Aims. The conventionally described mechanism of distal biceps tendon rupture (DBTR) is of a ‘considerable extension force suddenly applied to a resisting, actively flexed forearm’. This has been commonly paraphrased as an ‘eccentric contracture to a flexed elbow’. Both definitions have been frequently used in the literature with little objective analysis or citation. The aim of the present study was to use video footage of real time distal biceps ruptures to revisit and objectively define the mechanism of injury. Methods. An online search identified 61 videos reporting a DBTR. Videos were independently reviewed by three surgeons to assess forearm rotation, elbow flexion, shoulder position, and type of muscle contraction being exerted at the time of rupture. Prospective data on mechanism of injury and arm position was also collected concurrently for 22 consecutive patients diagnosed with an acute DBTR in order to corroborate the video analysis. Results. Four videos were excluded, leaving 57 for final analysis. Mechanisms of injury included deadlift, bicep curls, calisthenics, arm wrestling, heavy lifting, and boxing. In all, 98% of ruptures occurred with the arm in supination and 89% occurred at 0° to 10° of elbow flexion. Regarding muscle activity, 88% occurred during isometric contraction, 7% during eccentric contraction, and 5% during concentric contraction. Interobserver correlation scores were calculated as 0.66 to 0.89 using the free-marginal Fleiss Kappa tool. The prospectively collected patient data was consistent with the video analysis, with 82% of injuries occurring in supination and 95% in relative elbow extension. Conclusion. Contrary to the classically described injury mechanism, in this study the usual arm position during DBTR was forearm supination and elbow extension, and the muscle contraction was typically isometric. This was demonstrated for both video analysis and ‘real’ patients across a range of activities leading to rupture. Cite this article: Bone Jt Open 2022;3(10):826–831

Previous studies describing drill trajectory for single incision distal biceps tendon repair suggest aiming ulnar and distal (Lo et al). This suggests that the starting point of the drill would be anterior and radial to the anatomic insertion of the distal biceps tendon. Restoration of the anatomic footprint may be important for restoration of normal strength, especially as full supination is approached. To determine the safest drill trajectory for preventing injury to the posterior interosseous nerve (PIN) when repairing the distal biceps tendon to the ANATOMIC footprint through a single-incision anterior approach utilising cortical button fixation. Through an anterior approach in ten cadaveric specimens, three drill holes were made in the radial tuberosity from the centre of the anatomic footprint with the forearm fully supinated. Holes were made in a 30º distal, transverse and 30º proximal direction. Each hole was made by angling the trajectory from an anterior to posterior and ulnar to radial direction leaving adequate bone on the ulnar side to accommodate an eight-millimetre tunnel. Proximity of each drill trajectory to the PIN was determined by making a second incision on the dorsum of the proximal forearm. A K-wire was passed through each hole and the distance between the PIN and K-wire measured for each trajectory. The PIN was closest to the trajectory K-wires drilled 30° distally (mean distance 5.4 mm), contacting the K-wire in three cases. The transverse drill trajectory resulted in contact with the PIN in one case (mean distance 7.6 mm). The proximal drill trajectory appeared safest with no PIN contact (mean distance 13.3 mm). This was statistically significant with a Friedman statistic of 15.05 (p value of 0.00054). When drilling from the anatomic footprint of the distal biceps tendon the PIN is furthest from a drill trajectory aimed proximally. The drill is aimed radially to minimise blowing out the ulnar cortex of the radius. For any reader inquiries, please contact . vansurgdoc@gmail.com

Repair of distal biceps tendon rupture is a subject that has received increasing attention in the past decade. In the active individual who desires as close to normal function as possible, repair of biceps tendon is recommended. The author describes a tehnique with a single anterior incision and fixation with superanchors. This method was successfully used in 25 patients with excellent functional results. There were no failures and no complications of neurological injury. The single anterior incision approach in which superanchors are used is recommended as an alternative to the traditional two-incision method. The Biceps brachii is an important flexor of the elbow and is the main supinator of the forearm. Avulsion of its distal tendon insertion is rare injury that mostly affects middle-aged men. It represents only 3% of all biceps tendon ruptures. There is an average of 1.24 spontaneous complete distal biceps ruptures per 100,000 people per year. The decline in the number of distal biceps tendon ruptures with increasing age correlates with a decrease in at-risk activities after the fourth decade of life. Decreased vascularity, tendon impingement, degenerative changes of the distal biceps tendon and the use of anabolic steroids have been postulated to predispose to tendon rupture. Our study shows that repair of distal biceps tendon ruptures using superanchors is safe and gives clinically objective and functional results similar to bone tunnel fixation. We had no major complications, no suture anchor failures and no occurrence of synostosis and neurological injuries. We recommend the use of superanchors for the treatment of distal biceps tendon ruptures

The extracortical single-button (SB) inlay repair is one of the most preferred distal biceps tendon repair techniques. However, specific complications such as neurovascular injury and non-anatomic repairs have led to the development of techniques that utilize intracortical double-button (DB) fixation. To compare the biomechanical stability of the extracortical SB repair with the anatomical DB repair technique. Controlled laboratory study. The distal biceps tendon was transected in 18 cadaveric elbows from 9 donors. One elbow of each donor was randomly assigned to the extracortical SBor anatomical DB group. Both groups were cyclically loaded with 60N over 1000 cycles between 90° of flexion and full extension. The elbow was then fixed in 90° of flexion and the repair construct loaded to failure. Gap-formation and construct stiffness during cyclic loading, and ultimate load to failure was analysed. After 1000 cycles, the anatomical DB technique compared with the extracortical SB technique showed significantly less gap-formation (mean difference 1.2 mm; p=0.017) and significantly more construct stiffness (mean difference 31 N/mm; p=0.023). Ultimate load to failure was not significantly different comparing both groups (SB, 277 N ±92 vs. DB, 285 N ±135; p=0.859). The failure mode in the anatomical DB group was significantly different compared with the extracortical SB technique (p=0.002) and was due to fracture avulsion of the BicepsButton in 7 out of 9 specimens (vs. none in SB group). Our study shows that the intracortical DB technique produces equivalent or superior biomechanical performance to the SB technique. The DB repair technique reduces the risk of nerve injury and better restores the anatomical footprint of biceps tendon. The DB technique may offer a clinically viable alternative to the SB repair technique

Introduction and Aims: Distal biceps ruptures are an uncommon injury. They represent approximately three percent of all biceps ruptures. Intervention was popularised by Boyd and Anderson who described a two-incision technique. Improved outcome has been achieved with stronger fixation allowing early mobilisation. Method: All patients who underwent operative fixation of distal biceps ruptures by the senior two authors were identified. All patients were clinically reviewed at a minimum of six months from surgery. Functional outcomes scores in the form of Patient Rated Elbow Evaluation (PREE) and DASH scores were assessed. The operative technique utilised the Endobutton (Smith and Nephew) and is a substantial modification of that published by Bain,G et al. Results: Thirty-one patients were identified. All patients were male with an average age of 47 years. Average delay to surgery was 24 days. There were no postoperative complications and no repeat ruptures. Thirty patients have returned Patient Rated Elbow Evaluation (PREE) forms with an average score of eight. Cybex testing demonstrates good return of strength when compared to the uninjured side. Conclusion: Fixation of distal biceps ruptures using this modified Endobutton technique is a safe and effective method

This is largest collection of outcomes of distal biceps reconstruction in the literature. 8 subjects prospectively measured pre and post reconstruction Strength deficit in patients with chronic tendon deficit is described. To describe outcomes for 53 chronic distal biceps reconstructions with tendon graft. Clinical outcomes as well as strength and endurance in supination and flexion are reported. To examine eight patients measured pre- and post-reconstruction. To identify deficit in supination and flexion in chronic reconstruction. 53 reconstructions of chronic distal biceps with tendon graft were carried out between 1999 and 2015. 26 subjects agreed to undergo strength testing after minimum one year follow up. Eight subjects were tested both before and after reconstruction. Primary outcomes were strength in elbow flexion and forearm supination. Strength testing of supination and flexion included maximum isokinetic power and endurance performed on a Biodex. Clinical outcomes measures included pre-operative retraction severity, surgical fixation technique, postoperative contour, range of motion, subjective satisfaction, SF-12, DASH, MAYO elbow score, ASES and pain VAS Non-parametric data was reported as median (interquartile range), while normally-distributed data was reported as mean with 95% Confidence Limits. Hypothesis testing was performed according to two-tailed, paired t-tests. Median time from index rupture to reconstructions 9.5 (range 3–108) months. Strength measurements were completed at a median follow-up time of 29 (range 12–137) months on 26 subjects. The proportion of patients that achieved 90% strength of the contralateral limb post-reconstruction was 65% (17/26) for peak supination torque, and 62% (16/26) for peak flexion torque. Supination and flexion endurance was 90% of the contralateral arm in 81% (21/26) and 65% (17/26) of subjects, respectively. Ten subjects (39%) achieved 90% strength of the contralateral arm on at least four of five strength tests. Eight of the 26 patients were evaluated pre- and post-surgery. As compared to the contralateral limb, chronic distal biceps rupture was found to have a mean [95%CI] deficit in peak supination torque of 31.0 [21.0, 42.9]% (p=0.002). Mean deficit in peak flexion torque of 34.2 [23.1, 45.4]% (p <0.001). Reconstruction resulted in an increase in peak supination torque of 33.5 [8.7, 58.3]% (p=0.0162), increase in peak flexion torque of 35.0 [6.4, 63.6]% (p=0.023), increase in isometric strength of 57.6 [36.1, 79.1]% (p<0.001), increase in supination endurance of 0.6 [-22.2, 23.4]% (p=0.668), and a decrease in flexion endurance of 4.8 [-23.3, 13.7](p=0.478). Ninety-six percent of the patients (25/26) were satisfied, or very satisfied with the overall outcome of the surgery, while median Mayo score post-reconstruction was 100 (range: 55–100). Chronic distal biceps tendon rupture results in less supination loss and greater flexion loss than previously reported. Reconstruction with tendon graft results in a significant, but incomplete recovery of peak supination and flexion torque, but no significant change in endurance. Clinical patient satisfaction with surgical outcomes is high

Introduction. Tendon ruptures are a common injury and often require surgical intervention to heal. A refixation is commonly performed with high-strength suture material. However, slipping of the thread is unavoidable even at 7 knots potentially leading to reduced compression of the sutured tendon at its footprint. This study aimed to evaluate the biomechanical properties and effectiveness of a novel dynamic high-strength suture, featuring self-tightening properties. Method. Distal biceps tendon rupture tenotomies and subsequent repairs were performed in sixteen paired human forearms using either conventional or the novel dynamic high-strength sutures in a paired design. Each tendon repair utilized an intramedullary biceps button for radial fixation. Biomechanical testing aimed to simulate an aggressive postoperative rehabilitation protocol stressing the repaired constructs. For that purpose, each specimen underwent in nine sequential days a daily mobilization over 300 cycles under 0-50 N loading, followed by a final destructive test. Result. After the ninth day of cyclic loading, specimens treated with the dynamic suture exhibited significantly less tendon elongation at both proximal and distal measurement sites (-0.569±2.734 mm and 0.681±1.871 mm) compared to the conventional suture group (4.506±2.169 mm and 3.575±1.716 mm), p=0.003/p<0.002. Gap formation at the bone-tendon interface was significantly lower following suturing using dynamic suture (2.0±1.6 mm) compared to conventional suture (4.5±2.2 mm), p=0.04. The maximum load at failure was similar in both treatment groups (dynamic suture: 374± 159 N; conventional suture: 379± 154 N), p=0.925. The predominant failure mechanism was breakout of the button from the bone (dynamic suture: 5/8; conventional suture: 6/8), followed by suture rupturing, suture unraveling and tendon cut-through. Conclusion. From a biomechanical perspective, the novel dynamic high-strength suture demonstrated higher resistance against gap formation at the bone tendon interface compared to the conventional suture, which may contribute to better postoperative tendon integrity and potentially quicker functional recovery in the clinical setting

Acute distal biceps tendon repair reduces fatigue-related pain and minimises loss of forearm supination and elbow flexion strength. We report the short- and long-term outcome following repair using an EndoButton technique. Between 2010 – 2018, 102 patients (101 males; mean age 43 years) underwent acute (□6 weeks) distal biceps tendon repair using an EndoButton technique. The primary short-term outcome was complications. The primary long-term outcome was the Quick-DASH (Q-DASH). Secondary outcomes included the Oxford Elbow Score (OES), EuroQol-5D-3L (EQ-5D), return to function and satisfaction. At mean short-term follow-up of 4 months (2.0 – 55.5) eight patients (7.8%) experienced a major complication and 34 patients (33.3%) experienced a minor complication. Major complications included re-rupture (n=3, 2.9%), unrecovered nerve injury (n=4, 3.9%) and surgery for heterotopic ossification excision (n=1, 1.0%). Three patients (2.9%) required surgery for a complication. Minor complications included neuropraxia (n=27, 26.5%) and superficial infection (n=7, 6.9%). At mean follow-up of 5 years (1 – 9.8) outcomes were collected from 86 patients (84.3%). The median Q-DASH, OES, EQ-5D and satisfaction scores were 1.2 (IQR 0 – 5.1), 48 (IQR, 46 – 48), 0.80 (IQR, 0.72 – 1.0) and 100/100 (IQR, 90 – 100) respectively. Most patients returned to sport (82.3%) and employment (97.6%) following surgery. Unrecovered nerve injury was associated with a poor outcome according to the Q-DASH (p< 0.001), although re-rupture and further surgery were not (p > 0.05). Acute distal biceps tendon repair using an EndoButton technique results in excellent patient reported outcomes and health-related quality of life. Although rare, unrecovered nerve injury adversely affects outcome

Purpose: Anatomic repair of an acute distal biceps tear has been demonstrated to improve flexion and supination strength compared with conservative treatment. The most commonly used fixation methods for a distal biceps tendon repair include suture anchors, bioabsorbable screws, and endobutton. The goal of this study was to. perform a radiologic evaluation of bioabsorbable screw tunnel osteolysis and. retrospectively review bioabsorbable-screw related clinical complications. Method: We included twenty (20) consecutive patients who underwent primary anatomic repair of the distal biceps tendon since 2005. We used a 7x23mm biote-nodesis. ®. screw (Arthrex) in 18 cases, and 8x23mm and 8x12mm screws in the other two cases. First, from the x-ray view done in the immediate postoperative period showing the complete screw tunnel, we measured the ratio of the volume of the bone tunnel to the volume of the radius bone section. A mathematical formula for cylindrical volume was used (¶ x r2 x h). We used a relation between two volumes rather than the tunnel volume itself for scaling purposes. Secondly, we calculated the same relation on the x-ray from the last follow-up. We then obtained the percentage of tunnel enlargement by relating the volumetric ratio from the first x-ray to the ratio from the last x-ray. Afterwards, we performed a retrospective chart review noting any bioabsorbable screw-related and postoperative complications. Results: In the group, the average age was forty-six (46) years. All subjects were male. Eighteen (18) cases were acute complete ruptures operated in the first three weeks, one case was a partial rupture and one case was chronic (one year). The average follow up was eighteen (18) months. We found that the average initial relative volume occupied by the screw tunnel was 47 % of the bone section. At the last follow-up, this volume increased to 68%. After our chart review, we found that one patient presented with a broken screw and increased pain and that another patient developed a severe foreign-body reaction with re-rupture of the tendon requiring three reoperations. Conclusion: The use of a bioabsorbable screw for distal biceps tendon fixation results in significant osteolysis of the radial bone at short term follow-up. Consequences of osteolysis in the radius are worrisome since iatro-genic fractures are more likely to occur. Osteolysis can be secondary to an inflammatory reaction to the screw material, bone necrosis secondary to pressure or initial thermal necrosis. We also noted two cases of severe bio-tenodesis screw-related complications among our series of twenty (20) patients. These results call into question the use of the bioabsorbable screw in distal biceps tendon repair and are important to present. Exact volume of bone loss using 3D computed tomography scan analysis as well as quality of life questionnaires and strength testing will be available for presentation

Introduction: Proximal radio-ulnar synostosis is a rare complication after distal biceps tendon repair. Synostosis results in usually painfree limitation of forearm rotation and loss of function. The outcome after synostosis excision has not been demonstrated. Methods: Between 1987 and 2003 twelve patients were identified with radio-ulnar synostosis and retrospectively reviewed clinically and radiographically. All patients initially experienced a complete distal biceps tendon rupture after lifting heavy objects. The average time to repair was fourteen days. Results: These twelve patients underwent excision of synostosis as early as two months post repair and as late as 18 months. The average age at time of excision was forty-five years and the dominant arm involved in seven patients. All received postoperative idomethacin for four weeks and only six received additional postoperative irradiation. The average follow-up was fifty-nine months. Function revealed an average pre-operative rotational arc of 19, six patients were ankylosed in a neutral position. The postoperative arc was 138 (p = 0.007). Flexion and extension was essentially normal preoperatively and postoperatively. All twelve patients demonstrated no pain pre- and postoperatively. All patients were very satisfied with the result. There were no complications after excision. Radiographically there was no recurrence of ectopic bone formation. Discussion and Conclusion: Excision of proximal radio-ulnar synostosis following distal biceps repair results in a significant improvement of limited forearm rotation and returning patients to a pain free functional rotational arc with a high satisfaction rate

Compared to single-incision distal biceps repair (SI), double-incision repair (DI) theoretically allows for reattachment of the tendon to a more anatomically favorable position. We hypothesized that DI repair would result in greater terminal supination torque compared to SI repair for acute distal biceps ruptures. In this retrospective cohort study, patients were included if they sustained an isolated, acute (° supinated position. Secondary outcomes included supination torque in 45° supinated, neutral, and 45° pronated positions, ASES elbow score, DASH, SF-12, and VAS. Power analysis revealed that at least 32 patients were needed to detect a minimum 15% difference in the primary outcome (β = 0.20). Statistical analysis was performed with significance level α = 0.05 using R version 3.4.1 (R Core Team 2017, Vienna, Austria). Of 53 eligible patients, 37 consented to participate. Fifteen were repaired using DI technique and 22 using SI technique. Mean age was 47.3yrs and median follow-up time was 28.1months. The groups did not differ with respect to age, time-to-follow-up, dominance of arm affected, Workers Compensation or smoking status. Mean supination torque, measured as the percentage of the unaffected side, was 60.9% (95%CI 45.1–76.7) for DI repair versus 80.4% (95%CI 69.1–91.7) for SI repair at the 60°supinated position (p=0.036). There were no statistically significant differences in mean supination torque at the 45°supinated position: 67.1% (95%CI 49.4–84.7) for DI versus 81.8% (95%CI 72.2–91.4) for SI (p=0.102), at the neutral position: 88.8% (95%CI 75.2–102.4) for DI versus 97.6% (95%CI 91.6–103.7) for SI (p=0.0.170), and at the 45°pronated position: 104.5% (95%CI 91.1–117.9) for DI versus 103.4 (95%CI 97.2–109.6) for SI (p=0.0.862). No statistically significant differences were detected in the secondary outcomes ASES Pain, ASES Function, DASH scores, SF-12 PCS or MCS, or VAS Pain. A small difference was detected in VAS Function (median 1.3 for DI repair versus 0.5 for SI repair, p=0.023). In a multivariate linear regression model controlling for arm dominance, age, and follow-up time, SI repair was associated with a greater mean supination torque than DI repair by 19.6% at the 60°supinated position (p=0.011). Contrary to our hypothesis, we found approximately a 20% mean improvement in terminal supination torque for acute distal biceps ruptures repaired with the single-incision technique compared to the double-incision technique. Patients uniformly did well with either technique, though we contend that this finding may have clinical significance for the more discerning, high-demand patient

Compared to single-incision distal biceps repair (SI), double-incision repair (DI) theoretically allows for reattachment of the tendon to a more anatomically favorable position. We hypothesized that DI repair would result in greater terminal supination torque compared to SI repair for acute distal biceps ruptures. In this retrospective cohort study, patients were included if they sustained an isolated, acute (° supinated position. Secondary outcomes included supination torque in 45° supinated, neutral, and 45° pronated positions, ASES elbow score, DASH, SF-12, and VAS. Power analysis revealed that at least 32 patients were needed to detect a minimum 15% difference in the primary outcome (β = 0.20). Statistical analysis was performed with significance level α = 0.05 using R version 3.4.1 (R Core Team 2017, Vienna, Austria). Of 53 eligible patients, 37 consented to participate. Fifteen were repaired using DI technique and 22 using SI technique. Mean age was 47.3yrs and median follow-up time was 28.1months. The groups did not differ with respect to age, time-to-follow-up, dominance of arm affected, Workers Compensation or smoking status. Mean supination torque, measured as the percentage of the unaffected side, was 60.9% (95%CI 45.1–76.7) for DI repair versus 80.4% (95%CI 69.1–91.7) for SI repair at the 60°supinated position (p=0.036). There were no statistically significant differences in mean supination torque at the 45°supinated position: 67.1% (95%CI 49.4–84.7) for DI versus 81.8% (95%CI 72.2–91.4) for SI (p=0.102), at the neutral position: 88.8% (95%CI 75.2–102.4) for DI versus 97.6% (95%CI 91.6–103.7) for SI (p=0.0.170), and at the 45°pronated position: 104.5% (95%CI 91.1–117.9) for DI versus 103.4 (95%CI 97.2–109.6) for SI (p=0.0.862). No statistically significant differences were detected in the secondary outcomes ASES Pain, ASES Function, DASH scores, SF-12 PCS or MCS, or VAS Pain. A small difference was detected in VAS Function (median 1.3 for DI repair versus 0.5 for SI repair, p=0.023). In a multivariate linear regression model controlling for arm dominance, age, and follow-up time, SI repair was associated with a greater mean supination torque than DI repair by 19.6% at the 60°supinated position (p=0.011). Contrary to our hypothesis, we found approximately a 20% mean improvement in terminal supination torque for acute distal biceps ruptures repaired with the single-incision technique compared to the double-incision technique. Patients uniformly did well with either technique, though we contend that this finding may have clinical significance for the more discerning, high-demand patient

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

Distal biceps tendon ruptures are uncommon with a reported incidence of 1.24 per 100,000 per year. They typically occur in males in the fourth decade. Operative treatment has been shown to improve functional outcomes in the treatment of distal biceps tendon ruptures. A variety of surgical techniques have been described, usually using the dual incision Boyd-Anderson approach. We report a series of 10 patients with 10 tendon ruptures treated using a single incision volar approach and using the Arthrex Biotenodesis screw to reattach the tendon to the radial tuberosity. This method has been previously described in only one case report. All ten patients underwent clinical assessment using the Mayo Elbow Performance Score (MEPS) and functional assessment using the DASH scoring system. The power was assessed isokinetically using the Nottingham Myometer. Based on the MEPS and DASH grading system all patients achieved a good or excellent result. In our experience reattachment of the distal biceps tendon using a single incision approach and Arthrex Biotenodesis screw is a new technique which gives a good functional outcome

Aim: The biceps brachii is an important elbow flexor and is the main supinator of the forearm. Avulsion of its distal tendon insertion is an uncommon injury and even more uncommon is the partial tear of this tendon. The rupture typically occurs at its attachment to the radial tuberosity. Nonoperative treatment of these injuries has been described, but significant weakness in flexion and supination or persistent pain may occur. Most authors recommend acute anatomic repair to improve function or relieve pain. Material and Method: Twenty-five ruptures of the distal biceps tendon were operated at our institution from 1992 to 1997. Twenty-three of the patients were male and 2 female. The dominant extremity was involved in 21 patients. Their average age was 48 years (range, 30–59). Eighteen ruptures were complete, 8 of them were acute, while 10 were chronic, as were the 7 partial ruptures. Three patients with complete rupture and all the patients with partial rupture had a MRI. In 2 chronic patients an anatomic repair was impossible and they were treated with a biceps-to-brachialis transfer. These patients were not included in the final follow-up. All other tendons were repaired anatomically through use of a single anterior incision and bone suture anchors. Follow-up averaged 36 months (range, 12–53 months). At final follow-up subjective and objective data were collected. Patients were questioned about their activity level, job status, and satisfaction at outcome. Elbow range of motion, strength and power were compared with those for the uninjured side while each value was adjusted for dominance and expressed as a percentage of the uninjured side. Results: All patients returned to their preinjury level of activity and employment by 6 months after surgery. All patients reported that they were satisfied with the result and would undergo the surgery again. The entire group of patients averaged 9.8% more flexion strength and 2.4% less supination strength for the repaired elbow that for the uninvolved elbow. Range of motion was normal in 20 patients. Three patients lacked 10° of extension and one of them lacked 10° of pronation. No patient experienced transient or permanent nerve deficit. None of the patients complained of pain or tenderness. There was no evidence of heterotopic ossification or change in the position of the suture anchors. Conclusion: The one incision technique with bone suture anchors is a safe and reliable technique for the treatment of complete or partial distal biceps tendon ruptures with very good results referring to restoration of flexion and supination strength and minimal complication rate

Introduction and Aims: Chronic distal biceps tendon ruptures have traditionally been treated with a biceps to brachialis tenodesis. The use of a semitendinosus autograft to reconstruct the distal biceps tendon for chronic rupture has been described. This study evaluates the functional outcome of a group of patients treated with autograft reconstruction. Method: This retrospective study identified six patients who underwent a late reconstruction of a biceps tendon rupture using a semitendinosis autograft. Functional outcome was evaluated objectively and subjectively. Clinical subjective evaluation included the MAYO elbow score and the outcome questionnaire from the Society of Shoulder and Elbow Surgeons (SSES). Objective outcomes were assessed by measurement of peak torque for both elbow flexion and supination using a Cybex II Isokinetic machine. Comparisons were made with the opposite limb. Results: Six right-handed male patients aged 42±7 yrs (range 34–48 yrs) were evaluated in this study, five of which achieved a good to excellent MAYO performance score (average 87 ±12), and SSES score (average 86±21). Peak torque obtained during maximal elbow flexion was 44±17 Nm (vs. 55 ±16 Nm opposite elbow) during supination was 8±4Nm (vs. 10±2Nm opposite elbow). Conclusion: This study represents a series of patients with autograft reconstruction of the chronic distal biceps rupture. It is the first study to quantitatively measure the recovery of strength of elbow flexion and supination. The semitendinosus autograft provides a strong and reliable reconstructive option in the majority of patients with chronic biceps tendon ruptures. Recovery of elbow flexion and supination power is nearly normal

Our study aims to demonstrate the efficacy of using endobutton and interference screw technique in the repair of acute distal biceps ruptures. From April 2009 to May 2013, 25 consecutive patients had acute distal biceps tendon repairs using an endobutton and interference screw technique. 3 patients were lost to follow up leaving 22 patients available for review. Mean follow up was 24 months(1–51). All were evaluated using a questionnaire, examination, radiographs, power measurements, and Oxford Elbow and MAYO scores. Overall 95% patients (21/22) felt that their surgery was successful and rated their overall experience as excellent or good. Mean return to work was at 100 days(0–280) and mean postoperative pain relief was 23 days(1–56). 55% returned to sport at their pre-injury level. There was one case (4.5%) of heterotopic calcification with 3 superficial infections(14%). There were no intra or postoperative radial fractures, metalwork failures or metalwork soft tissue irritations. Mean pre-operative Oxford Elbow Scores were 18(6–37) and post operative 43(24–48) (p<0.00001). Mean pre-operative Mayo scores were 48(5–95) and post-operative were 95(80–100)(p<0.00001). Our study supports that distal biceps repairs using the endobutton and interference screw technique appears to lead to high patient satisfaction rates with a relatively early return to function

Our study aims to demonstrate the efficacy of using endobutton and interference screw technique in the repair of acute distal biceps ruptures. From April 2009 to May 2013, 25 consecutive patients had acute distal biceps tendon repairs using an endobutton and interference screw technique. 3 patients were lost to follow up leaving 22 patients for review. Mean follow up was 24 months (1–51). All were evaluated using a questionnaire, examination, radiographs, power measurements, and Oxford Elbow (OES) and MAYO scores. Overall 95% patients (21/22) felt that their surgery was successful and rated their experience as excellent or good. Mean return to work was 100 days (0–280) and mean postoperative pain relief was 23 days (1–56). 55% returned to sport at their pre-injury level. There was one case (4.5%) of heterotopic calcification with 3 superficial infections (14%). There were no intra or postoperative radial fractures, metalwork failures or metalwork soft tissue irritations. Mean pre-operative OES were 18 (6–37) and post operative 43 (24–48) (p < 0.01). Mean pre-operative Mayo scores were 48 (5–95) and post-operative 95 (80–100) (p < 0.01). Our study supports that distal biceps repairs' with endobutton and interference screw technique appears to lead to high patient satisfaction rates with a relatively early return to function

Purpose. Based on anatomic studies, it appears that the short head (SH) and long head (LH) of the distal biceps tendons have discreet distal attachments on the radial tuberosity. The SH attaches distally and therefore may function as a stronger flexor, whereas the LH attaches more proximal and ulnar which would make it a greater supinator. The contribution of each of the two heads to flexion and supination has not yet been defined. The rationale of this study was to directly measure the contribution of the SH and LH of the biceps to elbow flexion and forearm supination and provide biomechanical evidence for what is inferred in the anatomical studies. Method. Twelve fresh-frozen cadaveric arms were secured using in vitro elbow simulator, while controlled loads were applied to the individual biceps tendons short and long heads. Isometric supination torque and flexion force were recorded with the forearm in 45 degrees supination, neutral rotation and 45 degrees pronation. Results. In all specimens examined the LH and SH of the distal biceps were important contributors to flexion and supination of the forearm. On average, the SH showed 16% more contribution to flexion for all forearm positions. Torque measurements showed that in pronation and neutral positions the SH contributed 11% more than LH. In the supinated forearm, the SH and LH showed no difference in contribution. A repeated measures analysis of variance (ANOVA) and post-hoc Student-Newman-Keuls tests were used for statistical analysis. Conclusion. In most anatomic studies, it has been suggested that the LH and SH of the distal biceps contribute in different ways to flexion and supination. Based on anatomy only, authors have suggested that the SH is a more important flexor and that the LH is more important in supination. In this biomechanical study we demonstrated that both the LH and SH contribute to flexion and supination. Loss of either the LH or SH will result in weakness in flexion or supination. When assessing contribution to flexion, as anatomic studies suggest, the SH alone is a stronger flexor than the LH. This is most likely due to the fact that the SH has a more distal attachment on the bicipital tuberosity. When assessing contribution to supination, the SH alone was a stronger supinator than the LH consistently in our model. This is in contradiction to previous authors who felt the anatomy of the LH attachment, in a slightly more ulnar position, would make it a stronger supinator

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