Hand and Upper Extremity Unit, Hospital Fremap, Majadahonda, Madrid, Spain
Purpose: The purpose of this study was to compare the results of three different techniques of surgical reattachment in distal biceps tendon ruptures.
Material and Methods: 32 consecutive patients with distal biceps tendon ruptures were randomly assigned to one of 3 treatment groups : 10 patiens using 2 biodegradable anchors (Panaloc© Mitek, Norwood, MA) through a single anterior approach (group A), 12 using 2 biodegradable anchors through a modified 2-incision technique (group B) and 10 using an Endobutton® (Acufex Smith & Nephew, Andover MA) by a single transverse anterior incision (group C). All patients were male. Average age was 42 (range 35-56). Postoperative protocol and rehabilitation was the same in both groups. Full range of motion as tolerated was allowed two week after surgery. Active range of motion, Mayo Elbow Performance Score (MEPS), pain, strength, patient satisfaction, and elbow radiographs were evaluated at 12 months postoperatively. The mean follow-up was 17 months (range, 12-34).
Results: Average operative time (minutes) : 62 (gA), 50 (gB) and 45 (gC). No complications in gA and gC. 2 patients in gB had a transient posterior interosseous nerve neurapraxia with spontaneous full recovery after 3 months. 1 patient (gB) had symptomatic heterotopic bone formation and synostosis was resected. There was no statistical significant difference in MEPS, ROM, time to work or strength isokinetic testing between 3 groups. All patientswere satisfied with their final result and eventually returned to their pre-injury activity level. Time to return to work was (weeks) : 13.8 (group A), 12.2 (group B) and 10.3 (group C).
Conclusion: Functional results of the three techniques studied were similar. Anterior approach showed lesser complications and less time off work than 2-incision technique. Endobutton single approach assisted tecniqueshould be considered the gold standard procedure for distal biceps tendon repair due to its shorter operative time and lower morbidity. |
