Distal Biceps Repair Using a Unicortical Intramedullary Button Technique
Nathan A Monaco, M.D.; Meghan W Richardson, M.D.; Alexander Duke, B.S.; Edward D. Wang, M.D.; Stony Brook University Hospital, Stony Brook, NY
Distal biceps tendon rupture is an uncommon elbow injury, predominantly affecting thirty to sixty year old males during eccentric loading of the musculotendinous unit. Although surgical repair has been shown to improve functional outcomes compared to nonoperative modalities, operative technique remains a matter of surgeon preference as one uniformly superior intervention has yet to be demonstrated. Catastrophic nerve injury and complications have been reported following most of the variously described operative repair methods. The purpose of this study was to retrospectively examine the results of a modified repair technique using a volar approach to distal biceps reinsertion secured with a unicortical intramedullary button in the proximal radial tuberosity. Goals of this surgical technique include restoration of normal anatomy and elbow function, while limiting major complications. Twenty eight elbows in twenty seven male patients, average age 48.5 (25-66), were treated with this technique by a single fellowship trained shoulder and elbow surgeon over a four year period (2012-2016). Review of the medical records identified an overall complication rate of 39% (11/28): nine lateral antebrachial cutaneous (LABC) neuropraxias, one superficial skin infection and one radial sensory neuropraxia. No major complications were observed (peripheral nerve injury, proximal radioulnar synostosis, re-rupture or additional surgery) at an average follow-up of 24 months. Outcomes including the Disabilities of the Arm, Shoulder and Hand (DASH) score, the American Shoulder and Elbow Surgeons (ASES) satisfaction score and the Mayo Elbow Performance Score (MEPS) are reported for all patients at time of most recent follow-up. Overall, results demonstrated low disability (mean DASH 2.9), high satisfaction (mean ASES 9.25) and acceptable performance (26 excellent, 1 good, 1 fair MEPS). Subcategory analysis demonstrated a correlation between time to surgery and complication reporting (p=0.034). Additionally, disability scores were higher in patients involved in workers compensation claims compared to privately insured patients (mean 11.0 vs. 1.0, p=0.013, MCID = 10). A modified volar approach to distal biceps repair with unicortical intramedullary button fixation can be used safely to obtain short term results and minor complication rates that mirror previous literature, with the significant benefit of limiting major complications.
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