Primary repair of severely retracted nonchronic distal biceps tendon rupture using 2-incision anterior-approach repair

• Main Authors: Noah DeAngelo, BS, Rachel A. Thomas, BS, H. Mike Kim, MD
• Format: Article
• Language: English
• Published: Elsevier 2020-06-01
• Series: JSES International
• Subjects: Distal biceps tendon; cortical button; anterior approach; 2-incision technique; supination strength; patient-reported outcome
• Online Access: http://www.sciencedirect.com/science/article/pii/S266663832030013X

Background: Primary repair of a severely retracted distal biceps tendon can pose a technical challenge. We sought to describe the method and clinical outcomes of a surgical technique used as an adjunct to the conventional anterior single-incision repair for severely retracted biceps tendons. This technique involves a second anterior incision proximally to retrieve a severely retracted tendon followed by passing the tendon through a soft-tissue tunnel. Methods: We identified 30 consecutive patients who had undergone a primary distal biceps tendon repair by an anterior-approach cortical-button technique. A phone survey was conducted for patient-reported outcomes. Patients returned for bilateral forearm supination strength testing in 2 positions (45º of pronation and 45º of supination). Outcomes were compared between patients who required a second incision and high elbow flexion (>60º) because of severe tendon retraction and those who did not require such interventions. Results: No significant differences in elbow range of motion, supination strength, or patient-reported outcomes were found between the 2 groups of patients (P > .05). Regarding supination strength, the operated side was significantly weaker than the uninjured side in both pronated and supinated positions (P < .05). Both the operated and uninjured sides showed significantly higher torque in a pronated position than in a supinated position (P < .05). Conclusions: Severely retracted distal biceps tendons can be successfully repaired using a second incision and high elbow flexion without negative effects on the outcomes. Supination strength was decreased following an anterior-approach cortical-button technique, but patient-reported outcomes were not affected negatively.