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Repair of distal biceps brachii tendon assessed with 3-T magnetic resonance imaging and correlation with functional outcome

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Abstract

Objective

Objectives were to study the MRI appearance of the repaired distal biceps tendon (DBT), anatomically reinserted, and to search for a correlation between tendon measurements and functional results.

Materials and methods

Twenty-five patients (mean age, 49 ± 4.9 years old) who benefited from 3-T MRI follow-up of the elbow after surgical reinsertion of the DBT were retrospectively included and compared to a control group (n = 25; mean age, 48 ± 10 years old). MRI was performed during the month of clinical follow-up and on average 22 months after surgery. Delayed complications (secondary avulsion, new rupture), intratendinous osteoma, tendinous signal on T1-weighted (T1w) and fat-suppressed proton density-weighted (FS-PDw) images as well as DBT measurements were recorded. The maximum isometric elbow flexion strength (MEFS) and range of motion of the elbow were assessed.

Results

Repaired DBT demonstrated a heterogeneous but normally fibrillar structure. Its low T1w signal was less pronounced than that of normal tendons, and the FS-PDW image signal was similar to that of T1w images. MRI detected seven osteomas (Se = 53 % vs. plain radiography), one textiloma and one secondary avulsion. Repaired DBT measurements were significantly correlated with MEFS (dominant arm R2: 0.38; nondominant arm R2: 0.54); this correlation involved the insertion surface (Δ = −75.7 mm2, p = 0.046), transverse diameter (Δ = −2.6 mm, p = 0.018), anteroposterior diameter at the level of the radial head (Δ = −3.9 mm, p = 0.001) and DBT cross-sectional area (Δ = −50.2 mm2, p = 0.003).

Conclusion

The quality of functional outcome after anatomical elbow rehabilitation of DBT correlates with the extent of tendinous hypertrophy during the healing process.

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References

  1. Safran MR, Graham SM. Distal biceps tendon ruptures: incidence, demographics, and the effect of smoking. Clin Orthop Rel Res. 2002(404):275-283

  2. Morrey BF. Injury of the flexors of the elbow: biceps tendon injury. The elbow and its disorders. 4th ed. Philadelphia: Saunders; 2008:518-535.

  3. Mazzocca AD, Spang JT, Arciero RA. Distal biceps rupture. Orthop Clin N Am. 2008;39(2):237–49. vii.

    Article  Google Scholar 

  4. Vidal AF, Drakos MC, Allen AA. Biceps tendon and triceps tendon injuries. Clin Sports Med. 2004;23(4):707–22.

    Article  PubMed  Google Scholar 

  5. Schneider A, Bennett JM, O’Connor DP, Mehlhoff T, Bennett JB, Savvidou C. Bilateral ruptures of the distal biceps brachii tendon Spontaneous distal biceps tendon ruptures: are they related to statin administration. J Should Elb Surg Am Should Elb Surg. 2009;18(5):804–7.

    Article  Google Scholar 

  6. Savvidou C, Moreno R. Spontaneous distal biceps tendon ruptures: are they related to statin administration? Hand surgery: An international journal devoted to hand and upper limb surgery and related research. J Asia Pac Fed Soc Surg Hand. 2012;17(2):167–71.

    Google Scholar 

  7. Rineer CA, Ruch DS. Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures. J Hand Surg. 2009;34(3):566–76.

    Article  Google Scholar 

  8. Bernstein AD, Breslow MJ, Jazrawi LM. Distal biceps tendon ruptures: a historical perspective and current concepts. Am J Orthop (Belle Mead NJ). 2001;30(3):193–200.

    CAS  Google Scholar 

  9. Chillemi C, Marinelli M, De Cupis V. Rupture of the distal biceps brachii tendon: Conservative treatment versus anatomic reinsertion—clinical and radiological evaluation after 2 years. Arch Orthop Trauma Surg. 2007;8:705–8.

    Article  Google Scholar 

  10. Baker BE, Bierwagen D. Rupture of the distal tendon of the biceps brachii. Operative versus non-operative treatment. J Bone Joint Surg Am. 1985;67(3):414–7.

    CAS  PubMed  Google Scholar 

  11. Geaney LE, Mazzocca AD. Biceps brachii tendon ruptures: a review of diagnosis and treatment of proximal and distal biceps tendon ruptures. Physician Sports Med. 2010;38(2):117–25.

    Article  Google Scholar 

  12. Catonne Y, Delattre O, Pascal-Mousselard H, d’Istria FC, Busson J, Rouvillain JL. Rupture of the distal tendon of the biceps brachialis: apropos of 43 cases. Rev Chir Orthop Reparatrice Appar Mot. 1995;81(2):163–72.

    CAS  PubMed  Google Scholar 

  13. Boyd HB, Anderson LD. A method for reinsertion of the distal biceps brachii tendon. J Bone Joint Surg Am. 1961;43(7):1041–3.

    Google Scholar 

  14. Lintner S, Fischer T. Repair of the distal biceps tendon using suture anchors and an anterior approach. Clin Orthop Relat Res. 1996;322:116–9.

    Article  PubMed  Google Scholar 

  15. Barnes SJ, Coleman SG, Gilpin D. Repair of avulsed insertion of biceps. A new technique in four cases. J Bone Joint Surg Br. 1993;75(6):938–9.

    CAS  PubMed  Google Scholar 

  16. Bain GI, Prem H, Heptinstall RJ, Verhellen R, Paix D. Repair of distal biceps tendon rupture: A new technique using the Endobutton. J Should Elb Surg Am Should Elb Surg. 2000;9(2):120–6.

    Article  CAS  Google Scholar 

  17. Morrey BF, Askew LJ, An KN, Dobyns JH. Rupture of the distal tendon of the biceps brachii. A biomechanical study. J Bone Joint Surg Am. 1985;67(3):418–21.

    CAS  PubMed  Google Scholar 

  18. Bell RH, Wiley WB, Noble JS, Kuczynski DJ. Repair of distal biceps brachii tendon ruptures. J Should Elb Surg Am Should Elb Surg. 2000;9(3):223–6.

    Article  CAS  Google Scholar 

  19. Nesterenko S, Domire ZJ, Morrey BF, Sanchez-Sotelo J. Elbow strength and endurance in patients with a ruptured distal biceps tendon. J Should Elb Surg Am Should Elb Surg. 2010;19(2):184–9.

    Article  Google Scholar 

  20. Balabaud L, Ruiz C, Nonnenmacher J, Seynaeve P, Kehr P, Rapp E. Repair of distal biceps tendon ruptures using a suture anchor and an anterior approach Repair of distal biceps tendon ruptures in athletes. J Hand Surg (Edinb Scotl). 2004;29(2):178–82.

    Article  CAS  Google Scholar 

  21. Cain RA, Nydick JA, Stein MI, Williams BD, Polikandriotis JA, Hess AV. Complications following distal biceps repair. J Hand Surg. 2012;37(10):2112–7.

    Article  Google Scholar 

  22. Schmidt CC, Diaz VA, Weir DM, Latona CR, Miller MC. Repaired distal biceps magnetic resonance imaging anatomy compared with outcome. J Should Elb Surg Am Should Elb Surg. 2012;21(12):1623–31.

    Article  Google Scholar 

  23. Marnitz T, Spiegel D, Hug K, Huper M, Gerhardt C, Steffen IG. MR imaging findings in flexed abducted supinated (FABS) position and clinical presentation following refixation of distal biceps tendon rupture using bioabsorbable suture anchors. RoFo: Fortschr auf dem Geb Rontgenstrahlen und Nuklearmedizin. 2012;184(5):432–6.

    Article  CAS  Google Scholar 

  24. Ramnath RR. 3T MR imaging of the musculoskeletal system (Part I): Considerations, coils, and challenges. Mag Reson Imaging Clin N Am. 2006;14(1):27–40.

    Article  Google Scholar 

  25. Brasseur JL. The biceps tendons: From the top and from the bottom. J Ultrasound. 2012;15(1):29–38.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Soucie JM, Wang C, Forsyth A, Funk S, Denny M, Roach KE. Range of motion measurements: Reference values and a database for comparison studies. Haemophilia. Off J World Fed Hemophilia. 2011;17(3):500–7.

    Article  CAS  Google Scholar 

  27. Sotje G, Besch L. Distal rupture of the biceps tendon—a magnetic resonance tomography follow-up. Aktuelle Traumatol. 1993;23(2):105–7.

    CAS  PubMed  Google Scholar 

  28. Roger B, Saillant G. Imagerie par résonance magnétique du tendon patellaire opéré Getroa Opus XXX: Sauramps Medical; 2003:389-394.

  29. Maffulli N, Thorpe AP, Smith EW. Magnetic resonance imaging after operative repair of Achilles tendon rupture. Scand J Med Sci Sports. 2001;11(3):156.

    Article  CAS  PubMed  Google Scholar 

  30. Khan KM, Cook JL, Bonar F, Harcourt P, Astrom M. istopathology of common tendinopathies. Update and implications for clinical management. Sports Med (Auckland NZ). 1999;27(6):393–408.

    Article  CAS  Google Scholar 

  31. Fantino O, Besse J, Moyen B, Tran Minh V. Imagerie du tendon calcanéen opéré: Echographie et IRM. Getroa Opus XXX: Sauramps Medical; 2003. p. 395–408.

    Google Scholar 

  32. Greenberg JA, Fernandez JJ, Wang T, Turner C. EndoButton-assisted repair of distal biceps tendon ruptures. J Should Elb Surg Am Should Elb Surg. 2003;12(5):484–90.

    Article  Google Scholar 

  33. Klonz A, Loitz D, Wohler P, Reilmann H. Rupture of the distal biceps brachii tendon: isokinetic power analysis and complications after anatomic reinsertion compared with fixation to the brachialis muscle. J Should Elb Surg Am Should Elb Surg. 2003;12(6):607–11.

    Article  Google Scholar 

  34. Behounek J, Hrubina M, Skotak M, Krumpl O, Zahalka M, Dvorak J. Evaluation of surgical repair of distal biceps tendon ruptures. Acta Chir Orthop Traumatol Cechoslovaca. 2009;76(1):47–53.

    CAS  Google Scholar 

  35. Freeman CR, McCormick KR, Mahoney D, Baratz M, Lubahn JD, Nesterenko S. Nonoperative treatment of distal biceps tendon ruptures compared with a historical control group. Elbow strength and endurance in patients with a ruptured distal biceps tendon. J Bone Joint Surg Am. 2009;91(10):2329–34.

    Article  PubMed  Google Scholar 

  36. Morrey BF, Chao EY, Hui FC. Biomechanical study of the elbow following excision of the radial head. J Bone Joint Surg Am. 1979;61(1):63–8.

    CAS  PubMed  Google Scholar 

  37. Askew LJ, An KN, Morrey BF, Chao EY, Morrey BF, Chao EY. Isometric elbow strength in normal individuals. Biomechanical study of the elbow following excision of the radial head. Clin Orthop Relat Res. 1987;61(222):261–6.

    Google Scholar 

  38. Wittstein J, Queen R, Abbey A, Moorman CT. 3rd. Isokinetic testing of biceps strength and endurance in dominant versus nondominant upper extremities. J Should Elb Surg Am Should Elb eons. 2010;19(6):874–7.

    Article  Google Scholar 

  39. Sotereanos DG, Pierce TD, Varitimidis SE. A simplified method for repair of distal biceps tendon ruptures. J Should Elb Surg Am Should Elb Surg. 2000;9(3):227–33.

    Article  CAS  Google Scholar 

  40. Leighton MM, Bush-Joseph CA, Bach Jr BR, Wittstein J, Queen R, Abbey A. Distal biceps brachii repair. Results in dominant and nondominant extremities Isokinetic testing of biceps strength and endurance in dominant versus nondominant upper extremities. Clin Orthop Relat Res. 1995;19(317):114–21.

    Google Scholar 

  41. D’Alessandro DF, Shields Jr CL, Tibone JE, Chandler RW, Wittstein J, Queen R. Repair of distal biceps tendon ruptures in athletes Isokinetic testing of biceps strength and endurance in dominant versus nondominant upper extremities. Am J Sports Med. 1993;21(1):114–9.

    Article  PubMed  Google Scholar 

  42. Hetsroni I, Pilz-Burstein R, Nyska M, Back Z, Barchilon V, Mann G. 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. 2008;39(7):753–60.

    Article  PubMed  Google Scholar 

  43. Silva J, Eskander MS, Lareau C, DeAngelis NA. Treatment of distal biceps tendon ruptures using a single-incision technique and a Bio-Tenodesis screw. edics. 2010;33(7):477.

    Google Scholar 

  44. Frazier MS, Boardman MJ, Westland M, Imbriglia JE. Surgical treatment of partial distal biceps tendon ruptures. J Hand ery. 2010;35(7):1111–4.

    Article  Google Scholar 

  45. Berlet GC, Johnson JA, Milne AD, Patterson SD, King GJ. Distal biceps brachii tendon repair. An in vitro biomechanical study of tendon reattachment. Am J Sports Med. 1998;26(3):428–32.

    CAS  PubMed  Google Scholar 

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Author disclosure statement

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Musculoskeletal Imaging, University Hospital of Besancon, 3 boulevard Fleming, 25000, Besancon, France

    Guillaume Alemann, Emmanuel Dietsch, Bruno Kastler & Sébastien Aubry

  2. Department of Orthopedic Surgery, University Hospital of Besançon, 3 boulevard Fleming, Besancon, 25000, France

    David Gallinet & Laurent Obert

  3. I4S Laboratory-EA 4268-IFR 133, Franche Comté University, Besancon, 25000, France

    Bruno Kastler & Sébastien Aubry

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  1. Guillaume Alemann
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  2. Emmanuel Dietsch
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Correspondence to Guillaume Alemann.

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Alemann, G., Dietsch, E., Gallinet, D. et al. Repair of distal biceps brachii tendon assessed with 3-T magnetic resonance imaging and correlation with functional outcome. Skeletal Radiol 44, 629–639 (2015). https://doi.org/10.1007/s00256-014-2079-z

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  • DOI: https://doi.org/10.1007/s00256-014-2079-z

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