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Outcomes of distal biceps tendon reattachment using the ToggleLoc™ fixation device with ZipLoop™ technology with single mini-open technique

  • Florie Alech-TournierEmail author
  • Kamil Elkholti
  • Vincent Locquet
  • Michel Ninou
  • Nicolas Gibert
  • Marc Pozzetto
  • Frédéric Breden
  • Pascal Rostoucher
  • Antoine Marc
  • Lionel Erhard
  • Jérôme Vogels
Technical Note • ELBOW - ARTHROSCOPY

Abstract

Anatomical repair of distal biceps tendon ruptures has been shown to restore elbow supination and flexion strength. Here, we report the outcomes of distal biceps tendon reattachment using the ToggleLoc fixation device with ZipLoop technology through a single incision. This was a retrospective study of 38 patients with a mean age of 49.5 years. The mean follow-up time was 15 months (range 4/28). The average time to surgery was 21 days. The fixation button was introduced in a bone tunnel and the tendon passed through a bone window using the ToggleLoc™, which allows the tendon to be tensioned using sutures. The tendon was reattached in 30° elbow flexion. The mean strength deficit in supination was 23.9% in comparison with the contralateral side. We discovered four instances of heterotopic ossification on follow-up radiographs. There were seven cases of persistent lateral antebrachial cutaneous nerve paresthesia, but no damage to the posterior interosseous nerve. This new technique places the tendon in a bone tunnel using a single surgical approach. It provides the surgeon with good feedback on the tension of the repair, which is unique among endobutton-type devices. We recommend using the ToggleLoc™ with ZipLoop™ technology as it is a simple, reliable and reproducible technique for distal biceps tendon reattachment.

Keywords

Distal biceps Endobutton ZipLoop ToggleLoc 

Notes

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no competing interests.

References

  1. 1.
    Athwal GS (2016) Management of elbow trauma, an issue of hand clinics 31-4, E-Book. Elsevier Health Sciences, New YorkGoogle Scholar
  2. 2.
    Baker BE, Bierwagen D (1985) Rupture of the distal tendon of the biceps brachii. Operative versus non-operative treatment. J Bone Joint Surg Am 67:414–417CrossRefGoogle Scholar
  3. 3.
    Baker CLJ, Plancher KD (2006) Operative treatment of elbow injuries. Springer, BerlinGoogle Scholar
  4. 4.
    Cain RA, Nydick JA, Stein MI, Williams BD, Polikandriotis JA, Hess AV (2012) Complications following distal biceps repair. J Hand Surg 37:2112–2117CrossRefGoogle Scholar
  5. 5.
    Chavan PR, Duquin TR, Bisson LJ (2008) Repair of the ruptured distal biceps tendon: a systematic review. Am J Sports Med 36:1618–1624CrossRefGoogle Scholar
  6. 6.
    D’Alessandro DF, Shields CL, Tibone JE, Chandler RW (1993) Repair of distal biceps tendon ruptures in athletes. Am J Sports Med 21:114–119CrossRefGoogle Scholar
  7. 7.
    Dillon MT, Bollier MJ, King JC (2011) Repair of acute and chronic distal biceps tendon ruptures using the EndoButton. Hand N Y N 6:39–46CrossRefGoogle Scholar
  8. 8.
    DiRaimo MJ, Maney MD, Deitch JR (2008) Distal biceps tendon repair using the toggle loc with zip loop. Orthopedics 31:1201–1203CrossRefGoogle Scholar
  9. 9.
    Greenberg JA, Fernandez JJ, Wang T, Turner C (2003) EndoButton-assisted repair of distal biceps tendon ruptures. J Shoulder Elbow Surg 12:484–490CrossRefGoogle Scholar
  10. 10.
    Haute Autorité de Santé - Programmes de récupération améliorée après chirurgie (RAAC)Google Scholar
  11. 11.
    Keener JD (2011) Controversies in the surgical treatment of distal biceps tendon ruptures: single versus double-incision repairs. J Shoulder Elbow Surg 20:S113–S125CrossRefGoogle Scholar
  12. 12.
    Kodde IF, Bekerom MPJ van den, Eygendaal DE (2013) Reconstruction of distal biceps tendon ruptures with a cortical button. Knee Surg Sports Traumatol Arthrosc 23(3):919–925CrossRefGoogle Scholar
  13. 13.
    Lo EY, Li C-S, Van den Bogaerde JM (2011) The effect of drill trajectory on proximity to the posterior interosseous nerve during cortical button distal biceps repair. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 27:1048–1054CrossRefGoogle Scholar
  14. 14.
    Mazzocca AD, Burton KJ, Romeo AA, Santangelo S, Adams DA, Arciero RA (2007) Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair. Am J Sports Med 35:252–258CrossRefGoogle Scholar
  15. 15.
    Morrey BF (2009) The elbow and its disorders. Elsevier Health Sciences, New YorkGoogle Scholar
  16. 16.
    Morrey ME, Abdel MP, Sanchez-Sotelo J, Morrey BF (2014) Primary repair of retracted distal biceps tendon ruptures in extreme flexion. J Shoulder Elbow Surg 23:679–685CrossRefGoogle Scholar
  17. 17.
    Peeters T, Ching-Soon NG, Jansen N, Sneyers C, Declercq G, Verstreken F (2009) Functional outcome after repair of distal biceps tendon ruptures using the endobutton technique. J Shoulder Elbow Surg 18:283–287CrossRefGoogle Scholar
  18. 18.
    Ramsey ML (1999) Distal biceps tendon injuries: diagnosis and management. J Am Acad Orthop Surg 7:199–207CrossRefGoogle Scholar
  19. 19.
    Ranelle RG (2007) Use of the Endobutton in repair of the distal biceps brachii tendon. Proc Bayl Univ Med Cent 20:235–236CrossRefGoogle Scholar
  20. 20.
    Rose DM, Archibald JD, Sutter EG, Belkoff SM, Wilckens JH (2011) Biomechanical analysis suggests early rehabilitation is possible after single-incision EndoButton distal biceps repair with FiberWire. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 19:1019–1022CrossRefGoogle Scholar
  21. 21.
    Spang JT, Weinhold PS, Karas SG (2006) A biomechanical comparison of EndoButton versus suture anchor repair of distal biceps tendon injuries. J Shoulder Elbow Surg 15:509–514CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • Florie Alech-Tournier
    • 1
    Email author
  • Kamil Elkholti
    • 1
  • Vincent Locquet
    • 1
  • Michel Ninou
    • 1
  • Nicolas Gibert
    • 1
  • Marc Pozzetto
    • 1
  • Frédéric Breden
    • 1
  • Pascal Rostoucher
    • 1
  • Antoine Marc
    • 1
  • Lionel Erhard
    • 1
  • Jérôme Vogels
    • 1
  1. 1.Institut chirurgical de la main et du membre supérieurVilleurbanneFrance

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