Abstract
Introduction: When possible direct repair of the chronic distal biceps tendon ruptures is recommended because the results of chronic repairs with grafts have traditionally not been as successful. Some key surgical tips will allow successful direct repair as it is noted in our series.
Material and Methods: Sixteen males with a chronic (6–14 weeks post injury) distal biceps rupture were repaired with the one-incision technique and 2 suture anchors. Average follow-up was 38 (range, 23–48) months. Involved arm was the dominant in 14 patients. The patients were assessed with the DASH questionnaire, goniometric range of motion and isokinetic strength testing of elbow flexion and supination. The position of the suture anchors was also evaluated radiographically. Surgical tips: 1) release adhesions between biceps and brachiallis, 2) release the bicipital aponeurosis, 3) “tease” the retracted tendon out of scar, 4) release the superficial biceps fascia and place relaxing incisions in the epimysium, 5) apply a surgical clamp to the end of the tendon and pull distally for 10–20 minutes. Note that the lateral antebrachial cutaneous nerve is frequently entrapped in scar and requires neurolysis.
Results: All patients regained almost normal flexion and supination strength, with a deficit of 12% and 15% respectively, compared with the uninvolved arm. Six patients had an average loss of extension of 120 (range, 50–180). According to the DASH test all patients had an excellent/good result (12 excellent, 4 good). X-rays revealed unchanged position of the anchors. No complications were noted.
Discussion-Conclusions: The use of flexor carpiradialis and of fascia lata that was used in several studies for repair of chronic distal biceps tendon ruptures has given controversial results mainly due to enlongation and inferior strength of the graft. Based on our results we believe that chronic (6–14 weeks post injury) distal biceps tendon ruptures can be successfully repaired through an anterior approach with direct repair and the use of suture anchors, avoiding the use of a graft.
The abstracts were prepared by Eleni Koutsoukou. Correspondence should be addressed to him at the Hellenic Association of Orthopaedic Surgery and Traumatology (HAOST), 20, A. Fleming str, 15123 Marousi, Athens, Greece.
