title: Distal biceps reconstruction using an Achilles tendon allograft, transosseous EndoButton, and Pulvertaft weave with tendon wrap technique for retracted, irreparable distal biceps ruptures.
abstract: BACKGROUND
  Distal biceps ruptures can result in ongoing pain and weakness when treated nonoperatively. If retraction of the tendon renders primary repair impossible, reconstruction using a graft is recommended. The current literature includes a variety of techniques with studies reporting small patient numbers. The aim of this study was to report the results of a larger cohort of patients using a technique modified from those previously described in the literature.
  
  
  METHODS
  Twenty-one consecutive male patients underwent distal biceps reconstruction through 2 small anterior incisions using an Achilles tendon allograft that was fixed distally using a transosseous EndoButton and secured proximally using a Pulvertaft weave and tendon wrap. The mean age was 44 years, and the mean time to surgery was 25 months (range, 2-96 months). Functional outcomes were collected prospectively.
  
  
  RESULTS
  The mean preoperative Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score (11 patients) was 1.9 (range, 0-4.5). The mean postoperative Oxford Elbow Score, QuickDASH score, and Mayo Elbow Performance Score were 44.7 (range, 35-48), 4 (range, 0-20.5), and 92.9 (range, 70-100), respectively, at a mean follow up of 15 months (range, 6-35 months). The mean postoperative QuickDASH score was significantly improved compared with preoperatively (P < .001). All patients were satisfied and all returned to their previous level of activity. There were 2 transient lateral antebrachial cutaneous nerve paresthesias, and 2 patients had a 5° extension lag. There were no other complications.
  
  
  CONCLUSIONS
  Achilles allograft reconstruction of retracted irreparable distal biceps ruptures provides consistently good results with few complications using this technique.
authors.affiliation: Upper Limb Unit, Wrightington Hospital, Wigan, UK; Brighton and Sussex University Hospitals, Brighton, UK. Electronic address: joideep@doctors.org.uk.
authors.forename: Joideep
authors.initials: J
authors.lastname: Phadnis
authors.affiliation: Upper Limb Unit, Wrightington Hospital, Wigan, UK.
authors.forename: Olivia
authors.initials: O
authors.lastname: Flannery
authors.affiliation: Upper Limb Unit, Wrightington Hospital, Wigan, UK.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Watts
mesh_terms: D000125:Achilles Tendon / Q000637:transplantation*; D000328:Adult; D064591:Allografts; D004550:Elbow / Q000601:surgery*; D004551:Elbow Joint / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D012421:Rupture / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: Achilles; Biceps tendon; allograft; chronic; distal; graft