SURGICAL TREATMENT OF DISTAL BICEPS TENDON RUPTURES. A RANDOMIZED PROSPECTIVE STUDY COMPARING TWO DIFFERENT TECHNIQUES

Abstract

Introduction and objective: Distal biceps tendon ruptures commonly occur in the dominant arm of male between 40 and 60 years of age. The degenerative tendon avulses from the radial tuberosity. Conservative treatment results in decreased flexion and supination strength. Surgical reattachment is the treatment of choice and several surgical approaches and fixation devices have been proposed. The purpose of this study was to compare the results of two different techniques.

Materials and Methods: Twenty-four consecutive patients with distal biceps tendon ruptures were randomly assigned to one of two treatment groups: 12 using 2 biodegradable anchors through a modified 2-incision technique (group A) and 12 patients underwent distal biceps repair using an Endobutton^® (Acufex Smith & Nephew, Andover MA) using a single transverse anterior incision (group B). All patients were male. Average age was 40 (33–57) in groupA and 42 (29–59) in group B. The rupture was located in the dominant arm in 6 patients in groupA and 7 in group B.

The interval between injury and surgery was similar in both groups (< 12 days). Postoperative protocol and rehabilitation was the same in both groups. Full range of motion as tolerated was allowed two week after surgery.

Active range of motion, Mayo Elbow Performance Score (MEPS), pain, strength (Dexter isokinetic testing), patient satisfaction, operative time and elbow radiographs were evaluated at 12 months postoperatively. The mean follow-up was 17 months (range, 12–34).

Results: Average operative time (minutes):50 (group A) and 42 (group B). There were no complications in group B. Two patients in group A had a transient posterior interosseous nerve neurapraxia with spontaneous full recovery after 3 months, and other one developed symptomatic heterotopic bone formation and synostosis was resected. There was no statistical significant difference in MEPS score, range of motion, time to return to work or strength between both groups. All patients in both groups were satisfied with their final result and eventually returned to their pre-injury activity level without sequelae after 12.2 (group A) and 10.3 (group B) weeks.

Conclusion: Functional results of the two techniques studied were similar. Anterior approach showed lesser complications and less time off work than 2-incision technique. Endobutton^® single approach assisted tecnique should be considered the gold standard procedure for distal biceps tendon repair due to its shorter operative time and lower morbidity. However, we need series with a longer follow-up to confirm these results.