Laith M. Jazrawi, Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 333 East 38th Street, New York, NY 10016.
Am J Sports Med. 2013 Oct;41(10):2288-95. doi: 10.1177/0363546513502306. Epub 2013 Sep 5.
Chronic ruptures of the distal biceps are often complicated by tendon retraction and fibrosis, precluding primary repair. Reconstruction with allograft augmentation has been proposed as an alternative for cases not amenable to primary repair.
To investigate the clinical outcomes of late distal biceps reconstruction using allograft tissue.
Case series; Level of evidence, 4.
A total of 20 patients who underwent distal biceps reconstruction with allograft tissue between May 2007 and May 2012 were identified. Charts were retrospectively reviewed for postoperative complications, gross flexion and supination strength, and range of motion. Subjective functional outcomes were assessed prospectively with the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire.
Eighteen patients with adequate follow-up were included in the study. All had undergone late distal biceps reconstruction with allografts (Achilles [n = 15], semitendinosus [n = 1], gracilis [n = 1], or anterior tibialis [n = 1]) for symptomatic chronic ruptures of the distal biceps. At a mean office follow-up of 9.3 months (range, 4-14 months), all patients had full range of motion and mean gross strength of 4.7 of 5 (range, 4-5) in flexion and supination. After a mean out-of-office follow-up at 21 months (range, 7-68.8 months), the mean DASH score was 7.5 ± 17.9, and the mean MEPS increased from 43.1 preoperatively to 94.2 postoperatively (P < .001). The only complication observed was transient posterior interosseous nerve palsy in 2 patients. Additionally, all but 1 patient reported a cosmetic deformity. However, all patients found it acceptable.
Late reconstruction for chronic ruptures of the distal biceps using allograft tissue is a safe and effective solution for symptomatic patients with functional demands in forearm supination and elbow flexion. While there are several graft options, the literature supports good results with Achilles tendon allografts. Further studies are needed to evaluate the clinical outcomes of other allograft options.
慢性肱二头肌远端撕裂常伴有肌腱回缩和纤维化，不适合进行初次修复。异体肌腱增强重建已被提议作为不适合初次修复的替代方法。
研究使用同种异体组织进行晚期肱二头肌远端重建的临床结果。
病例系列；证据水平，4 级。
共确定了 2007 年 5 月至 2012 年 5 月期间接受同种异体组织肱二头肌远端重建的 20 例患者。回顾性查阅病历以了解术后并发症、总屈肌和旋后肌力以及活动范围。前瞻性使用 Mayo 肘部功能评分（MEPS）和上肢残疾问卷（DASH）评估主观功能结果。
18 例患者获得了足够的随访，纳入本研究。所有患者均因肱二头肌远端慢性撕裂导致症状性慢性撕裂而行同种异体肌腱（跟腱 [n = 15]、半腱肌 [n = 1]、股薄肌 [n = 1]或胫骨前肌 [n = 1]）进行晚期肱二头肌远端重建。在平均 9.3 个月的门诊随访（范围，4-14 个月）中，所有患者均恢复了全活动范围，平均总屈肌和旋后肌力为 4.7/5（范围，4-5）。在平均 21 个月的门诊随访（范围，7-68.8 个月）后，DASH 评分平均为 7.5 ± 17.9，MEPS 评分从术前的 43.1 增加到术后的 94.2（P <.001）。唯一观察到的并发症是 2 例患者短暂出现后骨间神经麻痹。此外，除 1 例患者外，所有患者均报告存在美容畸形。然而，所有患者都认为可以接受。
使用同种异体组织进行慢性肱二头肌远端撕裂的晚期重建是一种安全有效的方法，适用于对前臂旋后和肘部屈曲有功能要求的症状性患者。虽然有几种移植物选择，但文献支持跟腱同种异体移植物的良好结果。需要进一步研究来评估其他同种异体移植物选择的临床结果。
