Single Versus Double-Incision Technique for the Repair of Acute Distal Biceps Tendon Ruptures A Randomized Clinical Trial
ABSTRACT This clinical trial was done to evaluate outcomes of the single and double-incision techniques for acute distal biceps tendon repair. We hypothesized that there would be fewer complications and less short-term pain and disability in the two-incision group, with no measureable differences in outcome at a minimum of one year postoperatively.
Patients with an acute distal biceps rupture were randomized to either a single-incision repair with use of two suture anchors (n = 47) or a double-incision repair with use of transosseous drill holes (n = 44). Patients were followed at three, six, twelve, and twenty-four months postoperatively. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) elbow score. Secondary outcomes included muscle strength, complication rates, and Disabilities of the Arm, Shoulder and Hand (DASH) and Patient-Rated Elbow Evaluation (PREE) scores.
All patients were male, with no significant differences in the mean age, percentages of dominant hands affected, or Workers' Compensation cases between groups. There were also no differences in the final outcomes (at two years) between the two groups (p = 0.4 for ASES pain score, p = 0.10 for ASES function score, p = 0.3 for DASH score, and p = 0.4 for PREE score). In addition, there were no differences in isometric extension, pronation, or supination strength at more than one year. A 10% advantage in final isometric flexion strength was seen in the patients treated with the double-incision technique (104% versus 94% in the single-incision group; p = 0.01). There were no differences in the rate of strength recovery. The single-incision technique was associated with more early transient neurapraxias of the lateral antebrachial cutaneous nerve (nineteen of forty-seven versus three of forty-three in the double-incision group, p < 0.001). There were four reruptures, all of which were related to patient noncompliance or reinjury during the early postoperative period and appeared to be unrelated to the fixation technique (p = 0.3).
There were no significant differences in outcomes between the single and double-incision distal biceps repair techniques other than a 10% advantage in final flexion strength with the latter. Most complications were minor, with a significantly greater prevalence in the single-incision group.
SourceAvailable from: Giuseppe Coratella[Show abstract] [Hide abstract]
ABSTRACT: This clinical trial was done to describe a mini approach for distal biceps repair using two or three suture anchors. Twenty patients have undergone surgical repair over the last 10 years. All patients were males with mean age 46.8 (range 35-72), and dominant arm was involved in 70 %. Eighteen patients were evaluated with subjective and objective criteria including patient's satisfaction, active range of motion (ROM), and maximum isometric strength (in supination and flexion) using Cybex dynamometer. Functional scoring included Mayo Elbow Performance Score, Disabilities of the Arm, Shoulder and Hand score and Oxford Elbow Score. Eighty percent of patients were highly satisfied, with excellent results as defined by Mayo and Oxford Elbow score. Compared to contralateral, the active ROM was not affected in flexion and extension, but pronation and supination were decreased by 5°-10° in two cases. One of eighteen showed hypoesthesia of first and second fingers, and one of eighteen showed a symptomatic heterotopic ossification. There were no reruptures. Surgical repair of distal biceps tendon with a mini-single-incision as we described provides patient's satisfaction and very good results with respect to ROM and functional scoring, with a low complication rate.MUSCULOSKELETAL SURGERY 04/2015; DOI:10.1007/s12306-015-0372-1
The Journal of Bone and Joint Surgery 10/2014; 96(20):e176. DOI:10.2106/JBJS.N.00032 · 4.31 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Anatomic repair of the distal biceps tendon can be difficult to achieve. This study was designed to compare the effect of anatomic and nonanatomic repairs on forearm supination torque. A nonanatomic repair re-establishes the footprint radial and more anterior to the tuberosity apex, whereas an anatomic repair re-establishes the footprint ulnar and more posterior to the tuberosity apex. Eight fresh frozen cadaver arms were surgically prepared and mounted on an elbow simulator. Controlled loads were applied to the long head and short head in positions of pronation, neutral, and supination. This was done with intact tendons and then repeated with repaired tendons that were repaired either anatomically (ulnar position) or nonanatomically (radial position). All anatomic repairs showed no difference compared with intact tendon measurements. In comparing anatomic and nonanatomic repairs, we found no differences in the supination torque when the forearm was in 45° of pronation. However, when the arm was in neutral rotation, we found that 15% less supination torque was generated by the nonanatomic repair. When the arm was tested in 45° of supination, we found that 40% less supination torque was generated in the nonanatomic repair (P = .01). This study supports the idea that an anatomic repair of the biceps tendon onto the ulnar side of the radial tuberosity is important. If the tendon is repaired too radially, the biceps will lose the cam effect and may not be able to generate full supination torque when the forearm is in neutral rotation or in supination. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 12/2014; DOI:10.1016/j.jse.2014.09.039 · 2.37 Impact Factor