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Anatomic single-incision footprint reconstruction of the distal biceps tendon: an accuracy analysis of 31 men including force measurements

Anatomische Single-Incision-Footprint-Rekonstruktion der distalen Bizepssehne: eine Präzisionsanalyse von 31 Männern einschließlich Kraftmessungen

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Abstract

Background

Anatomic reconstruction of distal biceps tendon ruptures may prevent loss of strength and the associated restrictions in everyday life. We investigated whether an anterior single-incision approach is effective in anatomically reconstructing the tendon footprint using a bicortical endobutton and whether this affects postoperative force development.

Methods

All adult patients (≥ 18 years of age) with at least 1 year of follow-up after acute distal biceps tendon rupture treated by bicortical endobuttons using the single-incision technique were eligible for inclusion. Radiographic assessment included analysis of the anatomic footprint. Functional follow-up included range of motion, objective and subjective performance measures, flexion and supination forces, complications, and rates of return to sport and to work. Mean flexion and supination forces were statistically compared between the affected and unaffected side.

Results

After a mean follow-up of 31.5 ± 16.6 months, satisfactory results were obtained for 31 male patients (mean age: 50 ± 9 years). Postoperatively, supination strength measures (starting force, maximum force, terminal force, and average force) were significantly lower on the affected side vs. the unaffected side. This involved the dominant arm in 58% of cases. The tendon was anatomically reconstructed in 4 out of 31 cases (12.9%). On average, return to work was 6.2 ± 4.3 weeks and return to sports was 5.0 ± 2.9 months. The return-to-work and return-to-sports rates amounted to 100%.

Conclusion

Supination strength suffers after distal biceps tendon reconstruction relative to the unaffected side. In most cases (87.1%), the distal biceps tendon could not be reattached to its anatomic footprint via an anterior single-incision approach. Intraoperative radiographic control might improve anatomic positioning of the refixation and remains to be evaluated.

Zusammenfassung

Einleitung

Die anatomische Rekonstruktion von Rupturen der distalen Bizepssehne kann einen erheblichen Kraftverlust und die damit verbundenen Einschränkungen im Alltag verhindern. In der vorliegenden Arbeit wurde untersucht, ob ein anteriorer Single-Incision-Zugang bei der anatomischen Rekonstruktion des Sehnen-Footprints mit einem bikortikalen Endobutton erfolgreich ist und ob dies die postoperative Kraftentwicklung beeinflusst.

Methoden

Alle erwachsenen Patienten (> 18 Jahre) mit einer Nachbeobachtungszeit von mindestens einem Jahr nach einer akuten distalen Bizepssehnenruptur, die mit bikortikalen Endobuttons in Single-Incision-Technik behandelt wurde, wurden in die Studie aufgenommen. Die Patienten wurden hinsichtlich ihres klinischen Verlaufs nachbeobachtet. Die röntgenologische Beurteilung umfasste die Analyse des anatomischen Footprints. Die funktionelle Nachuntersuchung erfasste den Bewegungsumfang, objektive und subjektive Leistungsmessungen, Flexions- und Supinationskräfte, Komplikationen sowie die Wiederaufnahme des Sports und die Rückkehr an den Arbeitsplatz. Die mittleren Flexions- und Supinationskräfte wurden statistisch zwischen der betroffenen und der nicht betroffenen Seite verglichen.

Ergebnisse

Nach einer mittleren Nachbeobachtungszeit von 31,5 ± 16,6 Monaten wurden bei 31 männlichen Patienten mit einem Durchschnittsalter von 50 ± 9 Jahren zufriedenstellende Ergebnisse erreicht. Postoperativ waren die Werte für die Supinationskraft (Anfangskraft, Maximalkraft, Endkraft und Durchschnittskraft) auf der betroffenen Seite signifikant niedriger als auf der nicht betroffenen Seite. Dies betraf in 58 % der Fälle den dominanten Arm. In 4 von 31 Fällen (12,9 %) wurde die Sehne anatomisch rekonstruiert. Die Rückkehr zur Arbeit dauerte im Durchschnitt 6,2 ± 4,3 Wochen und die Rückkehr zum Sport durchschnittlich 5,0 ± 2,9 Monate. Die Raten für die Rückkehr an den Arbeitsplatz und die Rückkehr zum Sport betrugen jeweils 100 %.

Schlussfolgerung

Nach einer Rekonstruktion der distalen Bizepssehne leidet vor allem die Supinationskraft im Vergleich zur nicht betroffenen Seite. In den meisten Fällen (87,1 %) konnte die distale Bizepssehne über einen anterioren Single-Incision-Zugang nicht am anatomischen Footprint refixiert werden. Eine intraoperative radiologische Kontrolle könnte die anatomische Positionierung der Refixation möglicherweise verbessern. Dies sollte in zukünftigen Studien untersucht werden.

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Authors and Affiliations

  1. Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany

    Fabian Lanzerath, Gregor Berrsche MD, Sven Lichtenberg MD, Markus Loew MD PhD & Marc Schnetzke MD PhD

  2. Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany

    Fabian Lanzerath

  3. Department of Orthopedic and Trauma Surgery, BGU Hospital Ludwigshafen, Ludwigshafen, Germany

    Jannes Kreher MD

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  1. Fabian Lanzerath
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  2. Gregor Berrsche MD
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  3. Jannes Kreher MD
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  4. Sven Lichtenberg MD
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  5. Markus Loew MD PhD
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Correspondence to Fabian Lanzerath.

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Conflict of interest

M. Loew is a paid consultant for Wright Medical Inc. S. Lichtenberg is a paid consultant for Arthrex and Exactech and has received royalties from Arthrex, not related to the subject of this work. F. Lanzerath, G. Berrsche, J. Kreher and M. Schnetzke declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Lanzerath, F., Berrsche, G., Kreher, J. et al. Anatomic single-incision footprint reconstruction of the distal biceps tendon: an accuracy analysis of 31 men including force measurements. Obere Extremität 18, 261–266 (2023). https://doi.org/10.1007/s11678-023-00765-5

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  • DOI: https://doi.org/10.1007/s11678-023-00765-5

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