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. 2021 Jul 8;3(5):266-271.
doi: 10.1016/j.jhsg.2021.06.004. eCollection 2021 Sep.

Power-Optimizing Repair for Distal Biceps Tendon Rupture: Stronger and Safer

Joshua T Tadevich  1 , Neel D Bhagat  1 , Boon H Lim  2 , Jinling Gao  2 , Weinong W Chen  2 , Gregory A Merrell  3
Affiliations

Power-Optimizing Repair for Distal Biceps Tendon Rupture: Stronger and Safer

Joshua T Tadevich et al. J Hand Surg Glob Online. .

Abstract

Purpose: Many approaches have been described to accomplish tendon reattachment to the radial tuberosity in a distal biceps tendon rupture, with significant success, but each is associated with potential postoperative complications, including posterior interosseous nerve (PIN) injury. To date, there has been no consensus on the best approach to the repair. The purpose of this study was to evaluate the supination strength and the distance of drill exit points from the PIN in a power-optimizing distal biceps repair method and compare the findings with those of a traditional anterior approach endobutton repair method.

Methods: Cadaveric arms were dissected to allow for distal biceps tendon excision from its anatomic footprint. Each arm was repaired twice, first with the power-optimizing repair using an anterior single-incision approach with an ulnar drilling angle and biceps tendon radial tuberosity wraparound anatomic footprint attachment, then with the traditional anterior endobutton repair. Following each repair, the arm was mounted on a custom-built testing apparatus, and the supination torque was measured from 3 orientations. The PIN was then located posteriorly, and its distance from each repair exit hole was measured.

Results: Five cadaveric arms, each with both the repairs, were included in the study. On average, the power-optimizing repair generated an 82%, 22%, and 13% greater supination torque than the traditional anterior endobutton repair in 45° supination, neutral, and 45° pronation orientations, respectively. On average, the power-optimizing repair produced drill hole exit points farther from the PIN (23 mm) than the traditional anterior endobutton repair (14 mm).

Conclusions: The power-optimizing repair provides a significantly greater supination torque and produces a drill hole exit point significantly farther from the PIN than the traditional anterior endobutton approach.

Type of study/level of evidence: Therapeutic III.

Keywords: Distal biceps tendon repair; Posterior interosseous nerve; Supination.

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Figures

Figure 1
Figure 1
Demonstration of a cadaveric arm mounted on a custom-built testing apparatus with distal plate fixation connected to a torque sensor and proximal fixation via an olecranon pin and a mid-humeral strap. A pulley attaches the biceps tendon to a 9.07 kg weight.
Figure 2
Figure 2
Power-optimizing wraparound repair of the left arm. A Site of drill hole for repair with the arm hypersupinated. B–D A spinal needle is used to thread the suture through the bone and wrap repair around the radius to the native footprint. E Secured power-optimizing wraparound repair.
Figure 3
Figure 3
Traditional anterior endobutton repair of the left arm. A Drill and endobutton release site. B Secured traditional anterior endobutton repair.
Figure 4
Figure 4
Isolated PIN and drill exit holes. A guide wire pin was passed through the drill holes (green arrow) created by each repair to demonstrate proximity to the PIN (yellow arrow). A Representation of a power-optimizing repair. B Representation of a traditional anterior endobutton repair.
See this image and copyright information in PMC

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