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A Novel Tenorrhaphy Suture Technique with Tissue Engineered Collagen Graft to Repair Large Tendon Defects

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Surgical Technique for Single and Double-Incision Method of Acute Distal Biceps Tendon Repair

Ruby Grewal¹, George S Athwal¹, Joy C MacDermid¹

¹Hand and Upper Limb Center, St. Joseph's Health Care, Division of Orthopedic Surgery, University of Western Ontario, 268 Grosvenor Street, London, ON N6A 4L6, Canada. E-mail address for R. Grewal: rgrewa@uwo.ca. E-mail address for G.S. Athwal: gathwal@uwo.ca. E-mail address for J.C. MacDermid: joy.macdermid@sjhc.london.on.ca. E-mail address for K.J. Faber: kjfaber@uwo.ca. E-mail address for D.S. Drosdowech: ddros@mac.com. E-mail address for G.J.W. King: gking@uwo.ca.

JBJS Essential Surgical Techniques

|July 20, 2019

Abstract

Introduction:

Distal biceps tendon ruptures can be repaired with either a single or a double-incision technique.

Step 1 Single-Incision Technique Surgical Exposure And Preparation Of The Tendon:

Through a single anterior incision, identify the tendon and debride the distal degenerated portion.

Step 2 Single-Incision Technique Preparation Of The Radius:

Expose the bicipital tuberosity and prepare the bone for insertion of suture anchors.

Step 3 Single-Incision Technique Tendon Reattachment:

Suture the tendon with a reduction knot technique that allows for anatomic tendon apposition to bone.

Step 1 Double-Incision Technique Surgical Exposure And Preparation Of The Tendon:

Through a small anterior incision retrieve the tendon, debride the distal degenerated portion of the tendon, and place your sutures.

Step 2 Double-Incision Technique Preparation Of The Radius:

Through a second posterolateral incision, expose the biceps tuberosity and, using a burr, create a trough for the tendon.

Step 3 Double-Incision Technique Tendon Reattachment:

Pass the sutures through the transosseous tunnels and tension the sutures, allowing the biceps tendon to be pulled into the trough created in the bicipital tuberosity, and then tie the sutures.

Step 4 Postoperative Care:

Assess tension across the repaired tendon, initiate prophylaxis against heterotopic ossification, and begin rehabilitation.

Results:

We recently conducted a prospective randomized controlled trial at our center comparing the single and double-incision techniques for the repair of acute distal biceps tendon ruptures¹¹.

What To Watch For:

IndicationsContraindicationsPitfalls & Challenges.

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