Single incision technique using an interference screw for the repair of distal biceps tendon ruptures

Various techniques throughout the years have been published on surgical repair of the distal biceps tendon foracute ruptures or for recalcitrant biceps tendinosis. The first report of a single incision technique to repair this tendon was in 1897 by S. Johnson in the New York Medical Journal. Since that time many different approaches and techniques have been developed. Interference screw fixation has been a reliable and well-tested method of tendon/ligament to bone attachment. There is a large body of literature concerning the various aspects of interference fit in the anterior cruciate ligament and proximal biceps tendon literature. Anatomic measurements, osteological analysis, and radiographic examination have provided information for the design of an interference screw that can be safely used in the proximal radius. We describe a technique using an interference screw through a single incision. We present two techniques for open tenodesis of the long head of the biceps.     

Plane Talk About Shoulder Radiographs

Abstract

The biceps brachii is a unique muscle with 2 proximal tendons and a single distal tendon. Although these tendons are part of the same muscle, they have significantly different functions. It is hypothesized that the long head of the biceps acts as a pain generator in the shoulder, though the biomechanical function is still under debate. Conversely, the distal biceps tendon is the major supinator of the forearm and serves a secondary flexor. As such, injuries to these tendons must be evaluated independently. Biceps brachii ruptures most often occur in middle-aged men following a traumatic event. Injuries to the long head of the biceps are primarily treated nonoperatively with adequate results. Injuries of distal tendon occur less often, but are receiving significant attention in the literature in regard to treatment options. Surgical repair of distal biceps ruptures is indicated in patients who want to restore supination strength and endurance. It is unclear which operative technique is superior, although the most recent data suggest increased strength of the cortical button repair. This article provides a comprehensive review of both proximal and distal biceps brachii ruptures in addition to our treatment algorithm.     

上臂“大力水手”畸形:磁共振影像评价及临床意义

目的探讨肱二头肌长头腱断裂形成上臂远端屈侧"大力水手"畸形的MRI特征,并结合临床病史和体征,提高对该损伤的诊断。方法搜集2014年4月至2018年5月共31例肱二头肌长头腱断裂导致"大力水手"畸形患者的临床和MRI影像资料,回顾性分析患者的上臂MRI影像特征和临床特点。结果31例"大力水手"畸形患者MRI上均可清晰分辨出断裂的二头肌长头腱远端位置、形态,冠矢状面T2WI上,断裂肌腱呈弹簧状回缩低信号带,周边环绕高信号水肿区,呈典型的"飘带征";横断面T2WI上,中央圆形低信号代表断裂肌腱残端,周边伴环形水肿高信号,呈"靶环征"。回缩的二头肌肌腹无明显信号异常,上臂伸直状态下MRI检查影像上形态改变不明显。患者和接诊医师常忽略数月前二头肌长头腱断裂致肩痛病史,临床上容易误诊为肿瘤或肿瘤样病变。结论肱二头肌长头腱断裂导致的上臂远端屈侧"大力水手"畸形,在常规磁共振影像上具有典型的特征。认识该典型特征,结合患者的临床病史和体征,对该损伤的诊断十分关键。     

Traumatic isolated closed rupture of the short head of the biceps brachii in military paratrooper

Isolated closed rupture of the short head of the biceps brachii is rare and has been reported infrequently. We experienced a case of traumatic isolated closed rupture of the short head of the biceps brachii in a healthy 21-year-old military paratrooper and report this case. At the surgery, the distal portion of short head of biceps brachii was sutured to the proximal stump and long head of biceps. At the last follow-up, elbow flexion strength was revealed 79% of normal and medial depression in the mid-portion of the upper arm was improved. Isolated rupture of the short head of the biceps brachii is a rare injury and early intervention is recommended if a sulcus or gap in musculotendinous unit is palpable or considerable weakness is present.     

Suture anchor and percutaneous intra-articular transtendon biceps tenodesis

Several arthroscopic biceps tenodesis techniques have been described for surgical management of tendonitis and/or partial thickness tears of the long head of the biceps brachii tendon resulting in recalcitrant anterior shoulder pain. This chapter describes an arthroscopic tenodesis using percutaneous intra-articular transtendon technique with suture anchor fixation. The percutaneous technique allows excellent access to the biceps tendon, and the addition of a suture anchor provides superior fixation to isolated soft tissue fixation.     

Arthroscopic biceps tenodesis with interference screw fixation: The lateral decubitus position

The tendon of the long head of biceps brachii is an important stabilizer within the glenohumeral joint. Bicepstendon pathology commonly occurs in the presence of concomitant shoulder disorders, such as subacromial impingement, and rotator cuff tears. Biceps tenodesis is indicated in the case of a partial tear (50%), an unstable biceps tendon due to an incompetent medial sling, and in the presence of a torn subscapularis. This article will describe our technique of arthroscopic biceps tenodesis with biodegradable interference screw fixation. This technique uses a uniquely designed Bio-Tenodesis screw system (Arthrex Inc., Naples, FL) and is performed with the patient in the lateral decubitus position.     

Distal biceps brachii tendon repair: Suture anchor technique

Rupture of the biceps brachii tendon has been associated with significant loss of flexion and supination strength.Several techniques have been described with reports of clinical success. The single incision suture anchor repair technique produces clinical results comparable with other methods of fixation with low complication rates. The procedure can be performed through a limited 3-cm transverse incision with minimal dissection. The surgical technique and postoperative rehabilitation are described.     

Combined Button and Screw Technique for Distal Biceps Ruptures

Distal biceps tendon ruptures occur almost exclusively in middle aged men, and with the “baby boomer” population reaching that age group, publications discussing this injury increased 130% from 1995-2010. As nonoperative treatment of distal biceps rupture leads to 40% reduction in elbow supination strength, 79% decrease in supination endurance, 30% loss in flexion strength, and 30% decrease in flexion endurance, operative repair is favored for most patients. The most popular and biomechanically sound method of fixation is a combined cortical button or tension-slide technique with tenodesis screw fixation at the native footprint on the bicipital tuberosity. Several studies show this method has a lower incidence of early failure, rerupture, and stronger biomechanical properties in cadaveric studies. The preferred surgical method is detailed with appropriate dissection, preparation of the distal biceps tendon, preparation of the bicipital tuberosity, and tendon fixation and early mobilization with postoperative rehabilitation to ensure proper healing and return to activity.     

肱二头肌短头带喙突骨瓣移位治疗肩锁关节脱位

目的　探讨肱二头肌短头带喙突骨瓣移位手术治疗肩锁关节脱位的疗效。方法　收集 3 8例肩锁关节脱位患者 ,均采用肱二头肌短头带喙突骨瓣移位、克氏针内固定手术治疗 ,术后按Karlson标准评估疗效。结果　A级 (优 ) 3 6例 ,占 94 73 %;B级 (良 ) 2例 ,占 5 2 7%;C级(差 )无。结论　肱二头肌短头带喙突骨瓣移位手术治疗肩锁关节脱位 ,手术创伤小 ,操作简便 ,疗效可靠     

磁共振与超声在肱二头肌长头腱损伤的诊断价值比较

目的 探讨磁共振(MR)和超声(US)检查在肱二头肌长头腱损伤中的诊断价值.方法 收集肩关节镜检证实的肱二头肌长头腱损伤患者80例,均行MR及US检查,以肩关节镜检结果为评价标准,分别计算MR和US诊断肱二头肌长头腱损伤的准确性、敏感性、特异性,比较2种检查方法的有效性.结果 80例患者中,肩关节镜证实肱二头肌长头腱完全撕裂19例,部分撕裂45例,肌腱炎10例,脱位6例.MR与US诊断肱二头肌长头腱完全撕裂、部分撕裂、肌腱炎及脱位的准确性分别为98.7%、92.5%、97.5%、100%和96.2%、85.0%、96.3%、98.7%.MR与US诊断肱二头肌长头腱完全撕裂、肌腱炎及脱位准确性差异无统计学意义(P>0.05),但MR诊断部分撕裂的准确性高于US(P<0.05).结论 MR在判断肱二头肌长头腱部分撕裂优于US.US检查可作为常规检查方法用于排查怀疑有肱二头肌长头腱损伤的患者.     

Distal Biceps Tendon Repair: Suture Anchor Technique

In active patients, acute ruptures of the distal biceps tendon are best treated by primary repair due to a loss of strength with conservative management. Various techniques have been reported with good clinical outcomes. The single-incision suture anchor repair technique demonstrates clinical results comparable with other fixation methods and low complication rates. The surgical technique is described in detail in this chapter.     

Chondral print on humeral head: an indirect sign of long head biceps tendon instability

Long head biceps (LHB) tendon pathologies are becoming increasingly recognized causes of shoulder pain in the published literature. Instability of LHB presenting as dislocation or subluxation has been recently recognized as a possible cause of disabling pain or discomfort of the shoulder. A clinical diagnosis of LHB instability is very difficult and often confounding because of association with other shoulder pathologies. However, an early diagnosis of LHB instability is important in order to prevent the evolution of lesions of the biceps pulley until an internal anterosuperior impingement of the shoulder (ASI) and subscapular tear occur. The advent of arthroscopy contributed to enhance understandings. The goal of this article is to describe an arthroscopic sign, the chondral print on the humeral head, associated with a LHB instability, that when present can be very useful to help the surgeon to make the diagnosis of unstable LHB tendon.     

肱骨近端三部和四部分骨折的外科治疗

目的：寻找一种治疗肱骨近端三部或四部分骨折的新方法．方法：以肱二头肌长头腱为标志，切开复位、Ｔ形钢板内固定，同时修复撕裂的肩袖和关节囊，术后早期康复治疗．结果：７例随访３个月～４年，平均２．５年，患侧肩关节功能优良率达８５．７％．结论：Ｔ形钢板内固定治疗肱骨近段三部或四部分骨折具有内固定牢靠、术后不需外固定、早期功能锻炼的优点，有助于肩关节功能恢复．     

X-ray computed tomography in fractures of the acetabulum

Radiographic assessment of these fractures remains difficult. Conventional techniques according to Letournel show the lesions but not to the best advantage, for instance the "congruency" of femoral head with acetabulum. 54 CT scan were performed (1982-1984) every time a doubt was persisting. Incarcerations of fragments, impactions of the acetabulum, sacro-iliac joint disjunctions, congruency and lesions of femoral head are much better seen with scanner. In planing the surgical therapy (or orthopedic), CT scan add a great deal to the information and dramatically improves the results.     

Modified Two-Incision Approach for Repair of Distal Biceps Tendon Rupture

Rupture of the distal biceps tendon is an uncommon injury that usually results from an excessive eccentric load across the biceps tendon. Various operative techniques have been described but anatomical repair is preferred to restore near native function in patients for whom such deficits would be debilitating. Boyd and Anderson originally described a 2-incision technique that minimizes the incidence of surgical complications while restoring anatomical function. This technique was further modified by Morrey to reduce the rate of ectopic bone formation that has been observed in the original Boyd-Anderson approach. With Morrey’s modification, the 2-incision approach is a safe and effective method for repair of a distal biceps tendon rupture. We describe the modified procedure in full and report on recovery, complications, and comparative outcomes.     

Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff

OBJECTIVE: This study was performed to examine the relationship and association of abnormalities seen in the long head of the biceps brachii tendon to abnormal findings in the rotator cuff. MATERIALS AND METHODS: One hundred eleven patients underwent MR imaging for shoulder pain followed by arthroscopic or open shoulder surgery from January 1997 to December 2000. Patients were identified by a retrospective search, and all consecutive patients having undergone both MR imaging and surgery were included in the patient cohort. Official MR imaging interpretations were compared with operative reports, and all findings were recorded. RESULTS: Twenty-three patients were identified with partial- or full-thickness tears of the long head of the biceps tendon. The sensitivity, specificity, and accuracy of unenhanced MR imaging of the shoulder for detecting these bicipital tears were 52%, 86%, and 79%, respectively. When a tear was present in the biceps tendon, the prevalence of supraspinatous, infraspinatus, and subscapularis tendon tears was 96.2%, 34.6%, and 47.1%, respectively. Patients with biceps tendon tears were significantly more likely to also have subscapularis tendon tears (p < 0.0001) and supraspinatous tendon tears (p < 0.008) than those patients who did not have biceps tendon tears. No significant relationship was found between the presence or absence of a biceps tendon tear and the presence or absence of a infraspinatus or teres minor tendon tear (p = 0.17). CONCLUSION: Tears of the long head of the biceps tendon have a statistically significant association with tears of the anterior and superior rotator cuff and are highly correlated with tears of the supraspinatous and subscapularis tendons. When tears of these tendons are detected, specific attention directed toward the long biceps tendon is warranted to characterize the status of this structure that provides additional stability to the shoulder joint.     

Single incision technique for distal biceps tendon repair: using the endobutton

Techniques have been described in the literature for the repair of distal biceps tendon ruptures. This techniqueuses a single incision approach with an Endobutton (Acuflex; Smith & Nephew Endoscopy, Mansfield, MA) for fixation. This fixation allows for early active range of motion and minimizes the risk of radioulnar synostosis. We have had success with this easily reproducible technique and no incidence of synostosis or neurologic complications.     

To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures

Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union.Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties.Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures.There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h.A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote revascularization process and better healing of fractures. Patients with these fractures should be on longer non-weight bearing ambulation than other patients.To conclude, the dynamic MRI seems to be reliable, non-invasive, sensitive, specific and accurate method of assessing the femoral head vascularity after intracapsular femoral neck fractures as early as 48 h of injury and to predict the outcome of fractures and may be used as a guideline for management of intracapsular femoral neck fractures.     

A new operative treatment for chronic biceps femoris tendon avulsion

In this report, an original technique for augmentation of chronic biceps femoris tendon avulsion is described. The procedure is developed using a reverse fascia flap of biceps femoris to be a single-tailed graft. Then, a suture anchor is inserted on the fibular head to approximate and fix the retracted the biceps femoris. Finally, a tunnel is drilled at the proximal fibula to let the graft pass through, and the end of the graft loop is sutured to itself. This technique confers effective, firm fixation of chronic biceps femoris tendon avulsion.