Clinical Evaluation of the Reconstruction of the Biceps Brachii using Triceps Graft^[*]

Abstract

Objective Clinical and functional evaluation of the surgical treatment for chronic injury of the distal biceps brachii applying a surgical technique with grafting of the distal triceps brachii tendon.

Methods A study based on a review of the medical records and clinical evaluation of the patients submitted to surgical treatment for chronic injury to the distal insertion of the biceps brachii between February 2015 and February 2017. In a 12-month-minimum postoperative follow-up, 7 patients were evaluated regarding the range of motion of the operated and non-operated elbows, flexion, upper-limb extension and supination with a digital dynamometer, the hook test, the satisfaction index, and the Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Elbow Performance Score (MEPS) intruments.

Results During the postoperative functional evaluation, no patient reported dissatisfaction with the esthetic outcome of the incisions, and all of them were satisfied/very satisfied with the range of motion and strength of the operated limb. No neurovascular complications, surgical site infection or tendon rupture were observed. On the MEPS and DASH scales, all patients scored 100 and 0 respectively. The mean flexion was of 133.5° on the operated side, versus 139.2° on the non-operated side. The mean extension was of 5° on the operated side versus 0° on the non-operated side. The supination was of 86.5° versus 90°, and the pronation, 80° versus 80°, when comparing the operated and non-operated sides respectively. The mean flexion, extension and supination corresponded respectively to 92.5%, 96.4% and 86.8% of those of the non-operated limb.

Conclusion Recosntruction of the distal biceps brachii with triceps grafting seems to be an effective and safe option for the treatment of chronic distal biceps injuries.

Keywords

autografting - elbow - orthopedic procedures - tendon injuries - upper extremity

^* Work performed at Hospital Ortopédico e Medicina Especializada (HOME), Brasília, DF, Brazil.

Publikationsverlauf

Eingereicht: 12. Februar 2020

Angenommen: 28. Oktober 2020

Artikel online veröffentlicht:
13. August 2021

• Referências

• 1 Darlis NA, Sotereanos DG. Distal biceps tendon reconstruction in chronic ruptures. J Shoulder Elbow Surg 2006; 15 (05) 614-619
• 2 Wiley WB, Noble JS, Dulaney TD, Bell RH, Noble DD. Late reconstruction of chronic distal biceps tendon ruptures with a semitendinosus autograft technique. J Shoulder Elbow Surg 2006; 15 (04) 440-444
• 3 Safran MR, Graham SM. Distal biceps tendon ruptures: incidence, demographics, and the effect of smoking. Clin Orthop Relat Res 2002; (404) 275-283
• 4 Geaney LE, Mazzocca AD. Biceps brachii tendon ruptures: a review of diagnosis and treatment of proximal and distal biceps tendon ruptures. Phys Sportsmed 2010; 38 (02) 117-125
• 5 Levy HJ, Mashoof AA, Morgan D. Repair of chronic ruptures of the distal biceps tendon using flexor carpi radialis tendon graft. Am J Sports Med 2000; 28 (04) 538-540
• 6 Hang DW, Bach Jr BR, Bojchuk J. Repair of chronic distal biceps brachii tendon rupture using free autogenous semitendinosus tendon. Clin Orthop Relat Res 1996; (323) 188-191
• 7 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 (03) 418-421
• 8 Flint JH, Wade AM, Giuliani J, Rue JP. Defining the terms acute and chronic in orthopaedic sports injuries: a systematic review. Am J Sports Med 2014; 42 (01) 235-241
• 9 Bell RH, Wiley WB, Noble JS, Kuczynski DJ. Repair of distal biceps brachii tendon ruptures. J Shoulder Elbow Surg 2000; 9 (03) 223-226
• 10 Hallam P, Bain GI. Repair of chronic distal biceps tendon ruptures using autologous hamstring graft and the Endobutton. J Shoulder Elbow Surg 2004; 13 (06) 648-651
• 11 Boyd HB, Anderson MD. A method for reinsertion of the distal biceps brachii tendon. J Bone Joint Surg Am 1961; 43 (07) 1041-1043
• 12 Klonz A, Loitz D, Wöhler 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 Shoulder Elbow Surg 2003; 12 (06) 607-611
• 13 Sanchez-Sotelo J, Morrey BF, Adams RA, O'Driscoll SW. Reconstruction of chronic ruptures of the distal biceps tendon with use of an achilles tendon allograft. J Bone Joint Surg Am 2002; 84 (06) 999-1005
• 14 Patterson RW, Sharma J, Lawton JN, Evans PJ. Distal biceps tendon reconstruction with tendoachilles allograft: a modification of the endobutton technique utilizing an ACL reconstruction system. J Hand Surg Am 2009; 34 (03) 545-552
• 15 Martin CR, Hildebrand KA, Baergen J, Bitting S. Triceps tendon fascia for collateral ligament reconstruction about the elbow: a clinical and biomechanical evaluation. Am J Orthop 2011; 40 (09) E163-E169
• 16 Baumfeld JA, van Riet RP, Zobitz ME, Eygendaal D, An KN, Steinmann SP. Triceps tendon properties and its potential as an autograft. J Shoulder Elbow Surg 2010; 19 (05) 697-699
• 17 Terra BB, Rodrigues LM, Lima AL, Cabral BC, Cavatte JM, De Nadai A. Direct repair of chronic distal biceps tendon tears. Rev Bras Ortop 2016; 51 (03) 303-312
• 18 Mazzocca AD, Burton KJ, Romeo AA, Santangelo S, Adams DA, Arciero RA. Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair. Am J Sports Med 2007; 35 (02) 252-258
• 19 Olsen JR, Shields E, Williams RB, Miller R, Maloney M, Voloshin I. A comparison of cortical button with interference screw versus suture anchor techniques for distal biceps brachii tendon repairs. J Shoulder Elbow Surg 2014; 23 (11) 1607-1611
• 20 Sarda P, Qaddori A, Nauschutz F, Boulton L, Nanda R, Bayliss N. Distal biceps tendon rupture: current concepts. Injury 2013; 44 (04) 417-420
• 21 Grewal R, Athwal GS, MacDermid JC. et al. Single versus double-incision technique for the repair of acute distal biceps tendon ruptures: a randomized clinical trial. J Bone Joint Surg Am 2012; 94 (13) 1166-1174
• 22 Keener JD. Controversies in the surgical treatment of distal biceps tendon ruptures: single versus double-incision repairs. J Shoulder Elbow Surg 2011; 20 (2, Suppl) S113-S125