Repair of acute distal biceps tendon ruptures

Distal biceps tendon ruptures are most common in men between the ages of 40 and 60 years and usually arecaused by an unexpected extension force applied to the flexed arm. The most successful treatment of complete rupture of the distal biceps tendon is anatomical repair. The two-incision technique consistently restores flexion and supination strength. We have not found heterotopic ossification or synostosis to compromise results.     

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.     

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.     

Operative treatment of chronic distal biceps tendon ruptures

Chronic biceps tendon ruptures typically involve tendon retraction, scarring, and even compromised tissue. Indirect repair, such as tenodesis to the brachialis, does not provide optimal functional recovery. Chronic biceps tendon ruptures can be reconstructed with autogenous grafts (semitendinosis, tensor fascia lata) or allografts (typically Achilles tendon). The complications associated with these grafts include harvest site morbidity and graft incorporation. Using a vascularized local soft tissue source could minimize complications of graft reconstructions. The authors provide a novel reconstructive technique, reconstruction using the lacertus fibrosis, as a local graft source for chronic distal biceps tendon ruptures.     

Repair of chronic ruptures of the distal biceps tendon using flexor carpi radialis tendon graft

Five patients with chronic distal biceps tendon ruptures underwent tendon repair using double-looped flexor carpi radialis tendon graft. Fixation was performed with suture anchors through a single anterior incision. All patients had excellent functional results at a minimum 2-year follow-up.     

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.     

Single incision, transosseous suture repair technique for acute distal biceps tendon rupture

We describe a technique for repair of the distal biceps tendon using a single anterior incision, limited volardissection, and transosseous sutures through the radial tuberosity. This technique is simple, safe, and strong, allowing for prompt rehabilitation and recovery. Unlike the two-incision technique, there is no risk for heterotopic ossification or proximal radioulnar synostosis. Careful and limited dissection results in a low risk for iatrogenic neurovascular injury. Transosseous sutures have been shown to be stronger than suture anchors, allowing for more aggressive early motion and an early return to full motion. In addition, there is no additional cost for using transosseous sutures, as opposed to suture anchors or Endobutton (Arthrex Inc., Naples, FL), which may be quite expensive     

Repair of distal biceps tendon rupture with suture anchors

We retrospectively evaluated six cases of distal biceps tendon rupture that were treated by a two-incision operative repair using suture anchor attachment to the radial tuberosity for clinical outcome and strength testing. All patients had repair performed by the same surgeon. The average age of the patients, all male, was 43 years (range, 32–57 years). Average time from injury to operative repair was 22 days (range, 9–54 days). Follow-up time averaged 24 months after definitive treatment (range, 11–46 months). At follow-up no patient had limitation of activity and all patients were able to return to their previous employment, although three noted some minor antecubital fossa discomfort. No patient developed a synostosis. Cybex (Medway, Mass.) isokinetic testing revealed elbow flexion strength return for peak torque, total work, and average power, of 107%, 103%, and 110% of the uninjured arm, respectively. Elbow flexion endurance was 2% less in the injured arm. Forearm supination strength measured by peak torque, total work, and average power, was 97%, 85%, and 88% of the uninjured arm, respectively. Forearm supination endurance was 10% less in the injured arm. Our results using suture anchor repair are similar to those previously reported in the literature from bone tunnel repair. Based on our data, we believe that a two-incision repair with suture anchor attachment is a safe and effective method for treatment of distal biceps tendon ruptures. Received: 15 April 1998 Accepted: 13 October 1998     

Complications of distal biceps tendonrepairs

Surgical repair is the most reliable and appropriate method of restoring flexion and supination strength of the elbow and forearm following acute rupture of the distal biceps tendon. Although there may be small measurable deficits in power, endurance, and terminal forearm rotation when carefully evaluated, the vast majority of patients regain near normal upper extremity motion and function and can return to preinjury activities. There are currently two basic surgical approaches for distal biceps tendon repair, using one anterior incision or using one anterior and one lateral incision. Anterior repair alone has the advantage of a minimal risk of heterotopic bone formation but carries a greater chance of injury to the posterior interosseous nerve. In turn, the two-incision technique markedly diminishes the risk of radial nerve palsy but is associated with a greater likelihood of heterotopic bone formation limiting forearm rotation. Re-rupture of the distal biceps tendon following repair is uncommon with either technique, and the risk of all complications appears to increase with a delay in surgical intervention following rupture. When motion limiting heterotopic ossification does occur, surgical resection can proceed when the process becomes mature as defined by plain radiographs. Fortunately, functional forearm motion can be commonly restored in these cases with careful attention to surgical details and postoperative rehabilitation.     

Bilateral rupture of the distal tendon of the biceps brachii

We report a case of bilateral simultaneous rupture of the distal tendon of die biceps brachii muscle. A 56-year-old yachtsman had a double-sided rupture of the distal tendon of the biceps brachii On die left side die biceps tendon was sutured to me fascia of me brachialis muscle 3 months after me injury. On me right side, 3 months later, the procedure was supplemented with tendon transplantation with anatomical reinsertion. The operative treatment was followed by immobilization and rehabilitation. After 6 months die transplantation failed, and bilaterally me range of motion of the elbow including forearm rotation was normalized, the power of flexion was slightly reduced and me power of supination was markedly reduced. Two years after surgery, me flexion power was normalized, the patient was satisfied with the results and he was still a yachtsman.     

Bone tunnel and suture anchor fixation of distal biceps tendon ruptures

Several different techniques to secure the distal end of the biceps tendon back to the radial tuberosity have been described in the literature. This paper will focus on 2 of the more common ones: (1) a 2-incision technique using a bone tunnel and (2) a 1-incision technique with suture anchors. Both of these techniques have been shown to produce similarly good clinical results.     

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.     

Arthroscopic biceps tenodesis: Indications and technique

Biceps tendon pathology commonly occurs in combination with other shoulder disorders, such as subacromial impingement and rotator cuff tears. Although the arthroscopic treatment of impingement and rotator cuff tears has previously been reported, arthroscopic biceps tenodesis has rarely been described. In this article, we present our technique of arthroscopic biceps tenodesis, which uses a uniquely designed Bio-Tenodesis screw system. This system allows intra-articular manipulation of the biceps tendon, ensures placement of the tendon into the base of the bone socket, allows insertion of the screw while maintaining the position and tension in the tendon, and ensures an adequate screw-tendon-bone interface.     

Assessment of instability of the long head of the biceps tendon by MRI

Objective. To determine whether MRI can identify instability of the long head of the biceps tendon (LBT) in the rotator interval. Design and patients . A retrospective review was carried out of 19 patients, all arthroscopically examined, nine of whom had surgically confirmed instability of the LBT. Results. A LBT perched on the lesser tuberosity correctly indicated all nine cases of instability with one false positive. In six of seven cases where the LBT was oval in shape, no instability of the biceps tendon existed, whereas LBT instability was present in eight of 12 patients with a flat long head of the biceps tendon. In seven of eight acutely angled intertubercular sulci there was no instability of the LBT while eight of 11 obtusely angled sulci were associated with LBT instability. By consensus impression, instability of the LBT could be determined with 67% sensitivity, 90% specificity, 86% positive predictive value, and 75% negative predictive value. Conclusions. A flat LBT perched on the lesser tuberosity with an obtusely angled intertubercular sulcus suggests the diagnosis of instability of the LBT in the correct clinical setting. Received for publication: 3 May 2000 Revision requested: 2 July 2000 Revision received: 27 September 2000 Accepted: 27 November 2000     

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

Anatomical reinsertion of the avulsed distal biceps tendon is the recommended treatment, but the results are hampered by complications. The purpose of this study is to show the results of patients surgically treated with a non-anatomical reinsertion of this tendon. From 1972 to 2006, 26 non-professional athletic patients were surgically treated by suture of the tendon on the brachialis muscle tendon. At follow-up 23/26 patients underwent clinical and isokinetic evaluation. At a medium follow-up of 84 months, patients provided satisfactory subjective and objective clinical results. Flexion was restored in all patients, while a 10° supination deficit was found in two patients. Dynamometric tests showed satisfactory results both regarding Maximum Strength Power and Endurance tests. Reinsertion of the distal biceps tendon on the brachialis tendon can be considered, in a long-term follow-up, a safe and effective procedure, with low complication rate.     

Surgical repair of distal biceps tendon ruptures: a biomechanical comparison of two techniques

BACKGROUND: Rupture of the distal biceps brachii tendon has most commonly been repaired by anatomic reattachment of the tendon to the radial tuberosity by a single- or two-incision approach. Researchers have studied suture anchor attachment through a single incision, but the tendon-suture interface and bone quality have not previously been analyzed. HYPOTHESIS: Suture anchor repair results in stiffness and tensile strength equal to that of bone-tunnel repair for biceps tendon rupture. STUDY DESIGN: Controlled laboratory study. METHODS: Twelve matched pairs of fresh-frozen cadaveric elbow specimens were used. Suture anchor and bone-tunnel tendon repairs were performed in a randomized fashion. Each specimen was loaded to tensile failure. Load-displacement graphs were generated to calculate repair stiffness, yield strength, and ultimate strength. Computed tomography bone density measurements and additional statistical analyses were then performed after grouping the specimens by mode of failure. RESULTS: The bone-tunnel repair was found to be significantly stiffer in all cases and to have significantly greater tensile strength than the suture anchor repair in the younger, nonosteoporotic elbows. CONCLUSIONS: Suture anchor repairs were not as stiff or strong as bone-tunnel repairs. CLINICAL RELEVANCE: Biceps tendon surgery using the traditional two-incision technique yields a stronger and stiffer repair in the typical patient with this injury.     

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.