This article is more than 5 years old. Information may no longer be current.
Single- vs. double-incision distal biceps rupture repairs reveal no functional differences
Click Here to Manage Email Alerts
Findings from a randomized prospective trial revealed no differences in function and pain measures between the single-incision and double-incision techniques for treating distal biceps ruptures, but slightly more minor complications were found in patients treated with the single-incision technique.
“Historically, both the single- and double-incision techniques were fraught with complications,” Ruby Grewal, MD, MSc, FRCSC, co-director of the clinical research lab at the Hand and Upper Limb Center at the University of Western Ontario, London, Ontario, said at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. “The original description for the single-incision technique involved a large anterior exposure resulting in a high incidence of radial nerve palsy. The two-incision technique as described by Boyd and Anderson had a high synostosis rate. As these techniques have been modified over the years, the safety of both has improved.”
Grewal and colleagues randomly assigned 90 patients with acute distal biceps ruptures presenting within 4 weeks of injury to undergo the single-incision repair technique with two suture anchors (48 patients) or a double-incision repair using transosseous drill holes (42 patients). They followed up the patients at 3, 6, 12 and 24 months post-surgery. Grewal reported no significant differences in baseline demographics including dominant hands affected and workers compensation cases. All patients were men aged about 45 years old.
The single-incision technique involved an anterior exposure with insertion of two suture anchors, after which surgeons then identified and prepared the biceps tendon and used Ethibond sutures for repair.
|
|
“We then roughened up the tuberosity and the tendon was shuttled down to bone using a sliding suture,” Grewal said.
Surgeons began the two-incision technique with a small anterior incision and prepared the tendon similarly to that done in the single-incision technique.
“The radial tuberosity was approached through an extensor-splitting approach, and we created a trough in the bone with three transosseous drill holes above,” Grewal said. Surgeons then passed the tendon through the drill holes and inset the tendon into the trough.
Postoperatively, patients in both groups followed the same regimen, wearing a resting splint through 6 weeks, starting range of motion within the first week and strengthening at 12 weeks.
The investigators reported no differences in overall mean outcomes with the American Shoulder and Elbow Surgeons elbow pain (P=0.9) and function (P=0.5) scores, the Disabilities of the Arm, Shoulder and Hand score (P=0.9), and the PREE — patient-rated elbow evaluation — measure (P=0.7). They also found no differences in final extension, pronation or supination strength, however results with the double-incision technique revealed a small advantage in mean isometric flexion strength regained of 104% vs. 94% for the single-incision technique.
“There were no statistically significant differences in all ranges of motion measured, but the single-incision group did take slightly longer to recover full extension,” Grewal said, noting that the double-incision group, however, took slightly longer to achieve full pronation.
The single-incision technique was associated with higher overall complication rates due to a high number of early transient neurapraxias: 19 vs. three among patients who underwent a double-incision repair (P<0.001). All the neurapraxias resolved, but three in the single-incision group remained symptomatic beyond 6-months follow-up, according to Grewal. The researchers also found four tendons re-ruptured — three in the single-incision group and one in the double-incision group. – by Tina DiMarcantonio
Reference:
- Grewal R, et al. 1 vs. 2 incision technique for the repair of distal biceps tendon ruptures: A RCT. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19. San Diego.
- Ruby Grewal, MD, MSc, FRCSC, can be reached at the Hand and Upper Limb Center, St. Joseph’s Health Center, Suite D0-209, 268 Grosvenor St., London, ON N6A 4L6, Canada; +519-646-6286; email: rgrewa@uwo.ca.
- Disclosure: Grewal has no relevant financial disclosures.
The study compares 1- vs 2-incision approaches in distal biceps tendon repair by looking at the functional outcome and the complication rate. The homogeneous groups are prospectively randomized. The compared techniques can be seen as standard procedures, but there is no comment about the size of the incision. On a closer look, the results might speak for the two-incision technique because of a higher isometric flexion strength and a higher complication rate after one incision. The flexion strength might be higher because of a tendon shortening by fixation with suture anchors. The complication rate with neuropraxia might be the result of accidently drilling into the posterior interosseous nerve in the one-incision technique. To avoid these complications and to have a strong fixation with no shortening of the biceps tendon, we use two biceps flip buttons in an intramedullar technique. For this operation only one incision is necessary. Therefore we recommend an intraosseous fixation with biceps button technique and single incision.
— Andreas Lenich, MD
Consultant Klinikum
Rechts der Isar Technische Universität München
Munich
Disclosure: He has no relevant financial disclosures.