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Complications of repair of the distal biceps tendon with the modified two-incision technique
E W Kelly1, B F Morrey, S W O'Driscoll
1Department of Orthopedics, Mayo Clinic, Rochester, Minnesota 55905, USA.
Background:
The purpose of this paper is to describe the complications that we encountered after using a muscle-splitting two-incision technique to repair avulsed distal biceps tendons.
Methods:
We conducted a retrospective review of the results of seventy-eight consecutive anatomical repairs of the distal biceps tendon performed through a muscle-splitting two-incision technique at our institution between 1981 and 1998. Four of the patients required a graft to restore length. The seventy-four tendons that were repaired primarily through the modified Boyd-Anderson approach were analyzed in detail and form the basis of this report.
Results:
Complications developed after twenty-three (31 percent) of the seventy-four repairs. The complications included five sensory nerve paresthesias (three lateral antebrachial cutaneous and two superficial radial nerve paresthesias) in five patients. A temporary palsy of the posterior interosseous nerve developed in one patient; it resolved in six months. Six patients complained of persistent anterior elbow pain. Heterotopic ossification that did not limit forearm rotation developed in four patients, a superficial wound infection developed in three, one tendon reruptured, three patients lost forearm rotation, and reflex sympathetic dystrophy developed in one patient. No radioulnar synostoses were observed in our series. Complications developed after ten (24 percent) of the forty-one acute repairs (performed fewer than ten days after the injury), six (38 percent) of the sixteen subacute repairs (performed ten to twenty-one days after the injury), and seven (41 percent) of the seventeen delayed repairs (performed more than twenty-one days after the injury). The surgeon's experience with this procedure had no apparent effect on complication rates.
Conclusions:
Most of the morbidity from repair of the distal biceps tendon can be attributed primarily to a delay in the timing of the repair and secondarily to an extensive anterior exposure. More importantly, radioulnar synostosis is rare following the muscle-splitting modification of the two-incision technique, which can be performed safely even by surgeons with limited experience with this procedure.
Insights
This study reviewed distal biceps tendon repairs using a muscle-splitting technique, finding most complications linked to delayed surgery. The two-incision method showed rare radioulnar synostosis, suggesting safety for surgeons at all experience levels.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Musculoskeletal Research
Background:
- Distal biceps tendon avulsions require surgical repair.
- The muscle-splitting two-incision technique is one method used for repair.
- Understanding complications associated with this technique is crucial for patient outcomes.
Purpose of the Study:
- To describe complications encountered after using a muscle-splitting two-incision technique for distal biceps tendon repair.
- To evaluate the safety and efficacy of this surgical approach.
Main Methods:
- Retrospective review of 78 consecutive anatomical distal biceps tendon repairs.
- Repairs performed between 1981 and 1998 using a muscle-splitting two-incision technique (modified Boyd-Anderson approach).
- Analysis of 74 primary repairs, with four requiring grafts.
Main Results:
- Complications occurred in 31% (23/74) of repairs.
- Common complications included nerve paresthesias (6.8%), anterior elbow pain (8.1%), and heterotopic ossification (5.4%).
- Delayed repairs (more than 21 days) showed higher complication rates (41%) compared to acute repairs (24%).
Conclusions:
- Delayed timing of distal biceps tendon repair is the primary cause of morbidity.
- The muscle-splitting two-incision technique is associated with a low rate of radioulnar synostosis.
- This technique can be safely performed by surgeons with varying levels of experience.
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