Healio
Healio
April 23, 2008
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Long-term results good with distal biceps tendon repair assisted by fixation device

DASH scores averaged 9.2, which compared favorably with estimated scores for normal subjects.

SEATTLE — Patients can regain nearly normal range of motion after undergoing biceps tendon repair with an EndoButton-assisted single-incision technique, according to a group of Indiana researchers.

The research team that studied the results said the technique produced acceptable outcomes on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.

"The technique of EndoButton-assisted distal biceps tendon repair appears to be safe [Smith & Nephew Endoscopy]. There were no motor nerve palsies and no function-limiting heterotopic ossification, although it was present on radiographs in nearly all patients," C. Noel Henley, MD, said.

Patients lost 5° overall supination vs. their opposite arm, and that difference was statistically significant. But any differences seen in elbow range of motion (ROM), strength and endurance were minimal and not statistically significant, Henley noted during the 25th Adrian E. Flatt Residents and Fellows Conference in Hand Surgery, here.

Long-term follow-up

Jeffrey Greenberg, MD, performed the surgeries in 47 patients between 1996 and 2004; 22 patients (19 men, 3 women) returned for long-term follow-up evaluation at 4.3 years mean (range, 11 to 122 months). Their average age was 47 years at surgery.

Greenberg repaired 14 tendons up to 14 days after injury and eight tendons between 15 and 150 days postinjury.

Patients' DASH questionnaire scores averaged 9.2 at follow-up. They underwent a physical examination and had radiographs taken of the operated extremity. Researchers used the contralateral extremity as a comparison.

Greenberg used an anterior approach for all the surgeries, and patients started elbow ROM exercises at 3 or 4 postoperative days. Until 4 weeks postop, their elbows were splinted to limit motion to 30° extension, and they began full use of the elbow at 10 to 12 weeks postop, Henley said.

25% report numbness

At follow-up, five patients (25%) still experienced persistent numbness in the distribution of the lateral antebrachial cutaneous nerve, but no major complications were reported.

"Eighteen of 22 patients demonstrated some pattern of ossification on radiographs, and the remaining four patients had no evidence of ossification. No patients had radiographic ossification that limited their function," Henley said.

Among patients injured at work, the five who filed workers compensation claims presented with 11° less flexion on average at follow-up. Nearly every patient employed at the time of injury returned to work afterwards.

"It's reasonable to expect a return to a normal upper extremity functional level postoperatively," Henley said.

Nineteen of 20 patients who reported being active returned to the same activities afterwards.

For more information:

  • C. Noel Henley, MD, can be reached at Ozark Orthopaedic Clinic, 3317 N. Wimberly, Fayetteville, AR 72703. 479-521-2752; e-mail: cnoelhenley@gmail.com. He has no direct financial interest in the products discussed in this article, nor is he a paid consultant for any companies mentioned.
  • Reference:
  • Greenberg J, Henley CN. Eight year experience with EndoButton-assisted repair of distal bicep tendon ruptures. #RF-36. Presented at the Adrian E. Flatt Residents and Fellows Conference in Hand Surgery, American Society for Surgery of the Hand 62nd Annual Meeting. Sept. 26, 2007. Seattle.