RECONSTRUCTION OF CHRONIC DISTAL BICEPS RUPTURES WITH USE OF A LOCAL SOFT TISSUE GRAFT

Abstract

Introduction: Chronic ruptures of the distal biceps tendon are relatively infrequent and are complicated by the retraction of the tendon and extensive scar formation, which preclude satisfactory repair. Bibliographical data presents different surgical procedures for the reconstruction of chronic ruptures using allograft soft-tissue constructs with varying results. The purpose of this study was to describe the surgical technique for reconstruction of the tendon with local soft tissue as graft and to report our experience with this procedure.

Methods: 17 patients with an average age of 54 years underwent surgical reconstruction of a chronic disruption of the distal biceps tendon. The mean interval between tendon rupture and reconstruction was 14 months. In all patients a flap from lacertus fibrosus was used in continuation with the remnants of the tendon. A based distally strip of the biceps was reversed and entubulated in the lacertous fibrosus flap and the whole construct was then advanced to the bicipital tuberosity. The biceps was released and mobilized as necessary. In addition, 3 patients underwent a fractional lengthening of the muscle. All procedures were performed through a single anterior approach. Anchors and anchor sutures were used to stabilize the tendon to the tuberosity.

Results: After an average duration of follow-up of 3.5 years, all patients had an excellent subjective result and they had all returned to their previous occupation. Furthermore, the strength of flexion and supination was comparable with that on the contralateral side in 13 patients. According to the Mayo Elbow performance score, the results were excellent in 9 patients, good in 4 and fair in 4. Complications that were encountered included a superficial infection which resolved with oral antibiotics, a transient median nerve palsy and a case of puncture wound of the brachial artery.

Conclusions: The aforementioned technique yields satisfactory postoperative results for this challenging problem with almost equal development of force and functionality on both sides and with a minimal possibility of re-rupture.