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Single, double incision yielded low complication rates for distal biceps tendon rupture repair
Regardless of approach or technique, results published in The American Journal of Sports Medicine showed an overall low rate of serious complications in the surgical repair of distal biceps tendon ruptures. However, higher rates of posterior interosseous nerve palsy, heterotopic bone formation and reoperation were found with the double-incision technique.
“We found that the surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of fixation method or surgical approach (one incision or two incision),” Raffy Mirzayan, MD, an orthopedic surgeon and co-director of sports medicine, Kaiser Permanente Baldwin Park, told Healio.com/Orthopedics. “However, the double-incision technique had a significantly higher rate of posterior interosseous nerve palsy, heterotopic bone formation and reoperation rate.”
Mirzayan and colleagues analyzed patient demographics, surgeon characteristics, range of motion and complications for 784 distal biceps tendon repairs performed between Jan. 1, 2008 and Dec. 31, 2015. Researchers classified the repair methods as double-incision approach using bone tunnel-suture fixation or anterior single-incision approach. Researchers further classified anterior single incisions according to the fixation method of cortical button alone, cortical button and interference screw, or suture anchors alone.
Results showed 81.5% of repairs were performed using a single-incision approach. Researchers noted a significantly higher rate of posterior interosseous nerve palsy, heterotopic bone formation and reoperation among patients who underwent a double-incision repair. Although patients in the single-incision group were more likely to experience a lateral antebrachial cutaneous nerve palsy, when lateral antebrachial cutaneous nerve palsies were excluded, researchers found no significant difference in the overall nerve palsies between the two groups. According to results, patients had an overall rate of tendon re-rupture of 1.9%, an overall rate of postoperative wound infection of 1.5% and an average time from surgery to release from medical care of 14.4 weeks. Compared with other single-incision repair types, patients treated with cortical button plus interference screw were released significantly sooner. Researchers found no significant differences in rates of motor neurapraxia, infection, re-rupture and reoperation with regard to surgeons’ years of practice, fellowship training or case volume. – by Casey Tingle
Disclosures: Mirzayan reports he receives royalties from Wolters Kluwer and Thieme; receives an honorarium from Arthrex; receives research grants from Arthrex, Joint Restoration Foundation and BioD LLC; holds sock in AlignMed; and is on the editorial board of the American Journal of Orthopaedics. Please see the full study for a list of all other authors’ relevant financial disclosures.