Repair of distal biceps rupture using Arthrex Biceps Button
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The distal biceps tendon attaches onto the radial tuberosity, which is located on the posteromedial aspect of the proximal radius, where it is at risk of injury. The biceps itself comprises of two anatomically distinct portions, each with separate origin and insertion:
– The short head origin is from the coracoid and inserts distally and anteriorly on the radial tuberosity.
– The long head origin is from the supraglenoid tubercle of the scapula and inserts more proximally and posteriorly with an oval footprint on the radial tuberosity. It acts as a better supinator as it attaches to the apex of the radial tuberosity.
Rupture of the distal biceps tendon tends to occur in a working age population, with over 95% occurring in males. There is also an association with anabolic steroid use.
Non-operative management can result in almost a 50% decrease in supination endurance and up to a 40% drop in supination strength, and a 30% drop drop in flexion strength. Therefore in the working population, repair of the distal biceps is recommended to optimise function, flexion and supination strength.
Operative repair using a cortical button technique, as demonstrated here, has been demonstrated to restore flexion and supination strength to over almost 80% of the contralateral sides strength, which is a significant improvement on conservative management.
I tend to repair acute ruptures of the distal biceps tendon primarily using a one-incision technique, which helps minimise the risk of synostosis formation. I fix the tendon back using a cortical button and interference screw fixation with the Arthrex distal biceps tendon repair kit. The cortical button provides a robust fixation and has been shown to have the highest load to failure of the commonly used fixation methods. The Arthrex distal biceps button also allows early mobilisation, which helps reduce the chance of a loss of range of movement. The interference screw has also been show to induce direct tendon to bone healing which adds to the robustness of the construct.
Kelly MP, Perkinson SG, Ablove RH, Tueting JL. Distal Biceps Tendon Ruptures: An Epidemiological Analysis Using a Large Population Database. Am J Sports Med. 2015 Aug;43(8):2012-7. doi: 10.1177/0363546515587738. Epub 2015 Jun 10.
Author:Mr Sam Chan, FRCS (Tr & Orth)
Institution: The Queen Elizabeth Hospital, Birmingham, UK.