title: Single versus double-incision technique for the repair of acute distal biceps tendon ruptures: a randomized clinical trial.
abstract: BACKGROUND
  This clinical trial was done to evaluate outcomes of the single and double-incision techniques for acute distal biceps tendon repair. We hypothesized that there would be fewer complications and less short-term pain and disability in the two-incision group, with no measureable differences in outcome at a minimum of one year postoperatively.
  
  
  METHODS
  Patients with an acute distal biceps rupture were randomized to either a single-incision repair with use of two suture anchors (n = 47) or a double-incision repair with use of transosseous drill holes (n = 44). Patients were followed at three, six, twelve, and twenty-four months postoperatively. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) elbow score. Secondary outcomes included muscle strength, complication rates, and Disabilities of the Arm, Shoulder and Hand (DASH) and Patient-Rated Elbow Evaluation (PREE) scores.
  
  
  RESULTS
  All patients were male, with no significant differences in the mean age, percentages of dominant hands affected, or Workers' Compensation cases between groups. There were also no differences in the final outcomes (at two years) between the two groups (p = 0.4 for ASES pain score, p = 0.10 for ASES function score, p = 0.3 for DASH score, and p = 0.4 for PREE score). In addition, there were no differences in isometric extension, pronation, or supination strength at more than one year. A 10% advantage in final isometric flexion strength was seen in the patients treated with the double-incision technique (104% versus 94% in the single-incision group; p = 0.01). There were no differences in the rate of strength recovery. The single-incision technique was associated with more early transient neurapraxias of the lateral antebrachial cutaneous nerve (nineteen of forty-seven versus three of forty-three in the double-incision group, p < 0.001). There were four reruptures, all of which were related to patient noncompliance or reinjury during the early postoperative period and appeared to be unrelated to the fixation technique (p = 0.3).
  
  
  CONCLUSIONS
  There were no significant differences in outcomes between the single and double-incision distal biceps repair techniques other than a 10% advantage in final flexion strength with the latter. Most complications were minor, with a significantly greater prevalence in the single-incision group.
authors: Hand and Upper Limb Center, St. Joseph's Health Care, Division of Orthopaedic Surgery, University of Western Ontario, 268 Grosvenor Street, London, ON N6A 4L6, Canada. rgrewa@uwo.ca
authors: Ruby
authors: R
authors: Grewal
authors: George S
authors: GS
authors: Athwal
authors: Joy C
authors: JC
authors: MacDermid
authors: Kenneth J
authors: KJ
authors: Faber
authors: Darren S
authors: DS
authors: Drosdowech
authors: Ron
authors: R
authors: El-Hawary
authors: Graham J W
authors: GJ
authors: King
mesh_terms: D000208:Acute Disease; D000328:Adult; D001134:Arm Injuries / Q000175:diagnosis / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D018482:Muscle, Skeletal / Q000293:injuries / Q000601:surgery*; D019637:Orthopedic Procedures / Q000295:instrumentation* / Q000379:methods; D012016:Reference Values; D018570:Risk Assessment; D012421:Rupture / Q000175:diagnosis / Q000601:surgery; D053441:Suture Anchors; D013536:Suture Techniques; D013708:Tendon Injuries / Q000175:diagnosis / Q000601:surgery*; D013718:Tensile Strength; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology