Double Tension Slide Technique as a Novel Repair for Distal Biceps Tendon Tear: A Biomechanical Evaluation

Background Distal biceps tendon repair using endobutton fixation has shown the best biomechanical results in terms of pullout strength. Here, we compared Sethi’s enhanced tension adjustable endobutton technique known as the “tension slide technique” to a new knotless endobutton fixation technique without a post-fixation screw. Our new approach is as effective as the tension slide technique in terms of pullout strength and gapping after early mobilization. Methods A biomechanical cadaveric study with 16 paired arms was performed. With the radius held in place, the distal biceps tendon was loaded at 100 N for 500 cycles and the load was then increased until failure. Gapping after loading cycles and maximum load to failure were recorded and compared. Results Median bone-tendon gapping was 5.77 mm (interquartile range (IQR) 4.84–9.11) for tension slide technique and 4.72 mm (IQR 1.77–6.16) for the knotless fixation (p = 0.047). Median load to failure was 257.87 N (IQR 222.07–325.35) in the tension slide technique group and 407.78 N (IQR 358.54–485.20) in the knotless group (p = 0.047). Discussion The knotless endobutton provides better pullout strength and elongation results compared to the tension slide technique without the use of an interference screw, allowing early mobilization in order to faster return to daily living activities. Level of evidence: Basic science study.

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Distal biceps tendon injection

Clinics in Shoulder and Elbow ◽

10.5397/cise.2021.00010 ◽

2021 ◽

Vol 24 (2) ◽

pp. 93-97

Author(s):

Jacqueline van der Vis ◽

Stein J. Janssen ◽

Ronald L.A.W. Bleys ◽

Denise Eygendaal ◽

Michel P.J. van den Bekerom ◽

...

Keyword(s):

Upper Limb ◽

Ultrasound Guidance ◽

Biceps Tendon ◽

Lateral Approach ◽

Distal Biceps Tendon ◽

Tendon Tear ◽

Distal Biceps ◽

Surgical Residents ◽

Tendon Insertion ◽

Lateral Infiltration

Background: Injection therapy around the distal biceps tendon insertion is challenging. This therapy may be indicated in patients with a partial distal biceps tendon tear, bicipitoradial bursitis and tendinopathy. The primary goal of this study was to determine the accuracy of manually performed injections without ultrasound guidance around the biceps tendon.Methods: Seven upper limb specialists, two general orthopedic specialists and three orthopedic surgical residents manually injected a cadaver elbow with acrylic dye using an anterior and a lateral infiltration approach. After infiltration the cadaveric elbows were dissected to determine the location of the acrylic dye.Results: In total, 79% of the injections were localized near the biceps tendon. Of these injections, 20% were localized on the radius near the bicipitoradial bursa. In total, 53% of the performed infiltrations were injected by anterior and 47% by lateral approaches. Of the injections near the distal biceps (79%), 47% were injected by an anterior and 53% by a lateral approach. Of the injections on the radius (20%), 33% were injected by anterior and 67% by lateral approach. Of the inaccurate injections (21%), 75% were injected anterior and 25% lateral. Conclusion: Manual infiltration without ultrasound guidance for distal biceps pathology lacks accuracy. We therefore recommend ultrasound guidance for more accurate infiltration.

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