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Single-incision repair technique effective for distal biceps tendon ruptures

Only two of 53 patients had persistent loss of motion, which was limited to forearm rotation and caused by heterotopic ossification.

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A single-incision suture anchor technique can effectively repair distal biceps tendon ruptures and may improve postop cosmesis by minimizing scar formation, a retrospective study shows.

Chris K. John, MD, of the Roanoke Orthopaedic Center in Roanoke, Va., and colleagues reviewed their experience repairing such tears using a single limited antecubital incision. The study included 53 patients treated at 46.4 years of age on average. All cases were treated within 6 weeks of injury and followed for an average of 38.1 months postop.

In all cases, surgeons secured the biceps tendon rupture using two Mitek GII anchors [DePuy Mitek] loaded with two No. 2 Ethibond sutures [Ethicon], which were centered in the tuberosity about 1 cm apart. The sutures were also independently passed and tied in an interrupted mattress fashion through the biceps footprint "to reapproximate the footprint at the radial tuberosity," the investigators reported.

Surgeons then passed one to two sets of uncut sutures through the distal biceps tendon in a running Bunnell-type fashion, according to the study, published in the Journal of Shoulder and Elbow Surgery.

At final follow-up, no patients had failed. The overall Andrews-Carson score averaged 194.3, with excellent outcomes in 46 patients and good outcomes in seven.

Only two patients had persistent loss of motion, which was limited to forearm rotation and caused by heterotopic ossification in the operative area. But: "No patient had an appreciable loss of elbow flexion or extension," the authors reported.

"The only other complication in this series occurred in a patient in whom a temporary wrist drop developed as a result of a radial nerve traction injury that recovered fully within 8 weeks of surgery," they wrote.

The investigators said the study demonstrates that "nearly all complete distal biceps ruptures can be effectively reapproximated to the radial tuberosity within the first 6 weeks of injury, making graft usage or nonanatomic repairs rarely, if ever, necessary."

For more information:

• John CK, Field LD, Weiss KS, Savoie FH. Single-incision repair of acute distal biceps ruptures by use of suture anchors. J Shoulder Elbow Surg. 2007;16:78-83.