Clinical outcomes and safety of distal biceps repair using a modified entry point
Distal biceps ruptures represent 3–10% of all biceps tendon injuries.1 The peak incidence of this injury is in middle aged males.4 Left alone, the injury causes approximately 30% loss of flexion strength and 40% loss of supination strength.5 Recently, there has been a move away from the traditional two‐incision technique for repair, initially described by Boyd and Anderson,6 towards a one‐incision technique as described by Bain.7 The technique involves an incision in the anterior compartment, distal to the cubital fossa, followed by the identification of tendon stump and radial tuberosity. After stump preparation, the tuberosity is drilled with a guidewire which penetrates the dorsal cortex of the radius. That guidewire is over drilled. Fixation involves insertion of a cortical button, sutured to the tendon, which is then flipped. The posterior interosseous nerve (PIN) is at risk at a number of steps, namely – with overzealous retraction, during insertion of the guidewire, when drilling the tunnel, and finally during insertion and flipping of the cortical button. At our centre, we utilize a one‐incision technique with cortical button fixation. To minimize the risk of injury to the PIN, the senior author proposes a more proximal entry point on the radial tuberosity.
The purpose of our study was twofold. Firstly to determine how much safer this entry point is with respect to distance from PIN. Secondly, to evaluate the clinical results of this repair technique with particular emphasis on strength, elbow range of motion (ROM) and patient satisfaction levels.