Acute distal biceps tendon rupture: retrospective analysis of two different approaches and fixation techniques

Abstract Purpose The aim of our study is to compare the modified double incision (DI) with bone tunnel reinsertion with the single-incision (SI) double tension slide technique in terms of clinical and functional outcomes and complication rates. Methods A retrospective comparative analysis was performed on 65 patients treated for total distal biceps tendon rupture. The surgical technique adopted for each patient was based on the preference of two experienced elbow surgeons. The DASH and MAYO questionnaires, functional outcome and ROM were recorded in all subjects. Results Of 65 patients, we collected data of a cohort of 54 distal biceps tendon ruptures that satisfied inclusion criteria. Twenty-five were treated by modified DI and 29 SI techniques. The recovery of the complete ROM in terms of flexion/extension and prono-supination occurred in the 79.6% of the patients, without statistical significant difference between the adopted technique. We reported a complication rate of 12% and 20.7% for DI and SI techniques, respectively, without statistical correlation (P = 0.84). The average DASH score was similar for DI and SI techniques without significant differences (P = 0,848). The Mayo score results were excellent in the majority of the patients. No significant difference in MAYO results was reported comparing the surgical techniques (P = 1). Conclusion Both techniques provide a reliable and strong repair with an optimal recovery of ROM returning to preinjury activity with substantially overlapping timelines.

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Single- versus double-incision technique for the treatment of distal biceps tendon rupture

The Bone & Joint Journal ◽

10.1302/0301-620x.102b12.bjj-2020-0822.r2 ◽

2020 ◽

Vol 102-B (12) ◽

pp. 1608-1617

Author(s):

Davide Castioni ◽

Michele Mercurio ◽

Daniele Fanelli ◽

Orlando Cosentino ◽

Giorgio Gasparini ◽

...

Keyword(s):

Heterotopic Ossification ◽

Lower Risk ◽

Tendon Rupture ◽

Biceps Tendon ◽

Neurological Complications ◽

Dash Score ◽

Distal Biceps Tendon ◽

Distal Biceps ◽

Distal Biceps Tendon Rupture ◽

Biceps Tendon Rupture

Aims The aim of this systematic review and meta-analysis is to evaluate differences in functional outcomes and complications between single- (SI) and double-incision (DI) techniques for the treatment of distal biceps tendon rupture. Methods A comprehensive search on PubMed, MEDLINE, Scopus, and Cochrane Central databases was conducted to identify studies reporting comparative results of the SI versus the DI approach. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for search strategy. Of 606 titles, 13 studies met the inclusion criteria; methodological quality was assessed with the Newcastle-Ottawa scale. Random- and fixed-effects models were used to find differences in outcomes between the two surgical approaches. The range of motion (ROM) and the Disabilities of the Arm, Shoulder and Hand (DASH) scores, as well as neurological and non-neurological complications, were assessed. Results A total of 2,622 patients were identified. No significant differences in DASH score were detected between the techniques. The SI approach showed significantly greater ROM in flexion (standardized mean difference (SMD) -0.508; 95% confidence interval (CI) -0.904 to -0.112) and pronation (SMD -0.325, 95% CI -0.637 to -0.012). The DI technique was associated with significantly less risk of lateral antebrachial cutaneous nerve damage (odds ratio (OR) 4.239, 95% CI 2.171 to 8.278), but no differences were found for other nerves evaluated. The SI group showed significantly fewer events of heterotopic ossification (OR 0.430, 95% CI 0.226 to 0.816) and a lower reoperation rate (OR 0.503, 95% CI 0.317 to 0.798). Conclusion No significant differences in functional scores can be expected between the SI and DI approaches after distal biceps tendon repair. The SI approach showed greater flexion and pronation ROM and a lower risk of heterotopic ossification and reoperation. The DI approach was favourable in terms of lower risk of neurological complications. Cite this article: Bone Joint J 2020;102-B(12):1608–1617.

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The Role of Deadlifts in Distal Biceps Brachii Tendon Ruptures: An Alternative Mechanism Described With YouTube Videos

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121991811 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712199181

Author(s):

Mehmet Kapicioglu ◽

Emre Bilgin ◽

Necip Guven ◽

Anil Pulatkan ◽

Kerem Bilsel

Keyword(s):

Tendon Rupture ◽

Biceps Brachii ◽

Biceps Tendon ◽

Alternative Mechanism ◽

Distal Biceps Tendon ◽

Distal Biceps ◽

Biceps Tendon Rupture ◽

Significant Difference ◽

Biceps Brachii Tendon ◽

Youtube Videos

Background: The classic injury mechanism of a distal biceps brachii tendon rupture (DBBTR) is eccentric loading to the flexed elbow when the forearm is supinated. Purpose: To determine alternative mechanisms of a DBBTR in powerlifting sports, particularly in deadlift competitions, with the use of YouTube videos. Study Design: Descriptive epidemiology study. Methods: A search on YouTube was performed using the search terms “distal biceps tendon rupture” and “distal biceps tendon injury” combined with “competition,” “deadlift,” and “powerlifting.” The videos underwent an evaluation for accuracy by 3 surgeons according to predetermined criteria. Type of sports activity, participant sex, side of the injury, and arm positions at the time of the injury were recorded. Results: Among the videos reviewed, 35 injuries were found appropriate for an evaluation. All participants were male. The majority of the injuries (n = 25) were observed during the deadlift. Only in 1 deadlift injury were both forearms in supination. In the remaining deadlift injuries (n = 24), all elbows were in extension, with 1 forearm in supination and the other in pronation. Among the deadlift injuries in the mixed-grip position, all ruptures occurred in a supinated extremity: 25% (n = 6) of ruptures occurred on the right side, and 75% (n = 18) of ruptures occurred on the left side; this was a significant difference ( P = .014). Conclusion: We described an alternative mechanism for a DBBTR, namely, eccentric loading to an extended elbow when the forearm is supinated during the deadlift. As all the ruptures occurred in a supinated extremity, holding the bar with both forearms in pronation may prevent or decrease the risk of ruptures during the deadlift.

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Distal biceps tendon rupture operated on with the Boyd-Anderson technique: Follow-up of 9 patients with isokinetic examination after 1 year

Acta Orthopaedica Scandinavica ◽

10.1080/000164700317393411 ◽

2000 ◽

Vol 71 (4) ◽

pp. 399-402 ◽

Cited By ~ 55

Author(s):

Stefan Moosmayer ◽

Adalsteinn Odinsson ◽

Inger Holm

Keyword(s):

Tendon Rupture ◽

Biceps Tendon ◽

Distal Biceps Tendon ◽

Distal Biceps ◽

Distal Biceps Tendon Rupture ◽

Biceps Tendon Rupture

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Distal biceps tendon rupture

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-004-0153-2 ◽

2004 ◽

Vol 14 (3) ◽

Author(s):

OlgaD. Savvidou ◽

PanayiotisJ. Papagelopoulos ◽

AndreasF. Mavrogenis ◽

AntoniosA. Partsinevelos ◽

EvangelosJ. Karadimas ◽

...

Keyword(s):

Tendon Rupture ◽

Biceps Tendon ◽

Distal Biceps Tendon ◽

Distal Biceps ◽

Distal Biceps Tendon Rupture ◽

Biceps Tendon Rupture

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BET 1: Best Evidence Topic Report: is the hook test sensitive enough to be used to exclude distal biceps tendon rupture?

Emergency Medicine Journal ◽

10.1136/emermed-2020-211011.2 ◽

2020 ◽

Vol 38 (1) ◽

pp. 78.2-79

Author(s):

David Annison ◽

James McVie

Keyword(s):

Upper Limb ◽

Tendon Rupture ◽

Biceps Tendon ◽

Clinical Question ◽

Single Test ◽

Distal Biceps Tendon ◽

Distal Biceps ◽

Distal Biceps Tendon Rupture ◽

Biceps Tendon Rupture ◽

Study Type

A shortcut review was carried out to see whether the hook test is sensitive enough for a negative result to exclude complete distal biceps tendon rupture (DBTR) in adults. 3 papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that the hook test is moderately sensitive at detecting complete DBTR when carried out by skilled clinicians in specialist upper limb clinics. As a single test, it is not sensitive enough to be used to exclude complete DBTR.

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