The chief insertion of the bicipital aponeurosis is on the ulna. A study of collagenous bundle patterns of antebrachial fascia and bicipital aponeurosis

Congdon, E. D.; Fish, Harold S.

doi:10.1002/ar.1091160402

Cited by 17 publications

(14 citation statements)

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“…During distal biceps tendon repair, the lacertus fibrosus, also called the bicipital aponeurosis, is usually found to be torn. 7 Some have described the lacertus simply as a fascial cover of the underlying neurovasculature and recommend its excision or use as reinforcing material. 19 Others have hypothesized that the lacertus contributes significantly to elbow flexion.…”

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The Effect of Repair of the Lacertus Fibrosus on Distal Biceps Tendon Repairs

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The Effect of Repair of the Lacertus Fibrosus on Distal Biceps Tendon Repairs

et al. 2008

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“…As previously described, the BT consists of two distinct portions separated by an endotenon septum and surrounded by a common paratenon, which includes also the BA [ 5 ]. The latter may be regarded as the fascial expansion of the BT that finally reaches as far as to the posterior margin of the ulna [ 7 ]. Comparable expansions are present at different muscles throughout the body and their common functional significance is force transmission between adjacent muscles and force transmission to non-muscular tissue [ 13 ].…”

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Ultrasound visualization of an underestimated structure: the bicipital aponeurosis

2017

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PurposeWe established a detailed sonographic approach to the bicipital aponeurosis (BA), because different pathologies of this, sometimes underestimated, structure are associated with vascular, neural and muscular lesions; emphasizing its further implementation in routine clinical examinations.MethodsThe BA of 100 volunteers, in sitting position with the elbow lying on a suitable table, was investigated. Patients were aged between 18 and 28 with no history of distal biceps injury. Examination was performed using an 18–6 MHz linear transducer (LA435; system MyLab25 by Esaote, Genoa, Italy) utilizing the highest frequency, scanned in two planes (longitudinal and transverse view). In each proband, scanning was done with and without isometric contraction of the biceps brachii muscle.ResultsThe BA was characterized by two clearly distinguishable white lines enveloping a hypoechoic band. In all longitudinal images (plane 1), the lacertus fibrosus was clearly seen arising from the biceps muscle belly, the biceps tendon or the myotendinous junction, respectively. In transverse images (plane 2) the BA spanned the brachial artery and the median nerve in all subjects. In almost all probands (97/100), the BA was best distinguishable during isometric contraction of the biceps muscle.ConclusionWith the described sonographic approach, it should be feasible to detect alterations and unusual ruptures of the BA. Therefore, we suggest additional BA scanning during clinical examinations of several pathologies, not only for BA augmentation procedures in distal biceps tendon tears.

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“…Contraction of the forearm flexor muscles tensions the BA and pulls the biceps tendon distally and medially. 4,7 A BA rupture may occur concomitant to a rupture of the DBT, and the BA fails most often from its proximal origin near the short head of the biceps muscle and tendon. 16 Multiple theories exist about normal BA function.…”

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“…Proposed roles include protecting underlying neurovascular structures, providing an additional anatomic anchor to the DBT, and providing pretension proprioceptive information to the biceps based on forearm muscular activities. 4,11,13 Some have hypothesized that the BA may significantly contribute to elbow flexion. 8 Support for this idea is found in a report of a patient with weakness in elbow flexion who was found to have a torn BA and an intact DBT intraoperatively.…”

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“…There is no consensus as to whether a torn BA should be repaired during repair of a DBT rupture. Over half a century ago, Congdon and Fish 4 concluded that repair “is justified by the fact that the aponeurosis has considerable effectiveness in forearm flexion.” Others have suggested that repair of the BA may confer potential benefits when combined with DBT repair, such as increased strength, proprioception, and protection of the neurovasculature. 7 A study on cadaveric specimens showed that concomitant DBT and BA repair increases the mean failure strength and mean maximum strength of 2-incision DBT repair constructs by over 50%.…”

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

Conlin

Naderipour

Elmaraghy

2019

Orthopaedic Journal of Sports Medicine

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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.

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The chief insertion of the bicipital aponeurosis is on the ulna. A study of collagenous bundle patterns of antebrachial fascia and bicipital aponeurosis

Cited by 17 publications

References 1 publication

The Effect of Repair of the Lacertus Fibrosus on Distal Biceps Tendon Repairs

The Effect of Repair of the Lacertus Fibrosus on Distal Biceps Tendon Repairs

Ultrasound visualization of an underestimated structure: the bicipital aponeurosis

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

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