Radioulnar Heterotopic Ossification After Distal Biceps Tendon Repair: Results Following Surgical Resection

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, United States
The Journal Of Hand Surgery (Impact Factor: 1.67). 10/2007; 32(8):1230-6. DOI: 10.1016/j.jhsa.2007.06.018
Source: PubMed


The purpose of this study is to evaluate the clinical outcome of patients who had excision of a radioulnar heterotopic ossification (HO) as a complication of a distal biceps tendon repair. The hypothesis is that there are no measurable clinical losses that persist after excision.
Eight consecutive patients were identified between 1996 and 2005. All were treated with HO excision using a standard surgical technique and rehabilitation protocol. These individuals were studied and compared to a matched cohort of 8 patients who had a distal biceps tendon repair with a similar surgical technique that was uncomplicated. All study patients were evaluated at a minimum 1-year follow-up with physical examination, isokinetic dynamometry, and outcome measures. Comparisons were made both between groups as well as side-to-side within groups.
At follow-up examination, the mean arc of forearm rotation in the HO group measured 151 degrees. The mean arc of forearm rotation in the control group measured 165 degrees. With the numbers available, no measurable differences in arc of motion were identified between groups (p > .05). When compared to the normal, uninvolved side, patients who developed HO lost an average of 9 degrees of forearm pronation (p < .01). No differences were identified between the HO and control groups with respect to isokinetic torque, endurance strength, or Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire (American Academy of Orthopaedic Surgeons, Rosemont, IL) scores (p > .05).
When patients develop motion-limiting HO after distal biceps tendon repair, surgical resection can lead to a functional recovery of elbow and forearm motion. Biceps strength can be maintained with no measurable differences in clinical outcome when compared to individuals who do not suffer this complication following distal biceps repair.

38 Reads
  • Source
    • "There are different surgical techniques and fixation mechanisms for repair of a distal biceps tendon rupture. Historically, single incision technique is associated with higher incidences of nerve injury [16, 17], and dual incision carries a higher risk of heterotopic ossification [18]. The advent of new noninvasive techniques for both approaches has significantly decreased their complication rate. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Distal biceps tendon rupture is a relatively uncommon occurrence in the general female population, and to our knowledge, has not been reported in association with a supinator muscle tear. We report a case of 51-year-old woman who experienced sharp pain in her forearm and elbow after lifting a heavy object. History and physical examination raised suspicion for a distal biceps tendon rupture. MRI imaging determined a combined distal biceps tendon tear with a supinator muscle tear with subsequent confirmation at surgery. Surgical repair was performed for the distal biceps tendon only through a single incision approach using the Endobutton technique.
    08/2011; 2011:515912. DOI:10.1155/2011/515912
  • Source
    • "It has been previously reported that endobutton repairs had the greatest pull out strength (Chavan et al., 2008), but this has been refuted (Henry et al., 2007). Techniques other than the endobutton repair have been associated with a variety of complications (Kelly et al., 2003; Wysocki and Cohen, 2007; Cohen, 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The distal biceps brachii tendon is commonly susceptible to traumatic injury. This study aimed to describe the morphology of the distal biceps brachii tendon in relation to the commonly used endobutton repair of tendon rupture. The results suggested that the distal tendon is a series of distinct bands of variable number. These bands are obscured surgically by the tendon sheath. Upon opening this sheath, blunt dissection of the tendon released fibrous connections between the tendon bands. Adjacent bands were variably connected via small oblique bands. The separations between bands were continuous onto the radius. They were therefore considered as separate force-conducting units. This notion is of high relevance to endobutton repairs, as the sutures are typically only passed through the margins of the tendon. Where few connections exist between tendinous bands, this represents a potential weakness, as central bands are therefore free to be pulled proximally. This is of primary concern in the early rehabilitative stages of postoperative care. It may be suggested that sutures that cross the width of the tendon will eliminate the give of central bands, improving postoperative results, reducing revision numbers, and potentially reducing rehabilitation time.
    Clinical Anatomy 04/2009; 22(3):346-51. DOI:10.1002/ca.20786 · 1.33 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Irreparable distal biceps tendon tears typically are treated using a free tendon graft. We asked whether our new method to fix the graft--using two suture anchors--yields similar results to our previous bone canal method. We compared the two methods for strength, endurance, and clinical findings. There were two groups, the suture anchor group (Group A, seven patients) and the bone canal group operated on before suture anchors (Group B, seven patients). The patients were males with a mean age at surgery of 44.9 years. The operative delay from primary trauma to index surgery averaged 5.9 months. The minimum followup was 2 years (mean, 11.1 years; range, 2-23 years). The mean arc of elbow motion was 0 degrees to 132 degrees, pronation 83 degrees, and supination 80 degrees. Compared with the contralateral side, the maximal peak torque was 84% in supination and 91% in pronation, and the maximal static elbow flexion strength was 94%. The Mayo elbow score averaged 99 in Group A and 100 in Group B. There were no major differences between the two groups. Our novel modification to fix a tendon graft yields equal clinical outcomes compared with the bone canal method for treatment of irreparable distal biceps tendon injuries. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 10/2008; 466(10):2475-81. DOI:10.1007/s11999-008-0389-y · 2.77 Impact Factor
Show more


38 Reads
Available from