title: Treatment of distal biceps tendon rupture: why, when, how? Analysis of literature and our experience.
abstract: BACKGROUND
  The rupture of the distal biceps tendon is a relatively uncommon lesion. Even if conservative treatment may be an option in low demanding patients, young and active subjects may benefit from an early surgical reinsertion. Many techniques and fixation devices have been described, but in the literature, there are no clinical evidences that show the superiority of any of these. In this article, we report an analysis of the "state of the art" and our case series of surgical reinsertion with the double approach transosseous technique.
  
  
  METHODS
  Between 2003 and 2013, 26 patients underwent surgical reinsertion, either for acute or for chronic lesions of distal biceps tendon. We evaluated 21 acute cases treated with double approach using DASH and SECEC Elbow Scores. The mean follow-up was 22 months. Range of motion, supination and flexion strength were also recorded.
  
  
  RESULTS
  Mean final ROM was 6-132° in F/E and 89-0-87° in P/S; flexion and supination strength were 96 and 88 % compared to the opposite side. The main complications were two cases of heterotopic ossifications: one asymptomatic fracture of the proximal radius and one temporary neurapraxia of the radial nerve.
  
  
  CONCLUSIONS
  Analysing the literature and our outcomes, we underline the importance of timing for surgery, in young and compliant patients, with a valid rehabilitation protocol for excellent results. The choice of surgical technique remains controversial, and we believe that the double approach transosseous reinsertion is a safe, costless and relatively non-invasive technique, offering satisfactory results when performed early.
authors.affiliation: Department of Hand Surgery, CTO A.O. Città della Salute e della Scienza, Ospedale CTO, Via Zuretti 29, 10126, Turin, Italy. francesco.giacalone@hotmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Giacalone
authors.affiliation: Department of Hand Surgery, CTO A.O. Città della Salute e della Scienza, Ospedale CTO, Via Zuretti 29, 10126, Turin, Italy. elidutto@gmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Dutto
authors.affiliation: Department of Hand Surgery, CTO A.O. Città della Salute e della Scienza, Ospedale CTO, Via Zuretti 29, 10126, Turin, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Ferrero
authors.affiliation: Department of Hand Surgery, CTO A.O. Città della Salute e della Scienza, Ospedale CTO, Via Zuretti 29, 10126, Turin, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bertolini
authors.affiliation: Department of Hand Surgery, CTO A.O. Città della Salute e della Scienza, Ospedale CTO, Via Zuretti 29, 10126, Turin, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Sard
authors.affiliation: Department of Hand Surgery, CTO A.O. Città della Salute e della Scienza, Ospedale CTO, Via Zuretti 29, 10126, Turin, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Pontini
mesh_terms: D000328:Adult; D001132:Arm; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D012092:Replantation / Q000379:methods*; D012421:Rupture / Q000000981:diagnostic imaging / Q000601:surgery; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D061665:Time-to-Treatment
keywords: Distal biceps tendon; Distal biceps tendon rupture; Elbow; Elbow double approach; Tendon injury