Abstract
Purpose
Previous studies that have encouraged early postoperative motion after distal biceps repair shows little agreement on exactly when activity should be resumed after surgery or on the level of weight restriction that should be used. The aim of the current study was to define a service load that would permit, without failure, 2,000 cycles of immediate motion after single-incision EndoButton distal biceps repair with FiberWire.
Methods
In each of 15 cadaveric elbows, the distal biceps tendon was divided at its insertion and then repaired using a single-incision EndoButton technique with FiberWire. The repairs were then challenged according to the “staircase method” by cyclically loading the biceps tendon, so that the forearm flexed between 0° and 90°.
Results
The mean failure load of the repair was 166.7 N (95% confidence interval, 132.6–200.8). The data suggested that a 0.9 kg (9-N) weight at the hand was the limit for a 2,000-cycle early rehabilitation protocol after repair of a ruptured distal biceps tendon via a single-incision EndoButton repair technique.
Conclusion
Early active motion with a 0.9-kg weight restriction may therefore be possible in those patients undergoing distal biceps tendon repair using this technique.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
An KN, Chao EYS, Kaufman KR (1991) Analysis of muscle and joint loads. In: Mow VC, Hayes WC (eds) Basic orthopaedic biomechanics. Raven Press, New York, pp 1–50
An KN, Hui FC, Morrey BF, Linscheid RL, Chao EY (1981) Muscles across the elbow joint: a biomechanical analysis. J Biomech 14:659–669
Bain GI, Prem H, Heptinstall RJ, Verhellen R, Paix D (2000) Repair of distal biceps tendon rupture: a new technique using the EndoButton. J Shoulder Elbow Surg 9:120–126
Bisson LJ, de Perio JG, Weber AE, Ehrensberger MT, Buyea C (2007) Is it safe to perform aggressive rehabilitation after distal biceps tendon repair using the modified 2-incision approach? A biomechanical study. Am J Sports Med 35:2045–2050
Chavan PR, Duquin TR, Bisson LJ (2008) Repair of the ruptured distal biceps tendon. A systematic review. Am J Sports Med 36:1618–1624
Cheung EV, Lazarus M, Taranta M (2005) Immediate range of motion after distal biceps tendon repair. J Shoulder Elbow Surg 14:516–518
Cil A, Merten S, Steinmann SP (2009) Immediate active range of motion after modified 2-incision repair in acute distal biceps tendon rupture. Am J Sports Med 37:130–135
Collins JA (1981) Failure of materials in mechanical design. Analysis, prediction, prevention. John Wiley, New York
Collins JA (1981) Fatigue testing procedures and statistical interpretations of data. In: failure of materials in mechanical design analysis, prediction, prevention. John Wiley, New York, pp 360–378
Greenberg JA, Fernandez JJ, Wang T, Turner C (2003) EndoButton-assisted repair of distal biceps tendon ruptures. J Shoulder Elbow Surg 12:484–490
Heinzelmann AD, Savoie FH III, Ramsey JR, Field LD, Mazzocca AD (2009) A combined technique for distal biceps repair using a soft tissue button and biotenodesis interference screw. Am J Sports Med 37:989–994
Kettler M, Lunger J, Kuhn V, Mutschler W, Tingart MJ (2007) Failure strengths in distal biceps tendon repair. Am J Sports Med 35:1544–1548
Krackow KA (2008) The Krackow suture: how, when, and why. Orthopedics 31:931–933
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 35:252–258
Morrey BF, Askew LJ, An KN, Dobyns JH (1985) Rupture of the distal tendon of the biceps brachii. A biomechanical study. J Bone Joint Surg Am 67:418–421
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 18:283–287
Safran MR, Graham SM (2002) Distal biceps tendon ruptures. Incidence, demographics, and the effect of smoking. Clin Orthop Relat Res 404:275–283
Sethi P, Obopilwe E, Rincon L, Miller S, Mazzocca A (2009) Biomechanical evaluation of distal biceps reconstruction with cortical button and interference screw fixation. J Shoulder Elbow Surg. doi:10.1016/j.jse.2009.05.007
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 15:509–514
Spencer EE Jr, Tisdale A, Kostka K, Ivy RE (2008) Is therapy necessary after distal biceps tendon repair? Hand (N Y) 3:316–319
Sutton KM, Dodds SD, Ahmad CS, Sethi PM (2010) Surgical treatment of distal biceps rupture. J Am Acad Orthop Surg 18:139–148
Acknowledgments
The authors received a donation of EndoButton devices only from Smith and Nephew. Dr. David Rose also received financial support for his fellowship from Finsbury Orthopaedics, UK.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rose, D.M., Archibald, J.D., Sutter, E.G. et al. Biomechanical analysis suggests early rehabilitation is possible after single-incision EndoButton distal biceps repair with FiberWire. Knee Surg Sports Traumatol Arthrosc 19, 1019–1022 (2011). https://doi.org/10.1007/s00167-010-1348-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-010-1348-1