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Single Posterior Incision Approach to the Repair of Partial Distal Biceps Ruptures: A Case Series
Yehuda A. Masturov, B.S.
1, Thomas G. Knoedler, M.D.
1, Jason C. Flynn, B.S.
2, Sebastian D. Arango, M.D.
1, Pranav Jain, B.S.
1, Jacob H. Zeitlin, M.D.
1, Tristan B. Weir, M.D.
1, Andrew J. Miller, M.D.
1; Kenneth A. Kearns, M.D.
1(1)Philadelphia Hand to Shoulder Center, Philadelphia, PA, (2)Sidney Kimmel Medical College, Philadelphia, PA
Introduction: Complete distal biceps ruptures are treated via a single anterior incision (SAI) or a dual incision (DI) approach. Partial ruptures with failed nonoperative management or poor supination strength may necessitate surgical management. The SAI or DI approach is frequently utilized for partial rupture repairs due to excellent visualization of the tendon. The aim of this study was to assess the single posterior incision posterior (SPI) approach for operative management of partial ruptures, and discuss conversion to DI approach in cases of unexpected complete rupture.
Methods: This study was conducted at a single tertiary referral extremity surgery practice. A retrospective chart review was performed on 12 patients who underwent surgery for partial distal biceps rupture. A single physician performed an initial SPI approach with intraoperative conversion to DI as necessary for management of unexpected complete rupture with pseudotendon formation. Data collected included demographic information, comorbidities, injury characteristics, procedural data, and pre/post-surgery clinical evaluation. Patients were contacted to report long term follow up outcomes as well. Descriptive statistics were reported.
Results: All 12 patients shared similar demographic characteristics: all were male and 4 received conversion to DI approach. The average preoperative Quick Disabilities of Arm, Hand, and Shoulder (QuickDASH) score was 48.75 (9.1 - 93.2) overall, 54.06 (20.5 - 93.2) for those who did not receive conversion, and 36.37 (9.1 - 77.5) for those who received conversion. The average long term follow-up QuickDASH score was 4.2 (0 - 20.5) and pain scale rating was 1.2 (0 - 10). Five patients reported their condition to be much improved, with two of these respondents having had conversion. One patient reported no change in their condition and had intraoperative conversion. Zero patients required revision surgery. The average time between injury and operative treatment was 150.3 (23 - 402) days with patients receiving conversion undergoing surgery earlier on average. The mean operative time was one hour and nine minutes (0:52 - 1:29) for SPI procedures, and one hour and forty minutes (1:30 - 1:57) for those that required conversion.
Conclusion: This case series showed the SPI approach with possible intraoperative DI conversion to be an effective option for partial distal biceps repair. Compared to the DI approach, this technique requires less soft tissue dissection. If pseudotendon or complete rupture is encountered, conversion to the DI approach appears safe, and only extends operative time by 30 minutes on average.
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