A novel tension-slide double intramedullary cortical button technique for distal biceps tendon reconstruction: a case...

Complete distal biceps ruptures are primarily treated with direct repair; however, patients with chronic ruptures, poor tissue quality, or tendon deficiency may need to be treated with reconstruction. Prior studies have shown dual intramedullary cortical button fixation has the highest load to failure and unicortical fixation decreases the risk for injuring the posterior interosseous nerve intraoperatively. The tension-slide technique aids in tensioning the distal biceps tendon repair and significantly decreases bone-to-tendon gap formation. The aim of this study is to present the clinical outcomes of a novel reconstruction technique that utilizes dual intramedullary cortical button fixation with a tension-slide technique.

Three male patients underwent a distal biceps reconstruction and were followed for 10-19 months. An anterior curvilinear incision is made over the antecubital crease, and 2 3.2-mm unicortical drill holes are placed in the radial tuberosity. A semitendinosus allograft is fixed distally with 2 intramedullary cortical buttons. Using the tension-slide technique, the allograft is shuttled to the radial tuberosity in an onlay fashion. The allograft is secured proximally using a Pulvertaft weave with the elbow at 80° of flexion. Post-operative range of motion, strength, Quick Disabilities of the Arm, Shoulder and Hand score, Mayo Elbow Performance Score, and American Shoulder and Elbow Surgeons Shoulder scores were obtained.

Two patients sustained a chronic distal biceps tendon rupture, and one patient had a failed primary distal biceps tendon repair prior to undergoing the reconstruction procedure. Age ranged between 52 and 55 years. The average post-operative Quick Disabilities of the Arm, Shoulder and Hand score was 8.3 (range, 0-25.0), Mayo Elbow Performance Score was 95 (range 85-100), and American Shoulder and Elbow Surgeons score was 96 (range 88-100). Full range of motion was obtained in all 3 patients. Post-operative strength was evaluated, and bicep flexion strength was 5/5 in all patients. Supination strength was 5/5 in 2 patients and 4+/5 in one patient. The mean time to surgery was 9.7 months (range, 8-13 months). There were no post-operative complications.

We present a technique for distal biceps reconstruction that has similar patient-reported outcomes scores as prior studies with high patient satisfaction while implementing techniques that have shown to significantly decrease the gap between the bone-tendon junction, maintaining the posterior cortex of the radial tuberosity, and safely utilizing distal fixation methods with the highest load to failure. Our early experience with this technique has shown encouraging clinical results.