C Konrads1, K Rueckl2, T Barthel2, M Walcher2, M Rudert2, P Plumhoff2. 1. Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland. christian.konrads@gmail.com. 2. Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, Brettreichstr. 11, 97074, Würzburg, Deutschland.
Abstract
OBJECTIVE: Reinsertion of the distal biceps tendon onto the radial tuberosity restoring full force of flexion and supination. INDICATIONS: Distal biceps tendon avulsion from the radial tuberosity. Acute and chronic tears with a tendon stump, which can be mobilized and reduced to the radial tuberosity in flexion and supination. CONTRAINDICATIONS: Tears of the musculotendinous junction. Chronic distal biceps tendon tears with wide retraction and the need for tendon graft augmentation. Severe atrophy of the biceps muscle. SURGICAL TECHNIQUE: In supination, the skin is incised longitudinally for 4 cm, centered over the medial border of the radial tuberosity. Incision starts 2 cm distal from the humeroradial joint line. Bluntly the distal biceps tendon stump is found and mobilized. Preparation and debriding of the radial tuberosity sparing neurovascular structures. Crossing vessel branches are ligated, if needed. Positioning of two spreading anchors into the radial tuberosity and reinsertion of the tendon stump. POSTOPERATIVE MANAGEMENT: Adjustable elbow movement orthosis adapted to tendon quality and tissue tension for 6 weeks without active flexion or supination. Degree of extension is gradually increased by 20° every 2 weeks. After orthosis treatment is finished after 6 weeks, flexion and supination with weights is not allowed for another 6 weeks. RESULTS: In a retrospective study of 30 patients with a mean follow-up of 45 months (range 15-80 months), the clinical outcome was good or excellent in 99% of cases. On average, a Mayo Elbow Performance Score of 93 points (range 65-100 points) and a QuickDash of 5 points (range 0-39 points) were achieved.
OBJECTIVE: Reinsertion of the distal biceps tendon onto the radial tuberosity restoring full force of flexion and supination. INDICATIONS: Distal biceps tendon avulsion from the radial tuberosity. Acute and chronic tears with a tendon stump, which can be mobilized and reduced to the radial tuberosity in flexion and supination. CONTRAINDICATIONS: Tears of the musculotendinous junction. Chronic distal biceps tendon tears with wide retraction and the need for tendon graft augmentation. Severe atrophy of the biceps muscle. SURGICAL TECHNIQUE: In supination, the skin is incised longitudinally for 4 cm, centered over the medial border of the radial tuberosity. Incision starts 2 cm distal from the humeroradial joint line. Bluntly the distal biceps tendon stump is found and mobilized. Preparation and debriding of the radial tuberosity sparing neurovascular structures. Crossing vessel branches are ligated, if needed. Positioning of two spreading anchors into the radial tuberosity and reinsertion of the tendon stump. POSTOPERATIVE MANAGEMENT: Adjustable elbow movement orthosis adapted to tendon quality and tissue tension for 6 weeks without active flexion or supination. Degree of extension is gradually increased by 20° every 2 weeks. After orthosis treatment is finished after 6 weeks, flexion and supination with weights is not allowed for another 6 weeks. RESULTS: In a retrospective study of 30 patients with a mean follow-up of 45 months (range 15-80 months), the clinical outcome was good or excellent in 99% of cases. On average, a Mayo Elbow Performance Score of 93 points (range 65-100 points) and a QuickDash of 5 points (range 0-39 points) were achieved.