Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA.
Am J Sports Med. 2017 Dec;45(14):3340-3344. doi: 10.1177/0363546517727511. Epub 2017 Sep 22.
The bicipital aponeurosis, or lacertus fibrosus, can potentially be used as a reconstruction graft in chronic distal biceps tendon tears.
To evaluate construct stiffness, load to failure, and failure mechanism with lacertus fibrosus versus Achilles allograft for distal biceps tendon reconstruction.
Controlled laboratory study.
Ten fresh-frozen matched cadaveric pairs of elbows were used. Three centimeters of the distal biceps tendon was resected. Specimens were randomized to the lacertus fibrosus or Achilles tendon group. In one group, the lacertus fibrosus was released from its distal attachment and then tubularized and repaired intraosseously to the radius. In the other group, an Achilles tendon graft was sutured to the biceps muscle and repaired to the ulna. The prepared radii were rigidly mounted at a 45° angle on a load frame. The proximal biceps muscle was secured in a custom-fabricated cryogenic grip. Displacement was measured using a differential variable reluctance transducer mounted at the radius-soft tissue junction and in the muscle- or muscle allograft-tissue junction proximal to the repair. Specimens were loaded at 20 mm/min until failure, defined as a 3-mm displacement at the radius-soft tissue junction.
No significant difference was found in mean load to failure between the lacertus fibrosus and Achilles tendon group (mean ± SD, 20.2 ± 5.5 N vs 16.89 ± 4.54 N; P = .18). Stiffness also did not differ significantly between the lacertus fibrosus and Achilles tendon group (12.3 ± 7.1 kPa vs 10.5 ± 5.7 kPa; P = .34). The primary mode of failure in the lacertus fibrosus group was suture pullout from the tissue at the musculotendinous junction (7 of 10). In the Achilles group, failures were observed at the muscle-allograft interface (3) and the allograft-bone (radial tuberosity) interface (3), and 3 suture failures were observed. The button fixation did not fail in any specimens.
The mean stiffness and load-to-failure values were not significantly different between a lacertus fibrosus construct and Achilles tendon allograft.
Use of the lacertus fibrosus may be a potential alternative to Achilles tendon allograft reconstruction of chronic distal biceps tears when primary repair is not possible.
二头肌腱膜（或纤维性腱帽）可作为慢性远端二头肌肌腱撕裂的重建移植物。
评估二头肌腱膜与跟腱移植物在远端二头肌肌腱重建中的结构刚度、失效载荷和失效机制。
对照实验室研究。
使用 10 对新鲜冷冻匹配的肘部尸体。切除远端 3 厘米的二头肌肌腱。标本随机分为二头肌腱膜或跟腱组。在一组中，从其远端附着处释放纤维性腱帽，然后管化并修复入骨到桡骨。在另一组中，将跟腱移植物缝合到二头肌肌肉并修复到尺骨。准备好的桡骨以 45°角刚性安装在负载框架上。将近端二头肌肌肉固定在定制的低温夹持器中。使用安装在桡骨-软组织连接处和修复近端的肌肉或肌肉移植物-组织连接处的差动变磁阻传感器测量位移。标本以 20mm/min 的速度加载直至失效，定义为桡骨-软组织连接处 3mm 的位移。
二头肌腱膜和跟腱组的失效载荷无显著差异（均值±标准差，20.2±5.5N 与 16.89±4.54N；P=0.18）。二头肌腱膜和跟腱组的刚度也无显著差异（12.3±7.1kPa 与 10.5±5.7kPa；P=0.34）。二头肌腱膜组的主要失效模式是组织在肌-腱交界处的缝线拉出（10 个中有 7 个）。在跟腱组中，失效发生在肌肉-移植物界面（3 个）和移植物-骨（桡骨结节）界面（3 个），并且观察到 3 个缝线失效。在任何标本中，纽扣固定都没有失效。
二头肌腱膜结构与跟腱移植物的平均刚度和失效载荷值无显著差异。
当无法进行初次修复时，二头肌腱膜的使用可能是慢性远端二头肌撕裂的跟腱移植物重建的潜在替代方法。
