Skip to main content

Advertisement

Log in

High complication rate following distal biceps refixation with cortical button

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

There are several methods for the refixation of the distal biceps tendon which show a variable complication rate. The aim of the present study was to evaluate the clinical outcome and complication rate after distal biceps repair in cortical button technique.

Methods

Clinical results, complications, strength of elbow flexion and supination and radiological evidence of heterotopic ossification in patients reporting persistent pain were evaluated in 27 male patients after an average of 36.1 month following distal biceps tendon repair in cortical button technique.

Results

The mean Mayo elbow performance score was 95.9 (SD 11.9), the mean disabilities of the arm, shoulder and hand score was 1.9 (SD 4.9) and the mean American shoulder and elbow surgeons (ASES) score was 94.6 (SD 11.6). The mean flexion and supination strength of the involved side relative to the uninvolved side was 91.7 % (SD 12.6) and 87.8 % (SD 15.9). Nine patients had 14 different complications including four transient lesions of the posterior interosseous nerve, two persistent lesions of the superficial branch of the radial nerve, one symptomatic massive heterotopic ossification and one disengaged cortical button. Three patients had six revisions. Patients with complications had a significantly lower relative supination strength, Mayo elbow performance score, ASES score, pain on VAS (p < 0.05 each) and satisfaction (p = 0.005).

Conclusions

As described for other techniques there is a high complication rate of distal biceps tendon repair in cortical button technique which resulted in inferior functional results and satisfaction. Surgeons treating patients with distal biceps tendon rupture should know the specific complications and know how to avoid them.

Level of evidence

Case series with no comparison group, Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Bain GI, Prem H, Heptinstall RJ, Verhellen R, Paix D (2000) Repair of distal biceps tendon rupture: a new technique using endobutton. J Should Elbow Surg 9:120–126

    Article  CAS  Google Scholar 

  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 67:414–417

    PubMed  CAS  Google Scholar 

  3. Cain RA, Nydick JA, Stein MI, Williams BD, Polikandriotis JA, Hess AV (2012) Complications following distal biceps repair. J Hand Surg 37:2112–2117

    Article  Google Scholar 

  4. Citak M, Backhaus M, Seybold D, Suero EM, Schildhauer TA, Roetman B (2011) Surgical repair of the distal biceps brachii tendon: a comparative study of three surgical fixation techniques. Knee Surg Sports Traumatol Arthrosc 19:1936–1941

    Article  PubMed  Google Scholar 

  5. Chavan PR, Duquin TR, Bisson LJ (2008) Repair of the ruptured distal biceps tendon: a systematic review. Am J Sports Med 36:1618–1624

    Article  PubMed  Google Scholar 

  6. Chillemi C, Marinelli M, De Cupis V (2007) Rupture of the distal biceps brachii tendon: conservative treatment versus anatomic reinsertion—clinical and radiological evaluation after 2 years. Arch Orthop Trauma Surg 127:705–708

    Article  PubMed  Google Scholar 

  7. Dillon MT, Lepore DJ (2011) Heterotopic ossification after single-incision distal biceps tendon repair with an endobutton. J Surg Orthop Adv 20:198–201

    PubMed  Google Scholar 

  8. Dillon MT, Bollier MJ, King JC (2011) Repair of acute and chronic distal biceps tendon ruptures using the EndoButton. Hand 6:39–46

    Article  PubMed  Google Scholar 

  9. Freeman CR, McCormick KR, Mahoney D, Baratz M, Lubahn JD (2009) Nonoperative treatment of distal biceps tendon ruptures compared with a historical control group. J Bone Joint Surg Am 91:2329–2334

    Article  PubMed  Google Scholar 

  10. Gallinet D, Dietsch E, Barbier-Brion B, Lerais JM, Obert L (2011) Suture anchor reinsertion of distal biceps rupture: clinical results and radiological assessment of tendon healing. Orthop Traumatol Surg Res 97:252–259

    Article  PubMed  CAS  Google Scholar 

  11. Greenberg JA, Fernandez JJ, Wang T, Turner C (2003) EndoButton-assisted repair of distal biceps tendon ruptures. J Should Elbow Surg 12:484–490

    Article  Google Scholar 

  12. Heinzelmann AD, Savoie FH 3rd, 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

    Article  PubMed  Google Scholar 

  13. Hetsroni I, Pilz-Burstein R, Nyska M, Back Z, Barchilon V, Mann G (2008) Avulsion of the distal biceps brachii tendon in middle-aged population: is surgical repair advisable? A comparative study of 22 patients treated with either nonoperative management or early anatomical repair. Injury 39:753–760

    Article  PubMed  Google Scholar 

  14. Kettler M, Tingart MJ, Lunger J, Kuhn V (2008) Reattachment of the distal tendon of biceps: factors affecting the failure strength of the repair. J Bone Joint Surg Br 90:103–106

    PubMed  CAS  Google Scholar 

  15. Lo EY, Li CS, van den Boegaerde JM (2011) The effect of drill trajectory on proximity to the posterior interosseous nerve during cortical button distal biceps repair. Arthroscopy 27:1048–1054

    Article  PubMed  Google Scholar 

  16. Mazzocca AD, Burton KJ, Romeo AA, Santangelo AS, Adams DA, Arciero DA (2007) Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair. Am J Sports Med 35:252–258

    Article  PubMed  Google Scholar 

  17. Nesterenko S, Domire ZJ, Morrey BF, Sanchez-Sotelo J (2010) Elbow strength and endurance in patients with a ruptured distal biceps tendon. J Should Elbow Surg 19:184–189

    Article  Google Scholar 

  18. O’Driscoll SW, Goncalves LB, Dietz P (2007) The hook test for distal biceps tendon avulsion. Am J Sports Med 35:1865–1869

    Article  PubMed  Google Scholar 

  19. Peeters T, Ching-Soon NG, Jansen N, Sneyers C, Declercq G, Verstreken F (2009) Functional outcome after repair of distal biceps tendon ruptures using endobutton technique. J Should Elbow Surg 18:283–287

    Article  Google Scholar 

  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 19:1019–1022

    Article  PubMed  Google Scholar 

  21. Siebenlist S, Elser F, Sandmann GH, Buchholz A, Martetschläger F, Stöckle U, Lenich A (2011) The double intramedullary cortical button fixation for distal biceps tendon repair. Knee Surg Sports Traumatol Arthrosc 19:1915–1929

    Article  Google Scholar 

  22. Schmidt CC, Diaz VA, Weir DM, Latona CR, Miller MC (2012) Repaired distal biceps magnetic resonance imaging anatomy compared with outcome. J Should Elbow Surg 21

  23. Vidal AF, Koonce RC, Wolcott M, Gonzales JB (2012) Extensive heterotopic ossification after suspensory cortical fixation of acute distal biceps tendon ruptures. Arthroscopy 28:1036–1140

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

No author declares conflicts of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marc Banerjee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Banerjee, M., Shafizadeh, S., Bouillon, B. et al. High complication rate following distal biceps refixation with cortical button. Arch Orthop Trauma Surg 133, 1361–1366 (2013). https://doi.org/10.1007/s00402-013-1819-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-013-1819-1

Keywords

Navigation