Department of Orthopaedic Surgery, Tauranga Hospital, Bay of Plenty, New Zealand.
Department of Orthopaedic Surgery, Tauranga Hospital, Bay of Plenty, New Zealand.
J Shoulder Elbow Surg. 2022 Jun;31(6):1316-1322. doi: 10.1016/j.jse.2021.11.015. Epub 2021 Dec 30.
BACKGROUND: On the basis of the current literature, the optimal surgical technique for distal biceps tendon tears remains controversial. Cadaveric studies have investigated distal biceps anatomy but are limited by cohort size and tissue factors. We sought to investigate distal biceps anatomy in vivo by retrospectively reviewing magnetic resonance imaging (MRI) scans. An improved understanding of the anatomy of the distal biceps tendon will lead to better definition of the optimal anatomic surgical repair. METHODS: Two independent observers retrospectively reviewed 3-T MRI scans of elbows. Basic demographic data were collected, and measurements of tendon length, footprint width, footprint length, and footprint angle were taken using simultaneous tracker lines and a standardized technique. From the biceps muscle belly distally, the presence of a single tendon or double tendons was recorded and the tendon interdigitation point was measured if relevant. RESULTS: A total of 106 3-T MRI scans of 106 elbows of 103 patients were included. There were 71 male and 32 female patients, and the mean age was 44.7 years. Most distal biceps tendons exited the biceps muscle belly as separate entities (91%, 96 of 106 elbows) and then coalesced prior to insertion on the radial tuberosity (91%, 87 of 96 elbows). There was a positive correlation between tendon length and footprint length (P < .05), as well as between tendon length and footprint width (P < .05). The mean tendon length was 65.2 mm (95% confidence interval [CI], 63.3-66.8 mm; range, 44.3-86.8 mm), the mean distance from the musculotendinous junction to the interdigitation point was 38.3 mm (95% CI, 35.8-40.9 mm; range, 8.9-64.8 mm), the mean footprint width was 10.3 mm (95% CI, 9.9-10.7 mm; range, 5.9-16.3 mm), the mean footprint length was 16.2 mm (95% CI, 15.6-16.9; range, 7.3-25.4 mm), and the mean footprint angle was 32.1° (95% CI, 29.5°-34.6°; range, 8.5°-84.3°). CONCLUSION: An in vivo, high-resolution study of the anatomy of the distal biceps tendon improves our understanding of its complex morphology and hence our ability to perform an anatomic "footprint repair."
背景：根据目前的文献，远端肱二头肌肌腱撕裂的最佳手术技术仍存在争议。尸体研究已经调查了远端肱二头肌的解剖结构，但受到队列规模和组织因素的限制。我们试图通过回顾性地审查磁共振成像（MRI）扫描来研究活体中的远端肱二头肌解剖结构。对远端肱二头肌肌腱解剖结构的更好理解将导致更好地定义最佳的解剖修复。
方法：两名独立观察者回顾性地审查了肘部的 3-T MRI 扫描。收集了基本的人口统计学数据，并使用同步跟踪器线和标准化技术测量了肌腱长度、足印宽度、足印长度和足印角度。从肱二头肌肌腹向远端，记录是否存在单个肌腱或双肌腱，如果相关，则测量肌腱交错点。
结果：共纳入 106 例 103 例患者的 106 个肘部的 3-T MRI 扫描。其中 71 例为男性，32 例为女性，平均年龄为 44.7 岁。大多数远端肱二头肌肌腱以独立的实体从肱二头肌肌腹穿出（91%，96/106 肘部），然后在桡骨粗隆上汇合（91%，87/96 肘部）。肌腱长度与足印长度之间存在正相关（P<.05），肌腱长度与足印宽度之间也存在正相关（P<.05）。平均肌腱长度为 65.2mm（95%置信区间[CI]，63.3-66.8mm；范围，44.3-86.8mm），从肌肌腱结合部到交错点的平均距离为 38.3mm（95%CI，35.8-40.9mm；范围，8.9-64.8mm），平均足印宽度为 10.3mm（95%CI，9.9-10.7mm；范围，5.9-16.3mm），平均足印长度为 16.2mm（95%CI，15.6-16.9mm；范围，7.3-25.4mm），平均足印角度为 32.1°（95%CI，29.5°-34.6°；范围，8.5°-84.3°）。
结论：对远端肱二头肌肌腱解剖结构的活体、高分辨率研究提高了我们对其复杂形态的理解，从而提高了我们进行解剖“足印修复”的能力。
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