Outcome of Distal Biceps Tendon Repair With and Without Concomitant Bicipital Aponeurosis Repair

Abstract

Background: The bicipital aponeurosis (BA) can often be torn concomitantly with a distal biceps tendon (DBT) rupture. Its repair, although recommended by some, has not commonly been addressed during the surgical management of DBT ruptures, and to date, surgical repair of the BA with DBT repair has not been evaluated clinically. Purpose: To utilize subjective and objective outcome measures to examine the safety and efficacy of 2-incision DBT repair with and without repair of the BA in patients with a DBT rupture. Study Design: Cohort study; Level of evidence, 3. Methods: Demographic and surgical data were reviewed retrospectively. Patients returned to the clinic to complete subjective outcome measures and objective measurements of range of motion, strength, and biceps contour. All patients were evaluated at least 1 year after surgical treatment. Results: Data from 24 male patients with a DBT rupture were used for the analysis; 13 (54%) underwent concomitant DBT and BA repair, and 11 (46%) underwent isolated DBT repair. There were no complications at 1 year in either group. The DBT + BA repair group returned to recreational activities faster (77% within 6 months and 100% within 1 year) than the isolated DBT repair group (36% within 6 months, 91% within 1 year, and 100% after more than 2 years) ( P = .05). There was a trend toward better Patient-Rated Elbow Evaluation pain scores in the DBT + BA repair group than in the isolated DBT repair group (1.2 vs 5.3, respectively; P = .18). A trend also emerged toward closer return to subjective preinjury strength (77% vs 44%, respectively; P = .14). No significant difference emerged in patient satisfaction with the biceps contour, subjective scores on functional activities and disability, or objective measurements of strength, contour, and range of motion. Conclusion: This pilot study suggests that repair of the BA in conjunction with DBT repair leads to a faster return to recreational activities compared with isolated DBT repair. Also noted was a trend toward subjectively improved pain and greater perceived strength, after DBT + BA repair, although this was not statistically significant. Further investigation with a larger population is required to better elucidate these potential differences.

Anatomical considerations and clinical implications of bicipital aponeurosis: A magnetic resonance imaging study

“…Surgical treatment of BA may be required in various clinical situations, such as neurovascular entrapments, distal tendon rupture of biceps brachii, or spastic elbow deformity. Distal tendon rupture of the biceps brachii may be concomitant with a 45% association of BA tear (Luokkala et al, 2020; Midtgaard et al, 2020), and distal biceps brachii tendon repair with concomitant BA repair has better results than isolated distal biceps brachii tendon repair (Conlin et al, 2019). Neurovascular entrapments caused by BA are treated by BA release (Bassett 3rd et al, 1994; Bassett 3rd & Nunley, 1982; Seitz Jr. et al, 2007).…”

An anatomical study of the bicipital aponeurosis in embalmed and fresh frozen cadavers

“…[13,14] Landa et al [3] performed a cadaveric study and showed that termino-terminal sutures of the bicipital aponeurosis increased the mechanical strength in distal biceps tendon repair. Conlin et al [15] treated 24 male patients with a distal biceps tendon rupture. They reported that repair of the bicipital aponeurosis in conjunction with distal biceps tendon repair led to a faster return to activities compared with isolated tendon repair.…”

The biomechanical role of the lacertus fibrosus of the biceps brachii Muscle

“…Moreover, LF repair with distal biceps brachii tendon compared to the distal biceps brachii tendon repair alone seems lead to faster return to recreational activities. Furthermore, the patients report a subjective improved pain and better strength [4]. All these arguments associated with finding that LF repair is a safe procedure taking only 5 min more than that of the biceps brachii tendon repair alone [4] should lead to the LF repair as much as possible.…”

“…Furthermore, the patients report a subjective improved pain and better strength [4]. All these arguments associated with finding that LF repair is a safe procedure taking only 5 min more than that of the biceps brachii tendon repair alone [4] should lead to the LF repair as much as possible.…”

“…Finally, considering this biomechanical role, the use of LF as biceps brachii tendon autograft [4,9] or allograft [18] should be rethought and perhaps avoided in order not to weaken the operated tendon.…”