A Simple Grafting Method to Repair Irreparable Distal Biceps Tendon

Author(s): Vastamäki M, Vastamäki H

Source: Clin Orthop 466:2475–2481, 2008.

Summary:
When primary repair is not possible, tears of the distal biceps tendon can be reconstructed using free tendon grafts.  In this article, the authors performed a retrospective study to compare two methods used to affix the tendon grafts to the ulna: two suture anchors vs. bone tunnels.  The groups were compared in terms of  strength, endurance and clinical findings.  There were 14 patients, 7 in each group, followed for a minimum of 2 years. 
Time from injury to index surgery averaged 6 months.  Mean arc of flexion at the elbow was 0-132°, and strength was 94% compared with the contralateral side.  Average pronation was 83°, supination 80°, with peak torque compared to the contralateral side of 84% and 91% respectively.  There was no statistical difference in clinical outcomes for the two fixation methods.  Subjectively the majority of patients rated the end result of their surgeries as excellent or good. 

When diagnosis of distal biceps tendon rupture is delayed the tendon often retracts to the point that primary repair is not possible.  This necessitates the use of graft to augment the repair (these authors recommend the use of the plantaris longus tendon as the graft source).  For the fixation of the graft to the radial tuberosity,  the authors recommend the suture anchors as they can be placed more ulnarly and posteriorly in the radial tuberosity and they have the advantage of speed, ease of use, and superior yield strength.  However, their article showed no advantage of one fixation method over another.