Skip to main content
Top
Published in: International Orthopaedics 4/2014

01-04-2014 | Original Paper

The functional outcome of forty-nine single-incision suture anchor repairs for distal biceps tendon ruptures at the elbow

Authors: Sebastian Siebenlist, Stephanie C. Fischer, Gunther H. Sandmann, Philipp Ahrens, Petra Wolf, Ulrich Stöckle, Andreas B. Imhoff, Peter U. Brucker

Published in: International Orthopaedics | Issue 4/2014

Login to get access

Abstract

Purpose

The objective of this retrospective study was to evaluate the functional results of distal biceps tendon repair using suture anchors via a single-incision approach.

Methods

Forty-nine patients were re-examined at a mean follow-up of 44.2 ± 32.1 months (range, 12–119 months). Subjective and objective criteria included patient’s satisfaction, active range of motion (ROM), maximum isometric strength in flexion (at 45° and 90°), and supination of both arms. Functional scoring included the Morrey elbow score (MES) and the QuickDASH. Furthermore, follow-up radiographs were performed.

Results

Eighty-six percent of patients were highly satisfied or satisfied with their outcome. Compared to contralateral, the active ROM of elbow flexion, extension, and pronation was not affected; however, supination was decreased by 3° (P < 0.001). The isometric maximum strengths showed significant deficits in all tested scenarios (at 45°, P = 0.002; at 90°, P < 0.001; for supination, P < 0.001). The MES and the QuickDASH were 97.2 ± 4.9 and 7.9 ± 13.9, respectively. Heterotopic ossifications (HO) were found in 39 % of patients; however, with respect to scores and strength, no significant differences were seen compared to patients without HO. Moreover, four anchor failures were detected.

Conclusions

Single-incision suture anchor repair provides high patient’s satisfaction and good results with respect to ROM and functional scoring. Nevertheless, based on presented data, the patient has to be informed of postoperative HO and especially for supination strength weakness after surgery. Distal biceps tendon repair should be reserved for experienced upper extremity surgeons to avoid procedure-related complications.
Literature
1.
go back to reference Miyamoto RG, Elser F, Millett PJ (2010) Distal biceps tendon injuries. J Bone Joint Surg Am 92:2128–2138PubMedCrossRef Miyamoto RG, Elser F, Millett PJ (2010) Distal biceps tendon injuries. J Bone Joint Surg Am 92:2128–2138PubMedCrossRef
2.
go back to reference Hetsroni I, Pilz-Burstein R, Nyska M et al (2008) Avulsion of the distal biceps brachii tendon in middle-aged population: is surgical repair advisable? A comparative study of 22 patients treated with either nonoperative management or early anatomical repair. Injury 39:753–760PubMedCrossRef Hetsroni I, Pilz-Burstein R, Nyska M et al (2008) Avulsion of the distal biceps brachii tendon in middle-aged population: is surgical repair advisable? A comparative study of 22 patients treated with either nonoperative management or early anatomical repair. Injury 39:753–760PubMedCrossRef
3.
go back to reference Keener JD (2011) Controversies in the surgical treatment of distal biceps tendon ruptures: single versus double-incision repairs. J Shoulder Elbow Surg 20:113–125CrossRef Keener JD (2011) Controversies in the surgical treatment of distal biceps tendon ruptures: single versus double-incision repairs. J Shoulder Elbow Surg 20:113–125CrossRef
4.
go back to reference Boyd HB, Anderson LD (1961) A method for reinsertion of the distal biceps brachii tendon. J Bone Joint Surg Am 43:1041–1043 Boyd HB, Anderson LD (1961) A method for reinsertion of the distal biceps brachii tendon. J Bone Joint Surg Am 43:1041–1043
5.
go back to reference Morrey BF, Askew LJ, An KN, Dobyns JH (1985) Rupture of the distal biceps tendon of the biceps brachii. A biomechanical study. J Bone Joint Surg Am 67:418–421PubMed Morrey BF, Askew LJ, An KN, Dobyns JH (1985) Rupture of the distal biceps tendon of the biceps brachii. A biomechanical study. J Bone Joint Surg Am 67:418–421PubMed
6.
go back to reference Failla JM, Amadio PC, Morrey BF, Beckenbaugh RD (1990) Proximal radioulnar synostosis after repair of distal biceps brachii rupture by two-incision technique: report of four cases. Clin Orthop Relat Res 253:133–136PubMed Failla JM, Amadio PC, Morrey BF, Beckenbaugh RD (1990) Proximal radioulnar synostosis after repair of distal biceps brachii rupture by two-incision technique: report of four cases. Clin Orthop Relat Res 253:133–136PubMed
7.
go back to reference Kelly EW, Morrey BF, O’Driscoll SW (2000) Complications of repair of the distal biceps tendon with the modified two-incision technique. J Bone Joint Surg Am 82:1575–1581PubMed Kelly EW, Morrey BF, O’Driscoll SW (2000) Complications of repair of the distal biceps tendon with the modified two-incision technique. J Bone Joint Surg Am 82:1575–1581PubMed
8.
go back to reference Rantanen J, Orava S (1999) Rupture of the distal biceps tendon: a report of 19 patients treated with anatomic reinsertion, and a meta-analysis of 147 cases found in the literature. Am J Sports Med 27:128–132PubMed Rantanen J, Orava S (1999) Rupture of the distal biceps tendon: a report of 19 patients treated with anatomic reinsertion, and a meta-analysis of 147 cases found in the literature. Am J Sports Med 27:128–132PubMed
9.
go back to reference Fenton P, Qureshi F, Ali A, Potter D (2009) Distal biceps tendon rupture: a new repair technique in 14 patients using the biotenodesis screw. Am J Sports Med 37:2009–2015PubMedCrossRef Fenton P, Qureshi F, Ali A, Potter D (2009) Distal biceps tendon rupture: a new repair technique in 14 patients using the biotenodesis screw. Am J Sports Med 37:2009–2015PubMedCrossRef
10.
go back to reference Greenberg JA, Fernandez JJ, Wang T, Turner C (2003) EndoButton-assisted repair of distal biceps tendon ruptures. J Shoulder Elbow Surg 12:484–490PubMedCrossRef Greenberg JA, Fernandez JJ, Wang T, Turner C (2003) EndoButton-assisted repair of distal biceps tendon ruptures. J Shoulder Elbow Surg 12:484–490PubMedCrossRef
11.
go back to reference Heinzelmann AD, Savoie FH 3rd, Ramsey JR, Field LD, Mazzocca AD (2009) A combined technique for distal biceps repair using a soft tissue button and biotenodesis interference screw. Am J Sports Med 37:989–994PubMedCrossRef Heinzelmann AD, Savoie FH 3rd, Ramsey JR, Field LD, Mazzocca AD (2009) A combined technique for distal biceps repair using a soft tissue button and biotenodesis interference screw. Am J Sports Med 37:989–994PubMedCrossRef
12.
go back to reference McKee MD, Hirji R, Schemitsch EH, Wild LM, Waddell JP (2005) Patient-oriented functional outcome after repair of distal biceps tendon ruptures using a single-incision technique. J Shoulder Elbow Surg 14:302–306PubMedCrossRef McKee MD, Hirji R, Schemitsch EH, Wild LM, Waddell JP (2005) Patient-oriented functional outcome after repair of distal biceps tendon ruptures using a single-incision technique. J Shoulder Elbow Surg 14:302–306PubMedCrossRef
13.
go back to reference Germann G, Harth A, Wind G, Demir E (2003) Standardisation and validation of the German version 2.0 of the disability of arm, shoulder, hand (DASH) questionnaire. Unfallchirurg 106:13–19PubMedCrossRef Germann G, Harth A, Wind G, Demir E (2003) Standardisation and validation of the German version 2.0 of the disability of arm, shoulder, hand (DASH) questionnaire. Unfallchirurg 106:13–19PubMedCrossRef
14.
go back to reference Gummesson C, Ward MM, Atroshi I (2006) The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord 7:44PubMedCentralPubMedCrossRef Gummesson C, Ward MM, Atroshi I (2006) The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH. BMC Musculoskelet Disord 7:44PubMedCentralPubMedCrossRef
15.
go back to reference Morrey BF, An KN, Chao EYS (1985) Functional evaluation of the elbow and its disorders. In: Morrey BF (ed) The elbow and its disorders. WB Saunders, Philadelphia, pp 73–91 Morrey BF, An KN, Chao EYS (1985) Functional evaluation of the elbow and its disorders. In: Morrey BF (ed) The elbow and its disorders. WB Saunders, Philadelphia, pp 73–91
16.
go back to reference Hastings H 2nd, Graham TJ (1994) The classification and treatment of heterotopic ossification about the elbow and forearm. Hand Clin 10:417–437PubMed Hastings H 2nd, Graham TJ (1994) The classification and treatment of heterotopic ossification about the elbow and forearm. Hand Clin 10:417–437PubMed
17.
go back to reference Kahn AD, Penna S, Yin Q, et al (2008) Repair of distal biceps tendon ruptures using suture anchors through a single anterior incision. Arthroscopy 24:39–45CrossRef Kahn AD, Penna S, Yin Q, et al (2008) Repair of distal biceps tendon ruptures using suture anchors through a single anterior incision. Arthroscopy 24:39–45CrossRef
18.
go back to reference Peeters T, Ching-Soon NG, Jansen N et al (2009) Functional outcome after repair of distal biceps tendon ruptures using the endobutton technique. J Shoulder Elbow Surg 18:283–287PubMedCrossRef Peeters T, Ching-Soon NG, Jansen N et al (2009) Functional outcome after repair of distal biceps tendon ruptures using the endobutton technique. J Shoulder Elbow Surg 18:283–287PubMedCrossRef
19.
go back to reference Eardley WG, Odak S, Adesina TS, Jeavons RP, McVie JL (2010) Bioabsorbable interference screw fixation of distal biceps ruptures through a single anterior incision: a single-surgeon case series and review of the literature. Arch Orthop Trauma Surg 130:875–881PubMedCrossRef Eardley WG, Odak S, Adesina TS, Jeavons RP, McVie JL (2010) Bioabsorbable interference screw fixation of distal biceps ruptures through a single anterior incision: a single-surgeon case series and review of the literature. Arch Orthop Trauma Surg 130:875–881PubMedCrossRef
20.
go back to reference Hartman MW, Merten SM, Steinmann SP (2007) Mini-open 2-incision technique for repair of distal biceps tendon ruptures. J Shoulder Elbow Surg 16:616–620PubMedCrossRef Hartman MW, Merten SM, Steinmann SP (2007) Mini-open 2-incision technique for repair of distal biceps tendon ruptures. J Shoulder Elbow Surg 16:616–620PubMedCrossRef
21.
go back to reference Schmidt CC, Diaz VA, Weir DM, Latona CR, Miller MC (2012) Repaired distal biceps magnetic resonance imaging anatomy compared with outcome. J Shoulder Elbow Surg 21:1623–1631PubMedCrossRef Schmidt CC, Diaz VA, Weir DM, Latona CR, Miller MC (2012) Repaired distal biceps magnetic resonance imaging anatomy compared with outcome. J Shoulder Elbow Surg 21:1623–1631PubMedCrossRef
22.
go back to reference Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH. Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608PubMedCrossRef Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH. Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608PubMedCrossRef
23.
go back to reference Cil A, Merten S, Steinmann SP (2009) Immediate active range of motion after modified 2-incision repair in acute distal biceps tendon rupture. Am J Sports Med 37:130–135PubMedCrossRef Cil A, Merten S, Steinmann SP (2009) Immediate active range of motion after modified 2-incision repair in acute distal biceps tendon rupture. Am J Sports Med 37:130–135PubMedCrossRef
24.
go back to reference Banerjee M, Shafizadeh S, Bouillon B et al (2013) High complication rate following distal biceps refixation with cortical button. Arch Orthop Trauma Surg 133:1361–1366PubMedCrossRef Banerjee M, Shafizadeh S, Bouillon B et al (2013) High complication rate following distal biceps refixation with cortical button. Arch Orthop Trauma Surg 133:1361–1366PubMedCrossRef
25.
go back to reference Weinstein DM, Ciccone WJ II, Buckler MC et al (2008) Elbow function after repair of the distal biceps brachii tendon with a two-incision approach. J Shoulder Elbow Surg 17:82–86CrossRef Weinstein DM, Ciccone WJ II, Buckler MC et al (2008) Elbow function after repair of the distal biceps brachii tendon with a two-incision approach. J Shoulder Elbow Surg 17:82–86CrossRef
26.
go back to reference Chavan PR, Duquin TR, Bisson LJ (2008) Repair of the ruptured distal biceps tendon: a systematic review. Am J Sports Med 36:1618–1624PubMedCrossRef Chavan PR, Duquin TR, Bisson LJ (2008) Repair of the ruptured distal biceps tendon: a systematic review. Am J Sports Med 36:1618–1624PubMedCrossRef
27.
go back to reference El Hawary R, Macdermid JC, Faber KJ, Patterson SD, King GJ (2003) Distal biceps tendon repair: comparison of surgical techniques. J Hand Surg [Am] 28:496–502CrossRef El Hawary R, Macdermid JC, Faber KJ, Patterson SD, King GJ (2003) Distal biceps tendon repair: comparison of surgical techniques. J Hand Surg [Am] 28:496–502CrossRef
28.
go back to reference Freeman CR, McCormick KR, Mahoney D, Baratz M, Lubahn JD (2009) Nonoperative treatment of distal biceps tendon ruptures compared with a historical control group. J Bone Joint Surg Am 91:2329–2334PubMedCrossRef Freeman CR, McCormick KR, Mahoney D, Baratz M, Lubahn JD (2009) Nonoperative treatment of distal biceps tendon ruptures compared with a historical control group. J Bone Joint Surg Am 91:2329–2334PubMedCrossRef
29.
go back to reference Geaney LE, Brenneman DJ, Cote MP, Arciero RA, Mazzocca AD (2010) Outcomes and practical information for patients choosing nonoperative treatment for distal biceps ruptures. Orthopedics 33:391PubMed Geaney LE, Brenneman DJ, Cote MP, Arciero RA, Mazzocca AD (2010) Outcomes and practical information for patients choosing nonoperative treatment for distal biceps ruptures. Orthopedics 33:391PubMed
30.
go back to reference Forthman CL, Zimmerman RM, Sullivan MJ, Gabel GT (2008) Crosssectional anatomy of the bicipital tuberosity and biceps brachii tendon insertion: relevance to anatomic tendon repair. J Shoulder Elbow Surg 17:522–526PubMedCrossRef Forthman CL, Zimmerman RM, Sullivan MJ, Gabel GT (2008) Crosssectional anatomy of the bicipital tuberosity and biceps brachii tendon insertion: relevance to anatomic tendon repair. J Shoulder Elbow Surg 17:522–526PubMedCrossRef
31.
go back to reference Jobin CM, Kippe MA, Gardner TR, Levine WN, Ahmad CS (2009) Distal biceps tendon repair: a cadaveric analysis of suture anchor and interference screw restoration of the anatomic footprint. Am J Sports Med 37:2214–2221PubMedCrossRef Jobin CM, Kippe MA, Gardner TR, Levine WN, Ahmad CS (2009) Distal biceps tendon repair: a cadaveric analysis of suture anchor and interference screw restoration of the anatomic footprint. Am J Sports Med 37:2214–2221PubMedCrossRef
32.
go back to reference Schmidt CC, Weir DM, Wong AS, Howard M, Miller MC (2010) The effect of biceps reattachment site. J Shoulder Elbow Surg 19:1157–1165PubMedCrossRef Schmidt CC, Weir DM, Wong AS, Howard M, Miller MC (2010) The effect of biceps reattachment site. J Shoulder Elbow Surg 19:1157–1165PubMedCrossRef
33.
go back to reference Cain RA, Nydick JA, Stein MI et al (2012) Complications following distal biceps repair. J Hand Surg [Am] 37:2112–2117CrossRef Cain RA, Nydick JA, Stein MI et al (2012) Complications following distal biceps repair. J Hand Surg [Am] 37:2112–2117CrossRef
34.
go back to reference John CK, Field LD, Weiss KS, Savoie FH 3rd (2007) Single incision repair of acute distal biceps ruptures by use of suture anchors. J Shoulder Elbow Surg 16:78–83PubMedCrossRef John CK, Field LD, Weiss KS, Savoie FH 3rd (2007) Single incision repair of acute distal biceps ruptures by use of suture anchors. J Shoulder Elbow Surg 16:78–83PubMedCrossRef
35.
go back to reference Grewal R, Athwal GS, MacDermid JC et al (2012) Single versus double-incision technique for the repair of acute distal biceps tendon ruptures: a randomized clinical trial. J Bone Joint Surg Am 94:1166–1174PubMedCrossRef Grewal R, Athwal GS, MacDermid JC et al (2012) Single versus double-incision technique for the repair of acute distal biceps tendon ruptures: a randomized clinical trial. J Bone Joint Surg Am 94:1166–1174PubMedCrossRef
36.
go back to reference Kettler M, Lunger J, Kuhn V, Mutschler W, Tingart MJ (2007) Failure strengths in distal biceps tendon repair. Am J Sports Med 35:1544–1548PubMedCrossRef Kettler M, Lunger J, Kuhn V, Mutschler W, Tingart MJ (2007) Failure strengths in distal biceps tendon repair. Am J Sports Med 35:1544–1548PubMedCrossRef
37.
go back to reference Pereira DS, Kvitne RS, Liang M, Giacobetti FB, Ebramzadeh E (2002) Surgical repair of distal biceps tendon ruptures: a biomechanical comparison of two techniques. Am J Sports Med 30:432–436PubMed Pereira DS, Kvitne RS, Liang M, Giacobetti FB, Ebramzadeh E (2002) Surgical repair of distal biceps tendon ruptures: a biomechanical comparison of two techniques. Am J Sports Med 30:432–436PubMed
38.
go back to reference Siebenlist S, Buchholz A, Zapf J et al (2013) Double intramedullary cortical button versus suture anchors for distal biceps tendon repair: a biomechanical comparison. Knee Surg Sports Traumatol Arthrosc. Jul 6. [Epub ahead of print] Siebenlist S, Buchholz A, Zapf J et al (2013) Double intramedullary cortical button versus suture anchors for distal biceps tendon repair: a biomechanical comparison. Knee Surg Sports Traumatol Arthrosc. Jul 6. [Epub ahead of print]
39.
go back to reference Mazzocca AD, Burton KJ, Romeo AA et al (2007) Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair. Am J Sports Med 35:252–258PubMedCrossRef Mazzocca AD, Burton KJ, Romeo AA et al (2007) Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair. Am J Sports Med 35:252–258PubMedCrossRef
40.
go back to reference Saldua N, Carney J, Dewing C, Thompson M (2008) The effect of drilling angle on posterior interosseous nerve safety during open and endoscopic anterior single-incision repair of the distal biceps tendon. Arthroscopy 24:305–310PubMedCrossRef Saldua N, Carney J, Dewing C, Thompson M (2008) The effect of drilling angle on posterior interosseous nerve safety during open and endoscopic anterior single-incision repair of the distal biceps tendon. Arthroscopy 24:305–310PubMedCrossRef
Metadata
Title
The functional outcome of forty-nine single-incision suture anchor repairs for distal biceps tendon ruptures at the elbow
Authors
Sebastian Siebenlist
Stephanie C. Fischer
Gunther H. Sandmann
Philipp Ahrens
Petra Wolf
Ulrich Stöckle
Andreas B. Imhoff
Peter U. Brucker
Publication date
01-04-2014
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 4/2014
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-013-2200-2

Other articles of this Issue 4/2014

International Orthopaedics 4/2014 Go to the issue