The Intramedullary Cortical Button Technique for Distal Biceps Tendon Repair

Objectives: While various techniques for distal biceps repair have been described, biomechanical studies have shown cortical button fixation to outperform bone tunnels, intraosseous screws, and suture anchors. Furthermore, numerous studies have shown no difference in complication rate between single- and dual-incision approaches. Thus, it follows that a single-incision approach with cortical button fixation may provide superior clinical outcomes with minimal complications. The purpose of this study is first to investigate intra-operative and short-term complications of distal biceps tendon repair through a single-incision approach using unicortical button fixation, and secondly to assess clinical outcomes. Methods: 52 patients who underwent distal biceps repair with unicortical button fixation (Figure 1) at a single institution from 2014 to 2017 were identified. Exclusion criteria included age less than 18 or greater than 75 years, prior ipsilateral biceps repair, concomitant ipsilateral surgical procedure, and most recent follow-up less than 2 months. Postoperative nerve deficits, flexion and supination strength by manual testing, range of motion, Mayo Elbow Performance Score (MEPS) and radiographs for identification of heterotopic ossification (HO) were obtained and analyzed retrospectively. Results: Fifty-two patients with 53 distal biceps ruptures were included, with mean age 48 years (range 25-71 years). Median time from injury to surgery was 2 weeks (range 1 day to 16 weeks), with 15 patients being treated at greater than 3 weeks from injury. Forty-four patients (83%) had complete tears. Following surgery, average time to final follow-up was 22.8 weeks (range 8-65 weeks). Postoperatively, 49 patients (92.5%) had full range of motion, 48 patients (90.6%) had return of full supination and flexion strength by manual muscle testing (the remaining patients had strength graded as 5-/5). There was no difference in outcomes between those patients treated < 3 weeks from injury compared to those treated > 3 weeks from injury. Two patients (3.8%) initially reported sensory deficit in the lateral antebrachial cutaneous nerve distribution, both cases of which fully resolved by 7 and 11 weeks postoperative. Two patients (3.8%) displayed radiographic evidence of heterotopic ossification, Hastings and Graham class I (Figure 2). One of these was an incidental finding without any clinical symptoms, the other had mild pain but normal strength and neurovascular function. Mean postoperative MEPS was 93.9 (range 60-100), corresponding to “excellent” function (MEPS>90). Conclusion: Distal biceps repair using single incision, unicortical button fixation yields a low rate of complications with good clinical results compared to other techniques reported in the literature. The single incision approach in patients treated between 3 and 16 weeks from injury is safe and resulted in outcomes no different than in those patients treated <3 weeks from injury. Further investigation is warranted in the form of larger, comparative studies with more robust outcome measures and longer term follow up. [Figure: see text][Figure: see text]

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Risk of Posterior Interosseous Nerve Injury During Distal Biceps Tendon Repair Using a Cortical Button

Journal of Hand Surgery Global Online ◽

10.1016/j.jhsg.2021.09.003 ◽

2021 ◽

Author(s):

Brian Lynch ◽

Alex Duke ◽

David Komatsu ◽

Edward Wang

Keyword(s):

Nerve Injury ◽

Biceps Tendon ◽

Tendon Repair ◽

Posterior Interosseous Nerve ◽

Distal Biceps Tendon ◽

Distal Biceps ◽

Cortical Button ◽

Biceps Tendon Repair

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Mid-term clinical and functional outcomes of distal biceps tendon repair: A comparative study of two surgical fixation techniques

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491720903472 ◽

2020 ◽

Vol 27 (1) ◽

pp. 47-51

Author(s):

Emma Poyser ◽

Wahid Abdul ◽

Hemang Mehta

Keyword(s):

Suture Anchor ◽

Biceps Tendon ◽

Tendon Repair ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Distal Biceps Tendon ◽

Distal Biceps ◽

Cortical Button ◽

Patient Reported ◽

Biceps Tendon Repair

Objective: Acute rupture of the distal biceps tendon is relatively uncommon, and surgical repair is advocated for acute injuries to restore strength and function. Numerous techniques are described in the literature, with no true consensus regarding the optimal method of fixation. The aim of this study was to evaluate patient-reported outcome measures, clinical outcomes and complications for patients undergoing distal biceps tendon repair using two fixation techniques: cortical button and suture anchor. Methods: A retrospective single-unit case series of 51 cases (50 patients) underwent distal biceps tendon repair, comprising 19 cortical button and 32 suture anchor fixations. Patients were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and overall satisfaction. Clinical outcomes and complications were reviewed from patient records. Results: Thirty-eight (76.5%) patients responded to DASH questionnaires with a mean follow-up of 189 weeks (11.5–425 weeks). Mean DASH scores for cortical button and suture anchor groups were 6.2 (0–30.8) and 3.3 (0–16.7), respectively ( p = 0.21). Eight patients (16%) reported lateral cutaneous neuropraxia in the early post-operative period. All but two of these patients experienced complete resolution at the final follow-up. One patient had heterotrophic ossification, which did not require any further intervention. There was one re-rupture (suture anchor), but the patient declined further surgical intervention. Conclusion: There were no statistically significant differences in the patient-reported outcome measures, overall satisfaction and complication rate between patients undergoing either method of fixation. Level of evidence: III

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Outcomes of distal biceps tendon repair using a dual incison, cortical button technique: a single surgeon study.

JSES International ◽

10.1016/j.jseint.2021.03.001 ◽

2021 ◽

Author(s):

Murtaza K. Khwaja ◽

Emile Oliver ◽

Holly Wilson ◽

Kawaljit Dhaliwal ◽

Baseem Choudhry ◽

...

Keyword(s):

Biceps Tendon ◽

Tendon Repair ◽

Distal Biceps Tendon ◽

Distal Biceps ◽

Cortical Button ◽

Biceps Tendon Repair

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Radiological and Clinical Evaluation of the Transosseous Cortical Button Technique in Distal Biceps Tendon Repair

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2016.08.014 ◽

2016 ◽

Vol 41 (12) ◽

pp. e447-e452 ◽

Cited By ~ 7

Author(s):

Pieter Caekebeke ◽

Nicolas Vermeersch ◽

Joris Duerinckx ◽

Roger van Riet

Keyword(s):

Clinical Evaluation ◽

Biceps Tendon ◽

Tendon Repair ◽

Distal Biceps Tendon ◽

Distal Biceps ◽

Cortical Button ◽

Biceps Tendon Repair

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Acute distal biceps tendon repair using cortical button fixation results in excellent short- and long-term outcomes

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-2246.r1 ◽

2021 ◽

Vol 103-B (7) ◽

pp. 1284-1291

Author(s):

Thomas H. Carter ◽

Bevin J. Karunaratne ◽

William M. Oliver ◽

Iain R. Murray ◽

Timothy O. White ◽

...

Keyword(s):

Nerve Injury ◽

Biceps Tendon ◽

Tendon Repair ◽

Distal Biceps Tendon ◽

Term Outcome ◽

Long Term Outcome ◽

Distal Biceps ◽

Cortical Button ◽

Biceps Tendon Repair

Aims Acute distal biceps tendon repair reduces fatigue-related pain and minimizes loss of supination of the forearm and strength of flexion of the elbow. We report the short- and long-term outcome following repair using fixation with a cortical button techqniue. Methods Between October 2010 and July 2018, 102 patients with a mean age of 43 years (19 to 67), including 101 males, underwent distal biceps tendon repair less than six weeks after the injury, using cortical button fixation. The primary short-term outcome measure was the rate of complications. The primary long-term outcome measure was the abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Secondary outcomes included the Oxford Elbow Score (OES), EuroQol five-dimension three-level score (EQ-5D-3L), satisfaction, and return to function. Results Eight patients (7.8%) had a major complication and 34 (33.3%) had a minor complication. Major complications included re-rupture (n = 3; 2.9%), unrecovered nerve injury (n = 4; 3.9%), and surgery for heterotopic ossification (n = 1; 1.0%). Three patients (2.9%) overall required further surgery for a complication. Minor complications included neurapraxia (n = 27; 26.5%) and superficial infection (n = 7; 6.9%). A total of 33 nerve injuries occurred in 31 patients (30.4%). At a mean follow-up of five years (1 to 9.8) outcomes were available for 86 patients (84.3%). The median QuickDASH, OES, EQ-5D-3L, and satisfaction scores were 1.2 (IQR 0 to 5.1), 48 (IQR 46 to 48), 0.80 (IQR 0.72 to 1.0), and 100/100 (IQR 90 to 100), respectively. Most patients were able to return to work (81/83, 97.6%) and sport (51/62,82.3%). Unrecovered nerve injury was associated with an inferior outcome according to the QuickDASH (p = 0.005), OES (p = 0.004), EQ-5D-3L (p = 0.010), and satisfaction (p = 0.024). Multiple linear regression analysis identified an unrecovered nerve injury to be strongly associated with an inferior outcome according to the QuickDASH score (p < 0.001), along with infection (p < 0.001), although re-rupture (p = 0.440) and further surgery (p = 0.652) were not. Conclusion Acute distal biceps tendon repair using cortical button fixation was found to result in excellent patient-reported outcomes and health-related quality of life. Although rare, unrecovered nerve injury adversely affects outcome. Cite this article: Bone Joint J 2021;103-B(7):1284–1291.

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