Abstract
Distal biceps tendon rupture can lead, if left untreated, to substantial and appreciated decline of elbow flexion and forearm supination strength. In chronic cases (seen more than 6 weeks after injury) retraction of the muscle can render reattachment of the tendon to the bicipital tuberosity impossible. In this setting non-anatomic attachment of the biceps to the underlying brachialis is usually elected but this is not suitable for patients with high functional demands.
Eight male patients (mean age 40 years, range 30–52 years) with chronic distal biceps ruptures (mean time from injury 28 weeks, range 12–38 weeks) underwent distal biceps reconstruction. Five patients presented with pain and weakness during elbow loading (four with lateral antebrachial cutaneus (LAC) nerve distribution dysesthesias) and three with weakness alone. Indications for distal biceps reconstruction were a) inability to approximate the tendon stump to the bicipital tuberosity with the elbow in less than 700 of flexion after relaxing incisions to the epimysium were made and b) high functional demands in pronosupination in the patients occupation or recreational activities.
In the first patient in this series autologous fascia latta was used for reconstruction and in the seven subsequent patients an Achilles tendon allograft. Through an one-incision anterior approach the graft was secured to the biceps remnant and was attached to the bicipital tuberosity using suture anchors.
The mean follow up was 32 months (range 14–48 months). All patients were pain free and had returned to their previous occupation. Mean elbow flexion was 145 deg with an extension deficit of 10 deg observed in only one patient. The mean pronosupination was 170 deg. All patients had 5/5 strength of elbow flexion and supination on manual testing. Subjective weakness in supination was reported by one patient. The mean supination strength (tested using a BTE Work Simulator) was 87% of the contrallateral healthy extremity. Seven achieved an excellent and one a good rating in the Mayo elbow performance score. No complications were encountered.
Distal biceps reconstruction with Achilles tendon allograft using a one incision technique and suture anchors for reattachment provides an excellent alternative to non- anatomic repair in patients with a chronic retracted distal biceps rupture. Patients involved in activities that require strength in supination are most likely to benefit from this reconstruction.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
