Single-Incision Technique for Repair of Distal Biceps Tendon Avulsions With Intramedullary Cortical Button

Abstract

Patients who experience distal biceps tendon avulsions generally benefit from surgical intervention. Compared with nonoperative treatment, surgery has shown improved muscle endurance as well as increased flexion and supination strength. Although a number of surgical techniques exist, repair of the distal biceps through a single incision is gaining popularity. This may be due in part to patient preference and emerging technologies such as cortical button fixation, suture anchors, and intraosseous screws. In this report, we present a simple technique for anatomically repairing distal biceps injuries using an intramedullary tenodesis button. This technique has the benefit of using a single unicortical drill hole in the radius while allowing the surgeon to sequentially tighten the tendon to its desired level of tension. When appropriate surgical steps are followed, it can be completed in a reliable, safe, and efficient manner through a single incision.

Distal biceps tendon rupture: advantages and drawbacks of the anatomical reinsertion with a modified double incision approach

“…Several surgical options have been described in literature: one incision-approach, using suture anchors, endobutton, biotenodesis screw for fixation, and a double-incision approach, using bone tunnels [8, 15, 19, 21, 22]. Standard and modified double incision approach differ one to each other in ulnar periosteum exposure, avoided by the Morrey’s muscle-splitting technique that reduces risk of synostosis [23, 24].…”

“…Others have also described a modified double-incision technique, introducing a muscle-splitting approach through the digits common extensor. More recently, with the advent of improved techniques and implants such as suture anchors, intraosseous screws and suspensory cortical buttons, single-incision techniques have once again gained popularity [14, 15]. …”

Distal Biceps Repair Using a Unicortical Intramedullary Button Technique: A Case Series

“…In addition, more soft tissue dissection may place patients at risk for heterotopic ossification and subsequent proximal radioulnar synostosis. 8 Functionally limiting radioulnar synostosis rates as high as 7.0% were reported after dual-incision repairs. 20 In this study, no patients experienced radioulnar synostosis.…”

“…10 Other benefits of the single incision technique include improved cosmesis and avoidance of radioulnar synostosis. 8 Finally, several studies 11,12 showed that there are no major differences in tendon healing to cortical bone compared with healing to cancellous bone.…”

“…6 Use of suture buttons, however, has a risk because major peripheral nerve injury has been reported to both the posterior interosseous nerve (PIN) and the lateral antebrachial cutaneous nerve (LABCN). 7 The intramedullary button technique as described by Camp et al 8 fixes the tendon onto the surface of the bone, whereas the conventional cortical button or interference screw technique reattaches the tendon in an intramedullary location through a cortical window in the anterior cortex. By placing the suture button directly into the intramedullary space, it is believed that complications including PIN injury can be avoided.…”