Biomechanical analysis of single-incision anatomic repair technique for distal biceps tendon rupture using tunneling device

2021 ◽  
pp. 175857322110348
Author(s):  
Sohail Qazi ◽  
Steven Regal ◽  
Victor Greco ◽  
Drew Wroblewski ◽  
Patrick J Schimoler ◽  
...  
Keyword(s):  
Single Incision ◽  
Biceps Tendon ◽  
Tendon Repair ◽  
Maximum Load ◽  
Biomechanical Analysis ◽  
Moment Arms ◽  
Biceps Tendon Rupture ◽  
Flexion Extension ◽  
Before And After ◽  
Load To Failure

Hypothesis Single-incision biceps tendon repair with an arthrotunneling device has previously been shown to be a safe and effective technique that provides the anatomic restoration of a two-incision approach and a reduced complication profile. This repair provides adequate and comparable fixation to repairs utilizing anchors, buttons, screws, etc., at a lower cost. Material and methods This study utilized 10 cadaveric specimens. Native and repair specimens were cyclically loaded and graft displacement, flexion/extension (FE) and pronation/supination (PS) moment arms at 12.5° to 152.5° (in 5° increments) before and after repair, and maximum load to failure were measured. Results The FE and PS moment arms and overall maximum moment arms were both significantly larger in the repaired case than in the native case (p < 0.01). Moment arms for supinated specimens were significantly greater than neutral specimens, which in turn was greater than pronated specimens (p < 0.01). The maximum load up to 10 mm of repair displacement was 214.5.0 ± 66.6 N and the repair displacement due to 1000 cycles of 50 N was 2.56 ± 2.06 mm. Conclusion The single-incision arthrotunneling technique is a safe and effective repair that recreates the anatomic footprint and biomechanics of the native biceps and has a reduced complication profile compared to a two-incision approach.

MODIFIED SINGLE-INCISION DISTAL BICEPS TENDON REPAIR USING THREE SUTURE ANCHORS: SURGICAL TECHNIQUE

Hand Surgery ◽  
2012 ◽  
Vol 17 (03) ◽  
pp. 409-412 ◽  
Author(s):  
Du Hyun Ro ◽  
Goo Hyun Baek ◽  
Hyun Sik Gong
Keyword(s):  
Single Incision ◽  
Biceps Tendon ◽  
Tendon Repair ◽  
Suture Anchors ◽  
Confined Space ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Surgical Methods ◽  
Biceps Tendon Rupture ◽  
Biceps Tendon Repair

Complete distal biceps tendon rupture causes a considerable loss of supination and flexion strength, and thus, surgical repair is indicated in active individuals. To reduce the risk of injury to the radial nerve in the confined space where the distal biceps inserts into the radius, several surgical methods have been reported, such as, pull out sutures, two-incision techniques, and the use of suture anchors. Here, we describe our modified single-incision distal biceps tendon repair technique using three suture anchors, which widens the bone-tendon contact surface and simplifies tensioning of the tendon attachment.

scholarly journals Measurements of Tendon Movement Within the Bicipital Groove After Suprapectoral Intra-articular Biceps Tenodesis in a Cadaveric Model

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097753
Author(s):  
Brian J. Kelly ◽  
Alan W. Reynolds ◽  
Patrick J. Schimoler ◽  
Alexander Kharlamov ◽  
Mark Carl Miller ◽  
...  
Keyword(s):  
Biceps Tendon ◽  
Full Range ◽  
Elbow Flexion ◽  
Biceps Tenodesis ◽  
Bicipital Groove ◽  
Biceps Tenotomy ◽  
Flexion Extension ◽  
Before And After ◽  
Long Head ◽  
Scapular Motion

Background: Lesions of the long head of the biceps can be successfully treated with biceps tenotomy or tenodesis when surgical management is elected. The advantage of a tenodesis is that it prevents the potential development of a cosmetic deformity or cramping muscle pain. Proponents of a subpectoral tenodesis believe that “groove pain” may remain a problem after suprapectoral tenodesis as a result of persistent motion of the tendon within the bicipital groove. Purpose/Hypothesis: To evaluate the motion of the biceps tendon within the bicipital groove before and after a suprapectoral intra-articular tenodesis. The hypothesis was that there would be minimal to no motion of the biceps tendon within the bicipital groove after tenodesis. Study Design: Controlled laboratory study. Methods: Six fresh-frozen cadaveric arms were dissected to expose the long head of the biceps tendon as well as the bicipital groove. Inclinometers and fiducials (optical markers) were used to measure the motions of the scapula, forearm, and biceps tendon through a full range of shoulder and elbow motions. A suprapectoral biceps tenodesis was then performed, and the motions were repeated. The motion of the biceps tendon was quantified as a function of scapular or forearm motion in each plane, both before and after the tenodesis. Results: There was minimal motion of the native biceps tendon during elbow flexion and extension but significant motion during all planes of scapular motion before tenodesis, with the most motion occurring during shoulder flexion-extension (20.73 ± 8.21 mm). The motion of the biceps tendon after tenodesis was significantly reduced during every plane of scapular motion compared with the native state ( P < .01 in all planes of motion), with a maximum motion of only 1.57 mm. Conclusion: There was a statistically significant reduction in motion of the biceps tendon in all planes of scapular motion after the intra-articular biceps tenodesis. The motion of the biceps tendon within the bicipital groove was essentially eliminated after the suprapectoral biceps tenodesis. Clinical Relevance: This arthroscopic suprapectoral tenodesis technique can significantly reduce motion of the biceps tendon within the groove in this cadaveric study, possibly reducing the likelihood of groove pain in the clinical setting.

Distance of the Posterior Interosseous Nerve From the Bicipital (Radial) Tuberosity at Varying Positions of Forearm Rotation: A Magnetic Resonance Imaging Study With Clinical Implications

2021 ◽  
Vol 49 (5) ◽  
pp. 1152-1159
Author(s):  
Tyler A. Luthringer ◽  
David A. Bloom ◽  
David S. Klein ◽  
Samuel L. Baron ◽  
Erin F. Alaia ◽  
...  
Keyword(s):  
Anterior Approach ◽  
Single Incision ◽  
Biceps Tendon ◽  
Tendon Repair ◽  
Resonance Imaging ◽  
Forearm Rotation ◽  
Mri Scans ◽  
Biceps Tendon Repair ◽  
The Mean ◽  
Bicipital Tuberosity

Background: The proximity of the posterior interosseous nerve (PIN) to the bicipital tuberosity is clinically important in the increasingly popular anterior single-incision technique for distal biceps tendon repair. Maximal forearm supination is recommended during tendon reinsertion from the anterior approach to ensure the maximum protective distance of the PIN from the bicipital tuberosity. Purpose: To compare the location of the PIN on magnetic resonance imaging (MRI) relative to bicortical drill pin instrumentation for suspensory button fixation via the anterior single-incision approach in varying positions of forearm rotation. Study Design: Descriptive laboratory study. Methods: Axial, non–fat suppressed, T1-weighted MRI scans of the elbow were obtained in positions of maximal supination, neutral, and maximal pronation in 13 skeletally mature individuals. Distances were measured from the PIN to (1) the simulated path of an entering guidewire (GWE-PIN) and (2) the cortical starting point of the guidewire on the bicipital tuberosity (CSP-PIN) achievable from the single-incision approach. To radiographically define the location of the nerve relative to constant landmarks, measurements were also made from the PIN to (3) the prominent-most point on the bicipital tuberosity (BTP-PIN) and (4) a perpendicular plane trajectory from the bicipital tuberosity exiting the opposing radial cortex (PPT-PIN). All measurements were subsequently compared between positions of pronation, neutral, and supination. In supination only, BTP-PIN and PPT-PIN measurements were made and compared at 3 sequential axial levels to evaluate the longitudinal course of the nerve relative to the bicipital tuberosity. Results: Of the 13 study participants, mean age was 38.77 years, and mean body mass index was 25.58. Five participants were female, and 5 left and 8 right elbow MRI scans were reviewed. The GWE-PIN was significantly greater in supination (mean ± SD, 16.01 ± 2.9 mm) compared with pronation (13.66 ± 2.5 mm) ( P < .005). The mean CSP-PIN was significantly greater in supination (16.20 ± 2.8 mm) compared with pronation (14.18 ± 2.4 mm) ( P < .013).The mean PPT-PIN was significantly greater in supination (9.00 ± 3.0 mm) compared with both pronation (1.96 ± 1.2 mm; P < .001) and neutral (4.73 ± 2.6 mm; P < .001). The mean BTP-PIN was 20.54 ± 3.0, 20.81 ± 2.7, and 20.35 ± 2.9 mm in pronation, neutral, and supination, respectively, which did not significantly differ between positions. In supination, the proximal, midportion, and distal measurements of BTP-PIN did not significantly differ. The proximal PPT-PIN distance (9.08 ± 2.9 mm) was significantly greater than midportion PPT-PIN (5.85 ± 2.4 mm; P < .001) and distal BTP-PIN (2.27 ± 1.8 mm; P < .001). Conclusion: This MRI study supports existing evidence that supination protects the PIN from the entering guidewire instrumentation during anterior, single-incision biceps tendon repair using cortical button fixation. The distances between the entering guidewire trajectory and PIN show that guidewire-inflicted injury to the nerve is unlikely during the anterior single-incision approach. Clinical Relevance: When a safe technique is used, PIN injuries during anterior repair are likely the result of aberrant retractor placement, and we recommend against the use of retractors deep to the radial neck. Guidewire placement as close as possible to the anatomic footprint of the biceps tendon is safe from the anterior approach. MRI evaluation confirms that ulnar and proximal guidewire trajectory is the safest technique when using single-incision bicortical suspensory button fixation.

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

2021 ◽  
Author(s):  
Marco Di Stefano ◽  
Lorenzo Sensi ◽  
Leonardo di Bella ◽  
Raffaele Tucci ◽  
Efisio Bazzucchi ◽  
...  
Keyword(s):  
Tendon Rupture ◽  
Biceps Tendon ◽  
Dash Score ◽  
Complication Rates ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Distal Biceps Tendon Rupture ◽  
Biceps Tendon Rupture ◽  
Significant Difference ◽  
Flexion Extension

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.

scholarly journals Novel implant-free loop Tenodesis vs. simple Tenotomy of the long biceps tendon - a biomechanical investigation

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Maximilian Kerschbaum ◽  
Andreas Voss ◽  
Christian Pfeifer ◽  
Isabella Weiss ◽  
Agnes Mayr ◽  
...  
Keyword(s):  
Biceps Tendon ◽  
Maximum Load ◽  
Study Groups ◽  
Displacement Curve ◽  
The Novel ◽  
Shoulder Joints ◽  
Biomechanical Investigation ◽  
Mode Of Failure ◽  
Load To Failure ◽  
Group A

Abstract Background Simple tenotomy and anchor tenodesis are commonly used in treatment of long biceps tendon (LHB) pathologies. The tenotomy can result in biceps distalization or cosmetic deformities. A novel loop Tenodesis Technique (LTD) could prevent a distalization of the biceps muscle without the risk of implant associated complications. The purpose of this study was to investigate the biomechanical aspects of the novel LTD compared to a standard tenotomy of the LHB. It has been hypothesized that the novel technique will show biomechanical superiority in terms of resistance and distalization. Methods Seven paired adult human cadaveric shoulder joints were assigned to one of the two study groups: Loop tenodesis (LTD); simple tenotomy (STT). In both groups load-to-failure testing was performed. The load-displacement curve was used to determine the maximum load (N), the degree of distalization of the LHB (mm) and the stiffness (N/mm). Additionally, the mode of failure was registered. Results The LTD group achieved a significantly higher ultimate load to failure (LTD: 50.5 ± 12.5 N vs. STT: 6.6 ± 3.9 N; p = 0.001). Significantly less distalization of the tendon could be detected for the LTD group (LTD: 8 ± 2.3 mm vs. STT: 22.4 ± 2.4 mm; p = 0.001). Stiffness was 7.4 ± 3.9 N/mm for the LTD group and 0.23 ± 0.16 N/mm for the STT group (p = 0.001). In all specimens of the LTD group a tendon rupture was found as mode of failure, while the STT group failed because of pulling out the LHB through the bicipital groove. Conclusion The novel loop Tenodesis Technique shows biomechanically higher stability as well as less distalization compared to a simple tenotomy of the long biceps tendon.

scholarly journals Biomechanical Analysis of the Efficacy of Locking Plates during Cyclic Loading in Metacarpal Fractures

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Stefanie Doht ◽  
Rainer H. Meffert ◽  
Michael J. Raschke ◽  
Torsten Blunk ◽  
Sabine Ochman
Keyword(s):  
Cyclic Loading ◽  
Locking Plate ◽  
Screw Fixation ◽  
Maximum Load ◽  
Biomechanical Analysis ◽  
Locking Plates ◽  
Functional Rehabilitation ◽  
Metacarpal Bones ◽  
Load To Failure ◽  
Bicortical Screw

Purpose.To analyse the biomechanical characteristics of locking plates under cyclic loading compared to a nonlocking plate in a diaphyseal metacarpal fracture.Methods.Oblique diaphyseal shaft fractures in porcine metacarpal bones were created in a biomechanical fracture model. An anatomical reduction and stabilization with a nonlocking and a comparable locking plate in mono- or bicortical screw fixation followed. Under cyclic loading, the displacement, and in subsequent load-to-failure tests, the maximum load and stiffness were measured.Results.For the monocortical screw fixation of the locking plate, a similar displacement, maximum load, and stiffness could be demonstrated compared to the bicortical screw fixation of the nonlocking plate.Conclusions.Locking plates in monocortical configuration may function as a useful alternative to the currently common treatment with bicortical fixations. Thereby, irritation of the flexor tendons would be avoided without compromising the stability, thus enabling the necessary early functional rehabilitation.

scholarly journals Distal Biceps Tendon Repair Using A Single-incision Approach With Unicortical Intramedullary Button Fixation: Report Early Post-operative Outcomes And Complications

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0036
Author(s):  
Kenneth M. Lin ◽  
Justin Chan ◽  
Brian J. Lin ◽  
Christopher L. Camp ◽  
Grant Hoerig Garcia ◽  
...  
Keyword(s):  
Heterotopic Ossification ◽  
Single Incision ◽  
Biceps Tendon ◽  
Tendon Repair ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Distal Biceps Repair ◽  
Cortical Button ◽  
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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