Repair of distal biceps brachii tendon ruptures

Abstract

This study consisted of 26 male patients with distal biceps tendon ruptures, 2 of whom had bilateral injuries, making the total number of ruptures 28. The average age at injury was 45 years. The treatment groups were the following: 3 were treated without surgery, 4 were repaired with brachialis tenodesis, and 21 were reattached to the radial tuberosity by the 2-incision Boyd-Anderson approach. Patients underwent follow-up a minimum of 14 months after surgery, with the average being 43 months. Outcome was evaluated based on the physical examination, isokinetic testing of strength and endurance of flexion and supination, and radiographic analysis.

Surgical repair of the distal biceps brachii tendon: clinical and isokinetic long-term follow-up

“…Some authors advocate an anatomic reinsertion on the bicipital tubercle of the radius [2,3,7,17,23,26], claiming better post-operative results, both in terms of flexion and supination strength recovery, and regarding the restoration of the anatomic profile of the arm. However, other authors [3,17,22,25] state a satisfactory strength and functional recovery of the affected arm even after a reinsertion of the torn tendon in a non-anatomic position, such as the brachialis muscle tendon. While the first group of authors criticizes the potential supination weakness arising from a non-anatomic reinsertion, the second group supports the lack of post-operative complications related to the anatomical reinsertion, such as neurological problems, heterotopic ossifications and radioulnar synostosis.…”

“…Even the results of the authors supporting the reinsertion on the brachialis tendon [3,17,22,25] were criticized because of the lack of both a large number of patients and objective data [19,23]; the obvious biomechanical assumption that can be criticized in this surgical technique is the non-anatomical reinsertion of the torn tendon and therefore the possible deficit in strength of the elbow in flexion and supination.…”

“…Therefore, surgical treatment is the highly recommended option in the case of young and active patients, especially if engaged in sport activities or in heavy work [2]. There are different opinions in the literature about the site of reinsertion of the avulsed distal biceps tendon: while some authors support the theory of an anatomic reinsertion of the tendon directly on the radial tuberosity [2,3,5,7], other authors showed good results from a non-anatomic reinsertion of the tendon, such as a biceps tenodesis to the brachialis tendon muscle [22,25]. While the first authors support the option of an anatomic reinsertion (either with the single anterior incision or the Boyd and Anderson twoincision technique) of the torn tendon because of the satisfactory clinical and biomechanical results [17,23,26], advocates of non-anatomic reinsertion cite the prevention of some typical problems usually related with the abovementioned surgical techniques, such as neurological lesions [22,25], heterotopic ossifications and proximal radioulnar synostosis.…”

Reinsertion of the distal head of the biceps using mini-anchors and the anterior access: a retrospective study

“…Advantages and benefits of these different techniques were therefore highlighted in several studies: the single-incision technique exposes to higher risks of neurological damage as compared with the combined two-incision access which, however, due to a larger exposure, increases the risk of heterotopic ossifications and synostosis of the proximal radioulnar joint. The non-anatomic reinsertion is the safest surgical technique as it does not expose to any of the above-mentioned risks and is mostly used in case of nonrecent lesions where scarification processes and muscular retraction make reinsertion into the bicipital tuberosity more difficult; from a functional viewpoint (articular motion and strength), it is linked to poorest results [2,[19][20][21]25], but it can be indicated for elderly patients and/or patients with limited functional requirements.…”

Technik der gedeckten Refixierung der distalen Bizepssehne

“…Weit verbreitet ist auch die Technik nach Boyd-Anderson, bei der über einen zusätzlichen dorsoradialen Zugang der Radius freigelegt wird und die Sehne transossär befestigt wird [1,3,5,19,22,23]. Bei der Freilegung der Tuberositas radii kommt es bei beiden Verfahren trotz schonender Präparation zu einer nicht unerheblichen Weichteiltraumatisierung.…”