Conlin Catherine Ellen, Naderipour Alireza, ElMaraghy Amr
Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.
Department of Surgery, St Joseph's Health Centre, University of Toronto, Toronto, Ontario, Canada.
Orthop J Sports Med. 2019 Aug 22;7(8):2325967119865500. doi: 10.1177/2325967119865500. eCollection 2019 Aug.
The bicipital aponeurosis (BA) can often be torn concomitantly with a distal biceps tendon (DBT) rupture. Its repair, although recommended by some, has not commonly been addressed during the surgical management of DBT ruptures, and to date, surgical repair of the BA with DBT repair has not been evaluated clinically.
To utilize subjective and objective outcome measures to examine the safety and efficacy of 2-incision DBT repair with and without repair of the BA in patients with a DBT rupture.
Cohort study; Level of evidence, 3.
Demographic and surgical data were reviewed retrospectively. Patients returned to the clinic to complete subjective outcome measures and objective measurements of range of motion, strength, and biceps contour. All patients were evaluated at least 1 year after surgical treatment.
Data from 24 male patients with a DBT rupture were used for the analysis; 13 (54%) underwent concomitant DBT and BA repair, and 11 (46%) underwent isolated DBT repair. There were no complications at 1 year in either group. The DBT + BA repair group returned to recreational activities faster (77% within 6 months and 100% within 1 year) than the isolated DBT repair group (36% within 6 months, 91% within 1 year, and 100% after more than 2 years) ( = .05). There was a trend toward better Patient-Rated Elbow Evaluation pain scores in the DBT + BA repair group than in the isolated DBT repair group (1.2 vs 5.3, respectively; = .18). A trend also emerged toward closer return to subjective preinjury strength (77% vs 44%, respectively; = .14). No significant difference emerged in patient satisfaction with the biceps contour, subjective scores on functional activities and disability, or objective measurements of strength, contour, and range of motion.
This pilot study suggests that repair of the BA in conjunction with DBT repair leads to a faster return to recreational activities compared with isolated DBT repair. Also noted was a trend toward subjectively improved pain and greater perceived strength, after DBT + BA repair, although this was not statistically significant. Further investigation with a larger population is required to better elucidate these potential differences.
肱二头肌肌腱膜（BA）常可与肱二头肌远端肌腱（DBT）断裂同时发生撕裂。尽管一些人建议对其进行修复，但在DBT断裂的手术治疗中，其修复并不常见，并且迄今为止，BA与DBT修复同时进行的手术修复尚未得到临床评估。
采用主观和客观的结果指标，检查DBT断裂患者中，行两切口DBT修复并同时修复或不修复BA的安全性和有效性。
队列研究；证据等级，3级。
回顾性分析人口统计学和手术数据。患者返回诊所完成主观结果指标以及对活动范围、力量和肱二头肌轮廓的客观测量。所有患者在手术治疗后至少1年接受评估。
对24例DBT断裂男性患者的数据进行分析；13例（54%）同时进行了DBT和BA修复，11例（46%）仅进行了DBT修复。两组在1年时均无并发症。DBT + BA修复组比单纯DBT修复组更快恢复娱乐活动（6个月内77%，1年内100%），单纯DBT修复组6个月内36%，1年内91%，超过2年后100%（P = 0.05）。DBT + BA修复组的患者肘关节评估疼痛评分有优于单纯DBT修复组的趋势（分别为1.2和5.3；P = 0.18）。在恢复到主观伤前力量方面也出现了一种趋势（分别为77%和44%；P = 0.14）。在患者对肱二头肌轮廓的满意度、功能活动和残疾的主观评分，或力量、轮廓和活动范围的客观测量方面，未出现显著差异。
这项初步研究表明，与单纯DBT修复相比，BA与DBT修复同时进行可使患者更快恢复娱乐活动。还注意到，在DBT + BA修复后，疼痛主观改善和力量感增强有一定趋势，尽管这在统计学上不显著。需要对更多人群进行进一步研究，以更好地阐明这些潜在差异。
