down to surgeon preference. One incision techniques have lower reported rates of heterotopic ossification although has a higher rate of injury to the lateral antebrachial cutaneous nerve. Two incision techniques involve one incision in the antecubital fossa and a second posterolateral elbow incision. Proponents of this approach suggest a lower risk of injury to the PIN/radial nerve.
    Fixation method – These include bone tunnels, suture anchors, interference screws and suspensory cortical buttons.
    Different fixation methods have been described although all suggest good outcomes with repair with no significant difference between each group. Cadaveric studies suggest that endobutton fixation had the greatest load to failure when compared to other fixation methods.
    For chronic distal biceps ruptures (over 6 weeks), the surgical options vary depending on the level of retraction and whether the bicipital aponeurosis is involved. Generally speaking, chronic tendon ruptures may not be able to be repaired directly although this is not always the case.
    For chronic ruptures where there is a significant gap, options include direct repair with the elbow in flexion or bridging the gap with tendon graft.
    Direct repairs in flexion should stretch out with time and studies suggest there is no significant limitation of range of movement.
    Tendon graft options include autograft (semitendinosus) or allograft (Achilles tendon, semitendinosus). Again, good results have been described with this technique.
    NON-OPERATIVE MANAGEMENT
    Distal biceps tendon ruptures can be managed conservatively in patients of low demand or if they suffer with significant co-morbidies.
    CONTRAINDICATIONS
    There are no absolute contraindications for a biceps tendon repair other than dictated by the state of the patient.

    Setup

    In an appropriately anaesthetised and consented patient, the patient is set-up in a supine position with the arm on an arm table. The patient’s upper body is sited as close to the lateral edge of the table as possible to allow ease of access. It also aids the use of fluoroscopy if desired.
    Antibiotics are given on induction and according to Trust protocol.
    The upper limb is prepped from the hand to the shoulder and draped up to the shoulder. The hand and wrist are wrapped in a stockinette and secured using a four inch crepe bandage.
    A sterile high arm tourniquet is applied as proximal as possible to ensure that it is applied proximal to the convexity of the biceps muscle but not inflated until the biceps muscle and tendon have been mobilised.
    Kit required include the:
    Arthrex Bio-Tenodesis System
    Arthrex Distal Biceps Repair Implant System (disposable kit)
    An arthroscopic knot pusher
    A Mayo needle

    Operation – 1

    This patient is a 38 year old right hand dominant male. He presented to fracture clinic 3 days after injury. He was playing with his children on a merry-go-round when he felt a sudden snap in his left elbow and severe pain.
    His interests include going to the gym. There was no history of steroid use.
    The radiograph shows no bony injury. Of note, there is no avulsion fracture from the radial tuberosity (R).

    The orthogonal view of the elbow confirms no fracture.
    The radial tuberosity (R) on the AP view is noted.

    The ultrasound shows the contour of the biceps muscle belly (B).

    The distal biceps tendon has been marked by the dotted line.
    The retraction of the tendon was reported to be only 11mm.

    To perform a distal biceps tendon repair, you will need –
    The Arthrex Distal Biceps Repair Implant System (disposable system):
    1 – Biceps Button
    2 – Button inserter
    3 – 3.2mm Biceps Button drill pin
    4 – #2 Fibreloop with straight needle
    5 – PEEK 7 x 10mm tenodesis screw

    You will also need the Bio-tenodesis screw system:
    1 – Cannulated headed reamers
    2 – Drivers for bio-tenodesis screw
    3 – Handle with suture cleat (C)

    The whole upper limb is prepped using alcoholic chlorhexidine.

    A stockinette is applied the forearm to isolate the hand and wrist.
    The stockinette helps to isolate the hand from the sterile field to minimise the risk of infection.
    It also prevent blood getting into hard to clean areas.

    The stockinette is secured using four inch crepe and a sterile tourniquet is applied.
    The tourniquet is not inflated until the biceps muscle and distal tendon have been mobilised.
    It is important to ensure the tourniquet is applied proximal to the convexity of the biceps muscle belly. This ensures that when it is inflated, it prevents the muscle and distal tendon from retracting proximally.

    The elbow crease is marked as a landmark.
    This is to ensure that if the incision needs to be extended, the incision does not cross the elbow crease perpendicularly to minimise the risk of contracture.
    The medial edge of the brachioradialis muscle is palpated to help site the approach.

    The skin incision is centred over the radial tuberosity and medial to the medial edge of the brachioradialis muscle (A).The radial tuberosity is usually 4cm distal to the elbow crease. If in doubt, fluoroscopy can be used to confirm the anatomy.
    Any potential extension of the incision required is marked out as shown by the dotted marks. This extension is utilised if there is inadequate exposure of the distal biceps tendon if it has retracted significantly proximally.

    The skin is held taut and the incision is made through the skin.
    Care is taken to incise the skin only and not to penetrate deep into the soft tissues so that the lateral antebrachial cutaneous nerve can be identified.

    Blunt scissors dissection is used after skin incision to minimise the risk of injury to the lateral antebrachial cutaneous nerve (LABCN).The LABCN is a continuation of the musculocutaneous nerve and is a purely sensory nerve. It passes deep to the cephalic vein and pierces the deep fascia lateral to the biceps tendon. It divides into a volar and dorsal branch at the level of the elbow joint.
    The volar brach descends on the radial border of the forearm and supplies the skin over the lateral half of the volar surface.
    The dorsal branch descends on the dorsal surface on the radial side of the forearm.

    A West retractor is used to maintain tension in the soft tissues as dissection continues deeper.

    The median cubital veins are identified and either mobilised and retracted or ligated.The median cubital vein (forceps) lies in the cubital fossa superficial to the bicipital aponeurosis and connects the basilic and cephalic veins.
    There is naturally significant variation in the anatomy and location of the veins.
    The veins are either mobilised and retracted or ligated if it is obscuring the approach to the radial tuberosity.

    The median cubital vein is retracted using the Langenbeck retractor (A) in this case.
    The deep fascia of the forearm (B) is exposed.

    The deep fascia is incised and dissection is continued deeper using blunt dissection.It is natural for the field of view to ‘cone down’ as dissection proceeds through the deeper layers.
    If this occurs, it is important to revisit the more superficial layers at the edges of the incision to maximise the exposure.

    The branches of the recurrent radial artery(A) are identified and mobilised as they run transversely in the operative field.These branches arise from the radial artery immediately below the elbow.
    These vessels lie on the supinator muscle and run between the brachioradialis and brachialis muscle. They anastomose with the terminal part of the profunda brachii artery and form a rish anastomosis at the level of the elbow.

    If the recurrent radial artery branches obscure the approach to the radial tuberosity, the branches are clipped using artery clips.

    Control of both ends of the recurrent radial artery branches are obtained, and then cut.

    The cut ends of the recurrent radial artery vessels are ligated using 2-0 vicryl.
    To ensure that the sutures are secure, it is important to use an ‘ease and squeeze’ technique using the artery clips when tying the suture knots.

    After the recurrent radial artery is mobilised the the biceps tendon sheath(B) is located medial to the medial edge of brachioradialis.
    In the deeper layers, the biceps tendon lies between pronator teres and brachioradialis.
    Note, the brachial artery lies medial to the biceps tendon.
    The image shows the haematoma associated with the tendon rupture within the tendon sheath.

    The biceps tendon sheath is picked up using forceps.

    The biceps tendon sheath is incised and the ruptured biceps tendon fibres are identified and isolated.The is usually a gush of haemo-serous fluid once the sheath is opened if the rupture is acute.

    The biceps tendon sheath is laid open using MacIndoe scissors.

    Operation – 2

    In this case, there has been minimal retraction of the ruptured distal biceps tendon (A), which is unusual.
    Most complete biceps tendon ruptures tend to retract proximal to the elbow crease. The extent of retraction is usually determined by whether there is a rupture of the bicipital aponeurosis.

    The torn end of the ruptured distal biceps tendon is grasped using a Kocher.

    The distal biceps can be visually inspected for any remaining intact fibres attaching onto the radial tuberosity.
    B – biceps tendon
    R – level of the radial tuberosity

    Residual adhesions/tendon fibres are freed from the biceps sheath using MacIndoe scissors.There is no major risk to other anatomical structures as long as the dissection remains within the biceps tendon sheath.
    Of relevance, the brachial artery lies just medial to this.

    The Biceps Button is loaded onto the inserter.The Biceps Button docked onto inserter.
    This is not secure and has to be held upright, otherwise the button can come off easily.
    The Biceps Button has a proximal (A) and distal (B) window.

    The biceps tendon track is defined proximally to the muscle belly and freed circumferentially.In this case, the tendon track is easily defined as the tendon is sitting below the elbow crease.
    In most cases, the tendon has retracted proximal to the elbow crease. The track has to be defined by blunt dissection, best using the finger.
    If in doubt as to the correct tissue plane, it is best to go just deep to the median cubital veins.
    In a retracted tendon, if the correct plane is identified, the tendon stump can be palpated with the muscle belly. This can sometimes curled up on itself. The finger can then be used to hook it and unfurl it.
    If it is difficult to access due to it proximity, the elbow can be flex to aid access. If it is still not accessible, either a second incision at the level of the musculotendinous junction is made, or the incision is extended (along the original dotted line markings) in a lazy ‘S’.
    By unfurling the tendon and flexing the elbow, the tendon can be milked down to the level of the incision and can be grasped with a Kocher. Once under control and tension, the biceps tendon and muscle belly can be freed of adhesions circumferentially to allow mobilisation of the tendon.

    The distal biceps tendon is pulled taut and the tourniquet is inflated.By pulling it taut, the excursion can be checked to ensure that the tendon can be reattached to the radial tuberosity easily.
    From the image, it is clear that the biceps tendon (B) should reattach easily to the level of the radial tuberosity (R).
    Inflating the tourniquet at this point prevents the tendon from fully retracting back into the wound and allows easier preparation of the tendon.
    If a tendon does not reach, in an acute rupture, more time may be taken to mobilise the muscle tendon/belly fully to maximise excursion. In conjunction with this, the tourniquet position on the arm can be checked and re-inflated. If it is still short, the tendon can be repaired with the elbow in flexion. This should stretch out with rehabillitation.
    If it is significantly short, i.e. if the tendon is to be repaired with the elbow in full flexion, this can be technically difficult due to the limited access. The option is to consider a tendon graft to bridge the deficit. This is more common in chronic ruptures.

    The distal biceps stump is trimmed.
    The biceps tendon stump fibres are usually degenerate and flared.
    The MacIndoe scissors are used to trim it down so the diameter of the tendon will sit in the prepared bone tunnel on the radial tuberosity.

    The distal biceps stump is trimmed and the tendon is “Whipp-stitched” using a Fibre-loop on a straight needleThe Fibreloop is taken from the Arthrex Distal Biceps Repair Implant System.
    The tendon (B) is pulled through the loop of the Fibreloop (F) and pulled taut.

    The Fibreloop suture (F) is pulled taut and the straight needle (N) is passed through the substance of the biceps tendon as proximally as possible from posterior to anterior.
    To gain access proximally, the elbow can be flexed at this point.
    Note the needle passes through the tendon distal to the loop of the suture.

    The needle is passed through the tendon.

    The suture is then pulled taut to take any slack out of the suture.

    The two limbs of the Fibreloop are opened and the biceps tendon is passed through the loop of the Fibreloop and the needle passed through the tendon in the same fashion.
    This step is repeated 5-6 times depending on the length of the tendon to create the Whipp stitch.

    The result of the Whipp stitch and biceps tendon construct should look as as shown here.

    The biceps tendon stump is reassessed and any excess tissue is trimmed.This can be assessed using the apertures on the Arthrex Biotenodesis System’s driver paddles. There are varying sizes on the paddles and should pass through the 7-8mm apertures, and can help to determine the size of reamer required.
    With experience, this step can be eyeballed.

    The Fibreloop suture is cut using a knife leaving 2 limbs of suture of equal length. The straight needle is removed and put to one side for later use.Final image of the prepared distal biceps tendon with Whipp stitch.

    The location of the radial tuberosity is confirmed by palpation and prono-supination of the forearm.Attention is turned to preparation of the radial tuberosity.
    The anatomical site of the radial tuberosity is confirmed by pronosupination of the forearm.
    For demonstration purposes, the forceps have been used to pinpoint the location of the radial tuberosity. This is normally best confirmed using the finger.

    A mini-Hohmanns retractor (A) is placed medial to the proximal radius to retract the soft tissues.
    The Langenbeck retractor (B) retracts the tissues distally.
    The 3.2mm drill pin is guided into position once satisfactory exposure is achieved.

    The forearm is held in maximal supination and the 3.2mm drill pin is drilled through both cortices at the level of the radial tuberosity.The drill pin is drilled in an anteroposterior direction perpendicular to the bone.
    The drill pin is centred over the radial tuberosity.
    Consideration has to be given to the diameter of the reamer that will be used to over-ream the anterior cortex. The positioning of the drill pin is imperative in avoiding a blowout and potential fracture of the proximal radius.
    Although more anatomically desirable, a drill pin directed posterolaterally is avoided due to the risk of injury to the posterior interosseous nerve (PIN).

    Once maximal supination is eased off note how the drill pin tends to point postero-laterally.

    A cannulated reamer is chosen from the Bio-Tenodesis Screw System and loaded onto the chuck.
    The diameter of the reamer is dependent on the thickness of the distal biceps tendon.
    The PEEK interference screw has a diameter of 7mm so the reamer size ranges from 7.5mm to 8.5mm.

    The cannulated reamer is loaded onto the drill pin and only the anterior cortex of the radius is reamed.

    The drill pin and reamer is removed and the wound is irrigated with normal saline to remove any bone dust.

    The biceps tendon (B) an be seen at the proximal end of the wound.
    The radial bone tunnel can be seen at the distal end of the wound marked by the forceps.

    The Biceps Button inserter.
    The mechanism works by pulling back on the button (B). This retracts the tip (A) of the inserter. This deploys the Biceps Button by rendering it free from the tip and becomes mobile.

    Operation – 3

    This image shows the retracted tip once the button has been pulled back.

    One limb of the Fibreloop suture from the distal biceps tendon is taken through the proximal, then distal window of the Biceps Button.The free end of the Fibreloop suture is marked as shown (A).

    The second limb of the Fibreloop suture from the distal biceps tendon is loaded back onto the previously removed straight needle.This is for ease of shuttling the suture through the Biceps Button windows.

    The second fibreloop limb is passed through the Biceps Button in the opposite direction to the first suture through the distal, then proximal window.It may be easier to temporarily unload the Biceps Button from the inserter at this stage and hold the button manually for this step.

    The straight needle is removed from the Fibreloop suture once it has been passed through the proximal window.

    The two limbs of sutures are pulled taut and equalised.The sutures should be checked to ensure that they slide freely within the Biceps Button.
    The final configuration of the suture limbs is shown – the free ends of the two sutures are held (A). At the button (B), the image shows that one limb of suture exits from the proximal window, whilst the other exits from the distal window.

    The free suture limb exiting the distal window of the Biceps Button is identified and isolated (A).
    As the button on the inserter (B) is manoeuvred towards the radial tuberosity, the excess length in the two suture limbs between the biceps tendon and button (C) is removed by sliding the suture through the button windows.

    The Biceps Button on the inserter is manoeuvred towards the radial tuberosity.
    The excess length in the two suture limbs between the biceps tendon and button is removed by pulling on the free suture limbs to slide the suture through the button windows.At this stage, the button can fall off the inserter. If this occurs, this can be easily reloaded back onto the inserter.

    The Biceps Button on the inserter is passed through the bone tunnel and through the dorsal cortex.Once the button engages in the bone tunnel, there should be feedback as it passes through both cortices.

    The Biceps Button is deployed by pulling back on the button on the inserter.
    The Biceps Button becomes loose and the isolated suture limb (S) is pulled taut to flip the button.

    The biceps tendon is slid down until its stump is engaged in the bone tunnel.The two limbs of suture are slid through the Biceps Button by pulling on the free ends of the suture limbs sequentially to take out the excess slack.
    This draws to distal biceps into the bone tunnel.

    By holding the elbow slightly flexed, it allows the tendon to engage in the bone tunnel more easily.

    The suture limbs are held taut and the elbow is cycled from extension to full flexion ten times.The removes any residual slack in the suture/tendon construct.

    The elbow is flexed up fully when cycling.

    The suture is tied and secured with the elbow flexed.

    The suture knot is delivered down the to level of the bone tunnel.A useful tip is to use an arthroscopic knot pusher to deliver the knot into the bone tunnel.

    The PEEK 7 x 10mm interference screw from the disposable kit is removed from its packaging.

    The PEEK interference screw is loaded onto the driver.

    The paddle of the driver is rotated anti-clockwise to increase the length of the core of the driverA).

    Load one of the suture limbs through the core of the driver.This suture is retrieved from the proximal end of the driver and secured on the cleat located at the proximal end of the handle (labelled C on slide 6 and slide 72).

    The interference screw is guided down to the radial tuberosity by the suture limb.The core of the driver should be engaged in the bone tunnel.
    It is worth checking at this point that the tendon is lying ulnar to the driver.

    The suture limb in the core of the driver should be re-tensioned on the cleat once it is sat at the anterior cortex.
    The paddle of the driver is held and the interference screw is delivered and engaged in the anterior cortex of the bone tunnel by turning the driver clockwise.This is re-tensioned by unwinding off the cleat (C), pulling the taut, and re-securing on the cleat by winding it on.
    By holding the paddle firmly(A), the sleeve of the driver advances the interference screw when its handle (B) is turned clockwise, so that it engages in the bone tunnel.
    One the paddle is fully down, it is important to palpate the interference screw to ensure it is not proud of the bone before removing the driver.
    If it is proud, the driver can be turned until it is flush with the anterior cortex of bone.
    Care has to be taken to not advance the interference screw too far as it can fall into the intramedullary canal and lose the hold of the tendon against the anterior cortical bone.
    (The core suture will at least prevent the interference screw from migrating down the canal.)

    Once fully seated, the suture in the core of the driver can be removed from the cleat and the driver removed.

    This is the image of the seated distal biceps tendon with the elbow in full extension.
    A satisfactory repair should show:
    A full range of movement at the elbow with no extensor lag.
    The tendon should be fully seated in the bone tunnel.
    The tendon should lie on the ulnar aspect of the tunnel.
    The PEEK interference screw should provide good bony contact between the tendon and bone.
    The PEEK intereference screw should be flush with the anterior cortex of bone.

    One of the Fibreloop suture limbs is loaded on a Mayo needle and passed through the distal biceps tendon.

    Operation – 4

    The Fibreloop suture is tied and secured to the biceps tendon.

    Final images of the distal biceps tendon repair.

    The fat layer is closed using a 2-0 vicryl continuous suture.

    Skin is closed using a 3-0 monocryl continuous suture and closure is supplemented with half inch steristrips.

    The wound is dressed with a waterproof dressing and wool and crepe bandages.

    Post Operative

    Patients are given a polysling post-operatively for comfort.
    0 – 2 weeks
    Active finger, wrist and shoulder movement within the sling.
    Active flexion and extension as pain allows within the sling and bandages.
    Pronosupination as pain allows within the sling.
    2-6 weeks
    Progress active range of movement as pain allows.
    Aim for full flexion, extension and pronosupination by 6-8 weeks.
    6-12 weeks
    Continue active range of movement as pain allows.
    Commence light resistance work.
    Over 12 weeks
    Conditioning and strength work.

    Recommended Reading

    Baker BE, Bierwagen D. Rupture of the distal tendon of the biceps brachii. Operative versus non-operative treatment. J Bone Joint Surg Am. 1985 Mar;67(3):414-7.
    Morrey BF, Askew LJ, An KN, Dobyns JH. Rupture of the distal tendon of the biceps brachii. A biomechanical study. J Bone Joint Surg Am. 1985 Mar;67(3):418-21.
    Non-operative management can result in a 47% decrease in supination endurance and a 21-40% drop in supination strength, and a 30% drop drop in flexion strength.
    Mazzocca AD, Burton KJ, Romeo AA, et al. Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair. Am J Sports Med. 2007 Feb;35(2):252-8.
    This study show that endobutton fixation had the greatest load to failure when compared to other fixation methods. However, other clinical studies suggest that outcomes using different methods of fixation are comparable.
    Huynh T, Leiter J, MacDonald PB, Dubberley J, Stranges G, Old J, Marsh J. Outcomes and Complications After Repair of Complete Distal Biceps Tendon Rupture with the Cortical Button Technique. JB JS Open Access. 2019 Aug 27;4(3). pii: e0013.1-6. doi: 10.2106/JBJS.OA.19.00013. eCollection 2019 Jul-Sep.
    Repair of complete distal biceps tendon ruptures using this technique resulted in a slight decrease in elbow flexion and forearm supination strength. However, this was not clinically relevant. The complication rate was high although the complications were minor and resulted in little disability.
    Repair of complete distal biceps tendon ruptures using this technique resulted in a slight decrease in elbow flexion and forearm supination strength. However, this was not clinically relevant. The complication rate was high although the complications were minor and resulted in little disability.

    Reference

    • orthoracle.com

    Tags:

    You might be interested in

    Dark mode powered by Night Eye