Clinical case of the surgical treatment of complete rupture of distal biceps tendon using two cortical buttons

Abstract

Distal biceps tendon injuries mainly occur in men from the active groups of population. Among the athletes and military personnel, the incidence rate is 2–10  % of  the  upper limb tendon injuries. Comparative studies have shown the achievement of better functional results in surgical treatment, while maintaining overall complication rate of 4.6–25 %. The aim. To demonstrate a new reinsertion technique with two cortical buttons in case of complete rupture of distal biceps tendon as part of a clinical case. Materials and methods. The article presents a clinical case of surgical treatment of a patient with complete rupture of dominant limb distal biceps tendon which was more than 2 weeks old and was accompanied by lacertus fibrosus provocation and persistent muscle retraction. Results. We obtained the following clinical results by the week 24 after the surgery: VAS (Visual Analogue Scale) score – 1  cm, ASES (American Shoulder and Elbow Surgeons) score – 99  points, DASH (Disabilities of the Arm, Shoulder and Hand) score – 15 points. Dynamometry results: Dex. 85; sin. 90 (2daN); range of motion corresponds to the same of a healthy joint. MRI at 1.5 T shows no signs of synostosis or heterotopic ossification; MSCT shows no signs of migration of cortical buttons in comparison with intraoperative X-ray control. Discussion. Extracortical methods of distal biceps tendon positioning in anatomical reinsertion have lower strength indicators, comparable with the use of transosseous sutures and anchor fixators. A larger area of contact of the studied zone in case of minimal tendon compression in the area of proximal radioulnar space or inside the formed radial bone canal provides high strength indicators and reduces the risk of repeated injury. Conclusion. The scores of the scales (VAS, DASH, ASES) turned out to be better than when using other common methods. The technique of dipping distal biceps tendon stump into the formed oval canal of the “anatomical impression” using the proposed method meets the objectives of careful attitude to the tendon and provides the largest area of its contact with the bone.