title: Radioulnar space available at the level of the biceps tuberosity for repaired biceps tendon: a comparison of 4 techniques.
abstract: OBJECTIVE
  It is unknown whether certain methods of distal biceps tendon repair lead to an increased propensity of impingement of the repaired tendon. The purpose of this study was to evaluate various repair techniques in a cadaveric model to determine the radioulnar space available for the repaired biceps tendons.
  
  
  METHODS
  Nine matched pairs of quartered, fresh-frozen cadaveric arms were transected at the level of the humeral mid shaft and the distal radiocarpal joint. Distance measurements and the angular relation of the bicipital tuberosity were measured at 5 forearm pronation-supination positions. These measurements were taken under each of the following conditions: intact native biceps, resected native tendon, suture anchor fixation of the biceps, suspensory suture device fixation of the biceps, tendon repair using a tenodesis technique, and fixation of the tendon using a trough technique.
  
  
  RESULTS
  There were no significant differences in radioulnar space available after biceps tendon repair with the forearm in a supinated position. However, when the forearm was in a neutral or pronated position, the suture anchor method consistently had the lowest biceps insertion-to-ulna distance (0.6 to 2.1 cm). All forearm positions, except full supination, showed significant differences in terms of radioulnar space available for the repaired biceps.
  
  
  CONCLUSIONS
  This study shows that the space available for the biceps tendon decreases with forearm pronation after reconstruction for all repair techniques. It appears that using suture anchors to repair the biceps tendon may predispose the repaired tendon to impingement when compared with other fixation techniques.
authors.affiliation: Brooke Army Medical Center, Fort Sam Houston, TX, USA. Electronic address: cak0705@gmail.com.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Krueger
authors.affiliation: United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA.
authors.forename: James K
authors.initials: JK
authors.lastname: Aden
authors.affiliation: Brooke Army Medical Center, Fort Sam Houston, TX, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Broughton
authors.affiliation: Brooke Army Medical Center, Fort Sam Houston, TX, USA; WellSpan Health, York, PA, USA.
authors.forename: Damian M
authors.initials: DM
authors.lastname: Rispoli
mesh_terms: D000328:Adult; D001132:Arm / Q000601:surgery*; D002102:Cadaver; D005542:Forearm / Q000601:surgery; D006801:Humans; D006811:Humerus / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery; D011884:Radius / Q000601:surgery*; D053441:Suture Anchors; D013536:Suture Techniques; D013708:Tendon Injuries / Q000601:surgery*; D013710:Tendons / Q000601:surgery*; D014457:Ulna / Q000601:surgery*
keywords: Distal biceps repair; distal biceps impingement; distal biceps insertion; distal biceps repair techniques