Anatomic two-incision technique effective for distal biceps repair

At final follow-up, five high-level weight lifters regained biceps strength equivalent to pre-injury levels.

A new double mini-incision technique effectively repairs distal biceps tendon ruptures without causing neurovascular complications, according to a small study by Italian surgeons.

Several techniques already exist for biceps tendon repair, including single-incision and two-incision techniques. Although most yield good results, the techniques can cause complications, including neurologic injuries, according to Gian Luigi Canata, MD.

To address this, Canata and colleagues at the Koelliker Hospital SUISM in the University of Turin, Italy, developed an anatomic two-incision technique, which they have used since 1993. The procedure is only for patients with an acute injury no more than 20 days old, Canata said.

“The [double mini-incision] technique is an anatomic and suture repair,” he said. “We have a Kirschner wire, drilled through from the exact anatomic port of insertion of the biceps on the other side.” The surgeon attaches the tendon on the opposite side using transosseous button fixation and standard nonabsorbable sutures, he said. The forearm remains in a fully supine position throughout surgery, he noted.

Canata and colleagues evaluated the technique in a study of eight men, five of whom were high-level weight lifters. He presented the results at the 2005 International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Congress.

Patients had a mean age of 47 years and a mean follow-up of 61 months. All patients had acute lesions, Canata noted.

The researchers controlled for confounding factors, including arm dominance. At final follow-up, they found no statistically significant differences in peak torque at 60°, 120° and 180° flexion between the normal, healthy side and the surgically treated side. Additionally, they found no significant differences between the operated and healthy sides in total power, isokinetic evaluation, function and range of motion, according to the study.

“We did not have any postoperative complication, radioulnar synostosis or limitations in range of motion. All patients resumed their previous activity at the same level,” Canata said, adding that all patients were satisfied with their results.

Additionally, all five patients who lifted weights regained biceps strength equivalent to pre-injury levels, Canata noted. “We had no relapses, excellent subjective results and also good aesthetic results,” he said.

For more information:
Canata GL, Tarello MP. Anatomic mini-invasive repair of distal biceps tendon ruptures. #176. Presented at the 2005 International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Congress. April 3-7, 2005. Hollywood, Fla.