Rupture of the distal biceps brachii tendon: conservative treatment versus anatomic reinsertion--clinical and radiological evaluation after 2 years.
BACKGROUND
Distal biceps tendon rupture is a relatively rare injury. It commonly occurs in the dominant extremity of middle-aged men during an excessive eccentric tension as the arm is forced from a flexed position, while it is rarely observed during sport activities. Many techniques, including non-operative and surgical option, have been described for the treatment of a ruptured distal biceps tendon, but there is still considerable controversy about the management of choice.


METHODS
Nine patients affected with traumatic distal tendon ruptures of the biceps brachii were followed-up for a minimum of 24 months. Five patients underwent surgery (two-incision technique) and four patients were treated conservatively. Tendon readaptation to its origin was done by a suture metal anchor. Outcome was evaluated based on the physical examination, radiographic analysis and the SECEC elbow score.


RESULTS
The SECEC elbow score results show that every single item result is in favour of surgical treatment. On measurements of motion, we found a slight flexion-extension deficit in two patients, but reduced supination in six patients and reduced pronation in four. Two patients had postoperative dysfunction of the deep branch of the radial nerve. Radiographic examination showed heterotopic bone formation on the radial tuberosity around the presumed insertion of the reattached tendon in 2 of 5 patients and ectopic ossification more proximally in the area of the biceps muscle


CONCLUSIONS
Our findings confirm the view that anatomic repair of distal biceps tendon rupture provides consistently good results and early anatomic reconstruction can restore strength and endurance for the elbow.
Chillemi
Claudio
C
Istituto Chirurgico Ortopedico Traumatologico, Via del Lido, 110, 04100 Latina, Italy. c_chillemi@libero.it
Marinelli
Mario
M
De Cupis
Vincenzo
V
D000328:Adult; D002370:Casts, Surgical; D004550:Elbow / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000000981:diagnostic imaging / Q000503:physiopathology; D011183:Postoperative Complications / Q000503:physiopathology; D011403:Pronation / Q000502:physiology; D011826:Radial Nerve / Q000503:physiopathology; D011859:Radiography; D012189:Retrospective Studies; D012421:Rupture / Q000503:physiopathology / Q000628:therapy; D013484:Supination / Q000502:physiology; D053441:Suture Anchors; D013708:Tendon Injuries / Q000503:physiopathology / Q000628:therapy*; D013710:Tendons / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D000092464:Elbow Injuries