Acute distal biceps tendon repair using cortical button fixation results in excellent short- and long-term outcomes

Abstract

Aims Acute distal biceps tendon repair reduces fatigue-related pain and minimizes loss of supination of the forearm and strength of flexion of the elbow. We report the short- and long-term outcome following repair using fixation with a cortical button techqniue. Methods Between October 2010 and July 2018, 102 patients with a mean age of 43 years (19 to 67), including 101 males, underwent distal biceps tendon repair less than six weeks after the injury, using cortical button fixation. The primary short-term outcome measure was the rate of complications. The primary long-term outcome measure was the abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Secondary outcomes included the Oxford Elbow Score (OES), EuroQol five-dimension three-level score (EQ-5D-3L), satisfaction, and return to function. Results Eight patients (7.8%) had a major complication and 34 (33.3%) had a minor complication. Major complications included re-rupture (n = 3; 2.9%), unrecovered nerve injury (n = 4; 3.9%), and surgery for heterotopic ossification (n = 1; 1.0%). Three patients (2.9%) overall required further surgery for a complication. Minor complications included neurapraxia (n = 27; 26.5%) and superficial infection (n = 7; 6.9%). A total of 33 nerve injuries occurred in 31 patients (30.4%). At a mean follow-up of five years (1 to 9.8) outcomes were available for 86 patients (84.3%). The median QuickDASH, OES, EQ-5D-3L, and satisfaction scores were 1.2 (IQR 0 to 5.1), 48 (IQR 46 to 48), 0.80 (IQR 0.72 to 1.0), and 100/100 (IQR 90 to 100), respectively. Most patients were able to return to work (81/83, 97.6%) and sport (51/62,82.3%). Unrecovered nerve injury was associated with an inferior outcome according to the QuickDASH (p = 0.005), OES (p = 0.004), EQ-5D-3L (p = 0.010), and satisfaction (p = 0.024). Multiple linear regression analysis identified an unrecovered nerve injury to be strongly associated with an inferior outcome according to the QuickDASH score (p < 0.001), along with infection (p < 0.001), although re-rupture (p = 0.440) and further surgery (p = 0.652) were not. Conclusion Acute distal biceps tendon repair using cortical button fixation was found to result in excellent patient-reported outcomes and health-related quality of life. Although rare, unrecovered nerve injury adversely affects outcome. Cite this article: Bone Joint J 2021;103-B(7):1284–1291.

Single-Incision Distal Biceps Tendon Repair With Bicortical Tensionable Locking Button Fixation

“…Distal biceps repair using cortical button fixation has been associated with excellent patient-reported outcomes and satisfaction with minimal complications. 21 , 22 , 23 In a review of 102 patients who underwent distal biceps tendon repair with cortical button fixation with a mean follow-up of 5 years, Carter et al. 21 reported the median abbreviated Disabilities of the Arm, Shoulder, and Hand (i.e., QuickDASH) score, EuroQol 5-dimension 3-level (i.e., EQ-5D-3 L) score, Oxford Elbow Score (i.e., OES), and satisfaction scores were 1.2, 0.8, 48, and 100/100, respectively.…”

“… 21 , 22 , 23 In a review of 102 patients who underwent distal biceps tendon repair with cortical button fixation with a mean follow-up of 5 years, Carter et al. 21 reported the median abbreviated Disabilities of the Arm, Shoulder, and Hand (i.e., QuickDASH) score, EuroQol 5-dimension 3-level (i.e., EQ-5D-3 L) score, Oxford Elbow Score (i.e., OES), and satisfaction scores were 1.2, 0.8, 48, and 100/100, respectively. In this cohort, 97.6% of patients were able to return to work and 2.9% of patients required subsequent surgery.…”

Distal Biceps Tendon Repair Using a Single Incision, Dual Anchor Technique

“…1,7 In other studies, cortical button fixation is shown to be a reliable fixation technique, and utilization of a proximal suture anchor as a secondary fixation method allows for increased fixation strength while also increasing the tendon to bone contact area. 3,6…”