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American Association for Hand Surgery

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Biomechanical Analysis of Single-Incision Repair Technique for Distal Biceps Tendon Rupture Using Tunneling Device
Jon Hammarstedt, MD1, Mark C Miller, PhD2, Pat Schimoler, MS2 and Steven Regal, MD2, (1)1307 Federal Street, Pittsburgh, PA, (2)Allegheny General Hospital, Pittsburgh, PA


Hypothesis: Single incision biceps tendon repair with an arthrotunneling device has previously been shown to be a safe and effective technique that provides the anatomic restoration of a 2-incision approach with the advantage of a reduced complication profile. Use of this single incision repair of the distal biceps without implant fixation provides adequate and comparable fixation to repair utilizing anchors, buttons, screws, etc at a lower cost.

Material & Methods: This study utilized 10 cadaveric specimens. Cadaveric mid humerus to distal radius specimens were dissected to expose the native distal biceps insertion. Using standard landmarks, two ideal radial tuberosity tunnels were drilled, and suture was then passed through and fixated, securing the distal biceps in place. The elbow was cyclically loaded and graft displacement, flexion/extension (FE) and pronation/supination (PS) moment arms at 12.5° to 152.5° (in 5° increments) before and after repair, and maximum load to failure were measured.

Results: The FE and PS moment arms were both significantly larger in the repaired case than in the native case (p<0.01). The overall maximum FE and PS moment arms showed significant differences, with the repaired case larger than the native (p<0.01), and within forearm orientation, with the supinated case greater than the neutral case which in turn was greater than the pronated case (p<0.01). In the test of the strength of the repair, the maximum load up to 10mm of repair displacement was 214.5.0±66.6N and the repair displacement due to 1000 cycles of 50N was 2.56±2.06mm.

Conclusion: The single incision technique using an arthrotunneling device to recreate the dorsal and ulnar insertion is a safe and effective repair that recreates the anatomic footprint and biomechanics of the native biceps tendon combined with a reduced complication profile as compared to a two-incision approach with increased mechanical advantage when compared to the native biceps.

Level of Evidence: Basic science study

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