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.

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    • "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. "
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    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.
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    • "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). "
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