Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Minimally invasive distal biceps tendon repair: a case series

  • Received : 2023.03.28
  • Accepted : 2023.06.13
  • Published : 2023.09.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Distal biceps tendon repairs are commonly performed using open techniques. A minimally invasive distal biceps tendon repair technique using a speculum and hooded endoscope was developed to improve visualization, reduce soft-tissue dissection, and minimize complications. This paper describes the technique and reports the outcomes of 75 minimally invasive distal biceps tendon repairs. Methods: The operation reports and outcomes of 75 patients who underwent distal biceps tendon repair using this technique between 2011 and 2021 were retrospectively reviewed. Results: Median time to follow-up was 12 months (interquartile range [IQR], 6-56 months). Primary outcomes were function as measured by the Disabilities of Arm, Shoulder and Hand Score (DASH) questionnaire, and rate of complications. Median DASH score was 1.7 of 100 (IQR, 0-6.8). There were 2 of 75 (2.7%) re-ruptures of the distal tendon. There were no cases of vascular injury, proximal radius fracture, or posterior interosseous nerve, median, or ulnar nerve palsy. Conclusions: In this series, minimally invasive distal biceps repair was safe and effective with a low rate of major complications. Recovery of function, as indicated by low DASH scores, was satisfactory, and inconvenience during recovery was minimized. Level of evidence: IV.

Keywords

Acknowledgement

We would like to thank Emma Petta BSc (Nsg) for assistance in research design and data collection, and Jane Waddy BSc (Sports Science) MPhysio, Nicole Perera BSc (OT), and Simon Millichip B. Phys. Ed, Dip Physio, Post Grad Dip Physio. We are grateful to Dr Erin Cvejic BA (Hons) Psych PhD MBiostat GStat for assistance with statistical analysis.

References

  1. Jenk D, Battaglia TC. Repair and rehabilitation of distal biceps ruptures. Tech Shoulder Elb Surg 2014;15:25-7.  https://doi.org/10.1097/BTE.0000000000000011
  2. Sethi PM, Rubin E, Radler K. Distal biceps tendon ruptures and repairs: current trends. Curr Orthop Pract 2017;28:168-72.  https://doi.org/10.1097/BCO.0000000000000485
  3. Kettler M, Lunger J, Kuhn V, Mutschler W, Tingart MJ. Failure strengths in distal biceps tendon repair. Am J Sports Med 2007;35:1544-8.  https://doi.org/10.1177/0363546507300690
  4. Mazzocca AD, Burton KJ, Romeo AA, Santangelo S, Adams DA, Arciero RA. Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair. Am J Sports Med 2007;35:252-8.  https://doi.org/10.1177/0363546506294854
  5. Kelly MP, Perkinson SG, Ablove RH, Tueting JL. Distal biceps tendon ruptures: an epidemiological analysis using a large population database. Am J Sports Med 2015;43:2012-7.  https://doi.org/10.1177/0363546515587738
  6. Chebli C. An update on distal biceps tendon ruptures. Curr Orthop Pract 2015;26:119-25.  https://doi.org/10.1097/BCO.0000000000000210
  7. Vandenberghe M, van Riet R. Distal biceps ruptures: open and endoscopic techniques. Curr Rev Musculoskelet Med 2016;9:215-23.  https://doi.org/10.1007/s12178-016-9330-2
  8. Holt J, Preston G, Heindel K, Preston H, Hill G. Diagnosis and management strategies for distal biceps rupture. Orthopedics 2019;42:e492-501.  https://doi.org/10.3928/01477447-20190723-05
  9. Gregory T, Roure P, Fontes D. Repair of distal biceps tendon rupture using a suture anchor: description of a new endoscopic procedure. Am J Sports Med 2009;37:506-11.  https://doi.org/10.1177/0363546508326985
  10. Bhatia DN, Kandhari V. Analysis of technical feasibility and neurovascular safety of endoscopic distal biceps repair: a cadaveric study. J Shoulder Elbow Surg 2018;27:2057-67.  https://doi.org/10.1016/j.jse.2018.04.020
  11. Kruger N, Phadnis J, Bhatia D, Amarasooriya M, Bain GI. Acute distal biceps tendon ruptures: anatomy, pathology and management: state of the art. J ISAKOS 2020;5:304-13.  https://doi.org/10.1136/jisakos-2019-000279
  12. Spang JT, Weinhold PS, Karas SG. A biomechanical comparison of EndoButton versus suture anchor repair of distal biceps tendon injuries. J Shoulder Elbow Surg 2006;15:509-14.  https://doi.org/10.1016/j.jse.2005.09.020
  13. Taylor AL, Bansal A, Shi BY, Best MJ, Huish EG, Srikumaran U. Optimizing fixation for distal biceps tendon repairs: a systematic review and meta-regression of cadaveric biomechanical testing. Am J Sports Med 2021;49:3125-31.  https://doi.org/10.1177/0363546520986999
  14. Bain GI. Repair of distal biceps tendon avulsion with the Endobutton technique. Tech Shoulder Elb Surg 2002;3:96-101.  https://doi.org/10.1097/00132589-200206000-00005
  15. Greenberg JA. Endobutton repair of distal biceps tendon ruptures. J Hand Surg Am 2009;34:1541-8.  https://doi.org/10.1016/j.jhsa.2009.05.021
  16. Bain GI, Prem H, Heptinstall RJ, Verhellen R, Paix D. Repair of distal biceps tendon rupture: a new technique using the Endobutton. J Shoulder Elbow Surg 2000;9:120-6.  https://doi.org/10.1067/2000.102581
  17. Alech-Tournier F, Elkholti K, Locquet V, et al. Outcomes of distal biceps tendon reattachment using the ToggleLoc™ fixation device with ZipLoop™ technology with single mini-open technique. Eur J Orthop Surg Traumatol 2019;29:925-31.  https://doi.org/10.1007/s00590-019-02376-9
  18. Bhatia DN. Endoscopic distal biceps repair: endoscopic anatomy and dual-anchor repair using a proximal anterolateral "parabiceps portal". Arthrosc Tech 2015;4:e785-93.  https://doi.org/10.1016/j.eats.2015.07.031
  19. Sharma S, MacKay G. Endoscopic repair of distal biceps tendon using an EndoButton. Arthroscopy 2005;21:897. 
  20. Eames MH, Bain GI. Distal biceps tendon endoscopy and anterior elbow arthroscopy portal. Tech Shoulder Elb Surg 2006;7:139-42.  https://doi.org/10.1097/00132589-200609000-00004
  21. Bhatia DN. Endoscopic repair of acute and chronic retracted distal biceps ruptures. J Hand Surg Am 2016;41:e501-7.  https://doi.org/10.1016/j.jhsa.2016.09.008
  22. Caekebeke P, Verstreken F, van Riet R. Distal biceps endoscopy at the elbow. Tech Shoulder Elb Surg 2018;19:93-4.  https://doi.org/10.1097/BTE.0000000000000136
  23. Smith JR, Amirfeyz R. Does immediate elbow mobilization after distal biceps tendon repair carry the risk of wound breakdown, failure of repair, or patient dissatisfaction. J Shoulder Elbow Surg 2016;25:810-5.  https://doi.org/10.1016/j.jse.2015.11.066
  24. Ford SE, Andersen JS, Macknet DM, Connor PM, Loeffler BJ, Gaston RG. Major complications after distal biceps tendon repairs: retrospective cohort analysis of 970 cases. J Shoulder Elbow Surg 2018;27:1898-906.  https://doi.org/10.1016/j.jse.2018.06.028
  25. Saldua N, Carney J, Dewing C, Thompson M. The effect of drilling angle on posterior interosseous nerve safety during open and endoscopic anterior single-incision repair of the distal biceps tendon. Arthroscopy 2008;24:305-10.  https://doi.org/10.1016/j.arthro.2007.09.016
  26. Caekebeke P, Galatz L, van Riet R. Accuracy and safety of the endoscopic repair of the distal biceps: a cadaveric study. Acta Orthop Belg 2020;86:711-6. 
  27. Watson JN, Moretti VM, Schwindel L, Hutchinson MR. Repair techniques for acute distal biceps tendon ruptures: a systematic review. J Bone Joint Surg Am 2014;96:2086-90.  https://doi.org/10.2106/JBJS.M.00481
  28. Kodde IF, Baerveldt RC, Mulder PG, Eygendaal D, van den Bekerom MP. Refixation techniques and approaches for distal biceps tendon ruptures: a systematic review of clinical studies. J Shoulder Elbow Surg 2016;25:e29-37.  https://doi.org/10.1016/j.jse.2015.09.004
  29. Woodall BM, Youn GM, Elena N, et al. Anatomic single-incision repair of distal biceps tendon ruptures using intramedullary soft anchors. Arthrosc Tech 2018;7:e1177-80.  https://doi.org/10.1016/j.eats.2018.07.015
  30. Grewal R, Athwal GS, MacDermid JC, et al. Single versus double-incision technique for the repair of acute distal biceps tendon ruptures: a randomized clinical trial. J Bone Joint Surg Am 2012;94:1166-74. https://doi.org/10.2106/JBJS.K.00436