DeAngelo Noah, Thomas Rachel A, Kim H Mike
Department of Orthopaedics and Rehabilitation, Penn State College of Medicine Milton S. Hershey Medical Center, Hershey, PA, USA.
Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA.
JSES Int. 2020 Mar 3;4(2):231-237. doi: 10.1016/j.jseint.2020.01.003. eCollection 2020 Jun.
Primary repair of a severely retracted distal biceps tendon can pose a technical challenge. We sought to describe the method and clinical outcomes of a surgical technique used as an adjunct to the conventional anterior single-incision repair for severely retracted biceps tendons. This technique involves a second anterior incision proximally to retrieve a severely retracted tendon followed by passing the tendon through a soft-tissue tunnel.
We identified 30 consecutive patients who had undergone a primary distal biceps tendon repair by an anterior-approach cortical-button technique. A phone survey was conducted for patient-reported outcomes. Patients returned for bilateral forearm supination strength testing in 2 positions (45º of pronation and 45º of supination). Outcomes were compared between patients who required a second incision and high elbow flexion (>60º) because of severe tendon retraction and those who did not require such interventions.
No significant differences in elbow range of motion, supination strength, or patient-reported outcomes were found between the 2 groups of patients ( > .05). Regarding supination strength, the operated side was significantly weaker than the uninjured side in both pronated and supinated positions ( < .05). Both the operated and uninjured sides showed significantly higher torque in a pronated position than in a supinated position ( < .05).
Severely retracted distal biceps tendons can be successfully repaired using a second incision and high elbow flexion without negative effects on the outcomes. Supination strength was decreased following an anterior-approach cortical-button technique, but patient-reported outcomes were not affected negatively.
严重回缩的肱二头肌远端肌腱的一期修复可能带来技术挑战。我们试图描述一种手术技术的方法和临床结果，该技术用作常规前侧单切口修复严重回缩肱二头肌肌腱的辅助方法。此技术包括在近端做第二个前侧切口以找回严重回缩的肌腱，然后将肌腱穿过一个软组织隧道。
我们确定了30例连续接受前入路皮质纽扣技术进行肱二头肌远端肌腱一期修复的患者。进行电话调查以获取患者报告的结果。患者返回进行双侧前臂旋后力量测试，测试在2个位置（旋前45°和旋后45°）进行。比较因严重肌腱回缩而需要第二个切口和高肘屈曲（>60°）的患者与不需要此类干预的患者的结果。
两组患者在肘关节活动范围、旋后力量或患者报告的结果方面均未发现显著差异（P>.05）。关于旋后力量，在旋前和旋后位置，手术侧均明显弱于未受伤侧（P<.05）。手术侧和未受伤侧在旋前位置的扭矩均明显高于旋后位置（P<.05）。
严重回缩的肱二头肌远端肌腱可通过第二个切口和高肘屈曲成功修复，且对结果无负面影响。前入路皮质纽扣技术后旋后力量下降，但患者报告的结果未受到负面影响。
