Hugo Barret1, Matthias Winter2, Olivier Gastaud3, David J Saliken4, Marc Olivier Gauci5, Nicolas Bronsard5. 1. CHU Nice, 30, voie romaine, 06000 Nice, France. Electronic address: hugobarret89@gmail.com. 2. Clinique Saint-Jean, 06800 Cagnes sur mer, France. 3. CH Cannes, 06800 Cannes, France. 4. Orthopaedic surgery, Victoria BC, Canada. 5. CHU Nice, 30, voie romaine, 06000 Nice, France.
Abstract
INTRODUCTION: Surgical treatment of distal biceps tendon ruptures is recommended in an active population to avoid loss of strength, especially in supination and flexion. HYPOTHESIS: A double incision repair technique with immediate postoperative mobilization for acute distal biceps tendon ruptures is safe and provides good results after 2 years in active patients. MATERIAL AND METHODS: Seventy-four men (47±7 years) with acute tears of the distal biceps tendon tears were included in this retrospective single-center study. All patients were operated using the double-incision repair technique described by Morrey. The tendon was inserted with transosseous sutures into the biceps tuberosity. Patients were allowed to perform immediate postoperative active mobilization. A minimum follow-up of two years was required including clinical and radiological evaluation. RESULTS: Sixteen patients were lost to follow up leaving 58 (78%) patients for analysis with a mean follow-up of 53±19 months. At final follow-up, the mean evaluation for pain on the VAS scale was 0.22±0.7. Mean range of motion results included extension -1°±2°, flexion 138°±6°, pronation 72°±16° and supination 81°±10°. The strength ratio in flexion was 94±8% and in supination 90.5±12% compared to the contralateral limb. Subjective elbow value and DASH score were respectively 94±6% and 7.5±9%. All patients were satisfied or very satisfied and all except one returned to their previous sport. We noticed 2 heterotopic ossifications and one patient needed a reoperation for a radioulnar synostosis. Neither re-rupture nor nerve injury were observed. DISCUSSION: A double incision technique for distal biceps tendon repair is a minimally invasive procedure with reliable results. Morrey's modification of the initial procedure associated with early mobilization is associated with a low rate of complications and limited the occurrence of synostosis or ossifications. LEVEL OF EVIDENCE: IV, case series, with no comparison group.
INTRODUCTION: Surgical treatment of distal biceps tendon ruptures is recommended in an active population to avoid loss of strength, especially in supination and flexion. HYPOTHESIS: A double incision repair technique with immediate postoperative mobilization for acute distal biceps tendon ruptures is safe and provides good results after 2 years in active patients. MATERIAL AND METHODS: Seventy-four men (47±7 years) with acute tears of the distal biceps tendon tears were included in this retrospective single-center study. All patients were operated using the double-incision repair technique described by Morrey. The tendon was inserted with transosseous sutures into the biceps tuberosity. Patients were allowed to perform immediate postoperative active mobilization. A minimum follow-up of two years was required including clinical and radiological evaluation. RESULTS: Sixteen patients were lost to follow up leaving 58 (78%) patients for analysis with a mean follow-up of 53±19 months. At final follow-up, the mean evaluation for pain on the VAS scale was 0.22±0.7. Mean range of motion results included extension -1°±2°, flexion 138°±6°, pronation 72°±16° and supination 81°±10°. The strength ratio in flexion was 94±8% and in supination 90.5±12% compared to the contralateral limb. Subjective elbow value and DASH score were respectively 94±6% and 7.5±9%. All patients were satisfied or very satisfied and all except one returned to their previous sport. We noticed 2 heterotopic ossifications and one patient needed a reoperation for a radioulnar synostosis. Neither re-rupture nor nerve injury were observed. DISCUSSION: A double incision technique for distal biceps tendon repair is a minimally invasive procedure with reliable results. Morrey's modification of the initial procedure associated with early mobilization is associated with a low rate of complications and limited the occurrence of synostosis or ossifications. LEVEL OF EVIDENCE: IV, case series, with no comparison group.