Distal biceps reconstruction: a long-term follow-up of the complications and durability of the single-incision power optimizing cost-effective (SPOC) repair

Abstract

Background: The Single-Incision Power Optimizing Cost-Effective Repair (SPOC) method reattaches the distal biceps tendon to its original posterior anatomic footprint and utilizes the anterior cortex of the supinated radius for fixation. The purpose of the study was to define the long-term complications and durability of the SPOC method.

Methods: Two hundred and eighteen patients underwent the SPOC repair of distal biceps ruptures from 2008 to 2020, with 185 having at least 1-year follow-up data. The average follow-up was 50.1 months. Information regarding smoking, body mass index, interval between injury and surgery, peripheral nerve injury, heterotopic ossification, vascular injury, re-rupture, chronic regional pain syndrome, fracture of the radius, loss of motion, pain with use, and deformity were acquired.

Results: No complication occurred beyond the third postoperative month. No patient complained of severe lateral antebrachial cutaneous nerve-related symptoms. Major complications exclusive of re-rupture occurred include 1 case of heterotopic ossification and 1 deep infection. Major complications with re-ruptures occurred in 9 patients (4.8%). Seven of the re-ruptures (78%) were associated with an unexpected forceful contraction within the first 4 weeks postop. All complications aside from 1 minor complication occurred in the chronic group. Long term follow-up revealed no re-ruptures and high satisfaction rate with return of strength, motion, and biceps profile.

Conclusion: The safety profile of the SPOC repair is consistent with those of other published repairs. Major complications were associated with prolonged intervals between injury and reconstruction. Re-ruptures were associated with worker's compensation status and patient noncompliance with postoperative protocols.

Keywords: Complications; Distal bicep; Reconstruction; Repair; SPOC; Strength measurement.

Figure 1

A: SPOC repair. B: Cortical button repair. The radius is in supination in A and B: the tuberosity would be prominent on an anterior-posterior (AP) radiograph. A: The SPOC technique reverses the cortical button tendon insertion and fixation site, so replacing the tendon to its native insertion site and providing fixation to the anterior cortex of the radius. This restores the supination moment arm. In addition, the proximal radial to distal ulnar drill trajectory increases the distance from the posterior drill hole to the posterior interosseous nerve (Fig. 2).^, C: The SPOC method incorporates 2 separate sutures securing the distal biceps tendon to the anterior cortex of the radius, each tied over the bone bridge. SPOC, Single-incision power optimizing cost-effective repair.