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     

Mechanical properties of the long head of the biceps tendon

In this study, the geometric and mechanical properties of the long head of the biceps tendon were determined in order to elucidate its role in shoulder stability. We used a laser-micrometer system to measure the cross-sectional area and shape of seven fresh-frozen tendons at three levels: proximal, middle, and distal levels. The cross-sectional areas were found to be 22.7±9.3 mm², 22.7±3.5 mm², and 10.8±2.7 mm², respectively. While statistically significant differences could not be demonstrated between the magnitudes of the areas, a consistent difference in shape was noted between the proximal and middle levels, the tendon being flatter as it progressed over the humeral head and more triangular as it passed through the bicipital groove. We then performed cyclic relaxation tests and uniaxial tensile testing of the tendons which revealed a cyclic stress relaxation of 18±4% over ten cycles. All tensile failures occurred within the midportion of the tendon substance. Additionally, the modulus was calculated between 3% and 6% strain and found to be 421±212 MPa, while the ultimate tensile strength, ultimate strain, and strain energy density were 32.5±5.3 MPa, 10.1±2.7%, and 1.9±0.4 MPa, respectively. These mechanical properties of the long head of the biceps tendon are of the same order of magnitude as tendons from other joints. The high stiffness of this tendon indicates that it has an ability to support the large load transferred to it by the muscle and to act as a humeral head depressor.     

Arthroscopic reconstruction of a ruptured patellar tendon: a technical note

A traumatic patellar tendon rupture of a 35-year-old, otherwise healthy male was reconstructed with semi-tendinosus and gracillis tendons. Tendon grafts were harvested with an open-ended tendon stripper without dissecting them free from their tibial insertion. A transpatellar tunnel was drilled appropriate to the tendon size and a passing pin was used across the length of the patella. Graft bundles were passed in a standard fashion, traversing through the midst of the distal part of the patellar tendon via a beath pin with a loaded looped suture. The endo-button device was then flipped and fixed as an anchor. The patella was positioned at the original placement under arthroscopic visualization and the free ends of the hamstring tendons were attached to a post-fixation screw through the Krackow sutures. Tendon grafts were gathered on the tuberositas tibia and fixed with two additional staples. The patient could flex his knee up to 130 deg at the 3-month follow-up. It was demonstrated that arthroscopic reconstruction of a ruptured patellar tendon may be the optimal surgical choice to minimize trauma and begin early rehabilitation.     

Improved visualization of the radial insertion of the biceps tendon at ultrasound with a lateral approach

We report a new lateral approach for ultrasound visualization of the distal biceps tendon. A cadaver specimen was dissected to study distal biceps anatomy relevant to this approach. Sonograms obtained in volunteers and patients are provided to illustrate this alternative method.     

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.     

Bilateral congenital absence of the long head of the biceps tendon

Absence of the long head of the biceps tendon is a rare anomaly particularly when it occurs bilaterally. We present the magnetic resonance and arthroscopy findings in a patient with bilateral congenital absence of the long head of the biceps who presented with bilateral shoulder pain. Identification of a shallow or absent intertubercular groove may aid in differentiating congenital absence of the long head of the biceps from a traumatic tendon rupture.     

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.     

Intracapsular origin of the long head of the biceps tendon

A developmental anomaly of the long head of the biceps tendon was found in a cadaveric shoulder. Findings on arthroscopy, routine MR imaging, and MR arthrography were compared and correlated with results of anatomic dissection. MR arthrography appears to be a very good diagnostic imaging method for depicting this anomaly prior to arthroscopy. Received: 21 October 1998 Revision requested: 23 November 1998 Revision received: 14 December 1998 Accepted: 18 December 1998     

Arthroscopic double bundle ACL reconstruction using a bone patellar tendon bone—gracilis tendon composite autograft: a technical note

The authors devised an alternative arthroscopic double bundle ACL reconstruction technique using a bone patellar tendon bone (BPTB)–gracilis tendon composite autograft. One tibial and two femoral tunnels were used to reconstruct two bundles of anterior cruciate ligaments (ACL) [an anteromedial bundle (AM) and a post-erolateral bundle (PL)]. BTBB was fixed in the tunnels produced on the isometric points of the tibia and femur using the conventional technique. The gracilis tendon was then fixed in a PL tunnel produced using the outside-in technique. The authors consider that the devised technique based on a combination of autogenous bone patellar bone graft and gracilis tendon, can minimize tunnel widening post-operatively, allow easier revision should the reconstructed ACL fail, and also provides an alternative means of restoring rotation stability.     

Arthroscopic anterior cruciate ligament double-bundle reconstruction using hamstring tendon grafts-fixation with two interference screws: technical note

In this article, an original double-bundle anterior cruciate ligament reconstruction technique is described. The procedure is developed using hamstring tendon grafts while maintaining tibial osseous insertion. Two tibial tunnels are drilled and a simplified and precise outside-in double tunnel femoral drilling technique is utilized. The graft fixation is made using only two interference screws.     

Snapping of bilateral biceps femoris tendons: A case report and brief review

Snapping of the biceps femoris tendon is a rare cause of lateral knee pain often due to multiple factors including fibular head deformity and thickening of the anterior band of the biceps femoris tendon inserting on the tibia. Understanding the complex and poorly understood anatomy of the biceps femoris tendon is crucial and essential for proper diagnosis of its snapping. In this report, we describe the rare entity of bilateral biceps femoris tendon snapping in a young man using a multimodality diagnostic approach.     

Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus: a technical note

This technical note describes a new arthroscopic technique to repair a tear of posterior root of the medial meniscus. Cartilage at the insertion area of the posterior horn of the medial meniscus (PHMM) was removed using a curved curette inserted through an anteromedial portal. A metal anchor loaded with two FiberWires (Arthrex, Naples, FL) was placed at the insertion area of the PHMM through a high posteromedial portal. A PDS suture was passed the PHMM by curved suture hook through the anteromedial portal. Two limbs of the PDS were then used to pass two limbs of the FiberWire through the meniscus. The same procedure was repeated for the second FiberWire suture. The sutures were tied, achieving secure fixation of the posterior meniscal root at the anatomic insertion.     

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.     

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.     

Unusual late sequel of ruptured distal tendon of biceps brachii mimicking a soft-tissue tumor

Objective We report a rare case of chronic, neglected rupture of the distal biceps brachii which presented with gradually increasing swelling over the left lower arm. Fine-needle aspiration cytology was reported as indicative of a soft-tissue neoplasm. Computed tomography and magnetic resonance imaging were unable to rule out a neoplastic mass. Final histopathology after surgical excision revealed a reparative process.Conclusion Such a presentation of ruptured biceps brachii wherein the clinicoradiological features are misleading and suggestive of a soft-tissue tumor is quite unusual.     

Repair of chronic distal biceps tendon ruptures: Indications and use of tendon grafts

Reconstruction of chronic distal biceps tendon ruptures is complicated by the substantial retraction and poor quality of the remaining muscle and tendon tissue. Several types of tendon grafts have been described to augment the repair and restore length including both allografts and autografts. To date, we have found the Achilles tendon allografts to be perhaps the most reliable and versatile graft to reconstruct the chronic distal biceps tendon rupture and, when required, it has provided satisfactory clinical results in this difficult clinical setting.