Prud'homme-Foster Marc, Louati Hakim, Pollock J Whitcomb, Papp Steven
Division of Orthopaedics, University of Ottawa, Ottawa, ON, Canada.
Division of Orthopaedics, University of Ottawa, Ottawa, ON, Canada.
J Shoulder Elbow Surg. 2015 Apr;24(4):527-32. doi: 10.1016/j.jse.2014.09.039. Epub 2014 Dec 3.
Anatomic repair of the distal biceps tendon can be difficult to achieve. This study was designed to compare the effect of anatomic and nonanatomic repairs on forearm supination torque. A nonanatomic repair re-establishes the footprint radial and more anterior to the tuberosity apex, whereas an anatomic repair re-establishes the footprint ulnar and more posterior to the tuberosity apex.
Eight fresh frozen cadaver arms were surgically prepared and mounted on an elbow simulator. Controlled loads were applied to the long head and short head in positions of pronation, neutral, and supination. This was done with intact tendons and then repeated with repaired tendons that were repaired either anatomically (ulnar position) or nonanatomically (radial position).
All anatomic repairs showed no difference compared with intact tendon measurements. In comparing anatomic and nonanatomic repairs, we found no differences in the supination torque when the forearm was in 45° of pronation. However, when the arm was in neutral rotation, we found that 15% less supination torque was generated by the nonanatomic repair. When the arm was tested in 45° of supination, we found that 40% less supination torque was generated in the nonanatomic repair (P = .01).
This study supports the idea that an anatomic repair of the biceps tendon onto the ulnar side of the radial tuberosity is important. If the tendon is repaired too radially, the biceps will lose the cam effect and may not be able to generate full supination torque when the forearm is in neutral rotation or in supination.
肱二头肌远端肌腱的解剖修复可能难以实现。本研究旨在比较解剖修复和非解剖修复对前臂旋后扭矩的影响。非解剖修复是在结节顶点的桡侧且更靠前重建止点，而解剖修复是在结节顶点的尺侧且更靠后重建止点。
对8只新鲜冷冻尸体手臂进行手术准备并安装在肘部模拟器上。在旋前、中立和旋后位向肱二头肌长头和短头施加可控负荷。先对完整肌腱进行此操作，然后对分别采用解剖修复（尺侧位）或非解剖修复（桡侧位）的修复肌腱重复该操作。
与完整肌腱测量结果相比，所有解剖修复均无差异。在比较解剖修复和非解剖修复时，我们发现前臂处于45°旋前位时，旋后扭矩无差异。然而，当手臂处于中立旋转位时，我们发现非解剖修复产生的旋后扭矩减少了15%。当手臂在45°旋后位进行测试时，我们发现非解剖修复产生的旋后扭矩减少了40%（P = 0.01）。
本研究支持肱二头肌肌腱在桡骨结节尺侧进行解剖修复很重要这一观点。如果肌腱修复过于偏向桡侧，肱二头肌将失去凸轮效应，在前臂处于中立旋转位或旋后位时可能无法产生完全的旋后扭矩。
