Prada Carlos, Li Zhi, Sritharan Praveen, Khan Moin, Marcano-Fernández Francesc, Al Mana Latifah, Alolabi Bashar
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Shoulder Elbow. 2024 Oct;16(6):646-653. doi: 10.1177/17585732231215504. Epub 2023 Nov 17.
Distal biceps tendon (DBT) injuries are relatively uncommon. Controversies exist regarding the best approach, leading to variations in treatment. This study aims to understand the preferences and practices of orthopedic surgeons regarding management of DBT injuries, as well as assess the feasibility of a future pilot randomized controlled trial (RCT) to evaluate the impact of various surgical factors on patient outcomes.
A cross-sectional international survey was conducted amongst surgeons treating patients with DBT injuries. The survey included questions about treatment preferences, surgical techniques, case volumes, and interest in participating in a future RCT.
Responses from 491 orthopedic surgeons from 26 countries/territories were obtained. Most surgeons had limited exposure to DBT ruptures. Variations were observed in the work-up process, with some relying solely on clinical examinations while others used diagnostic imaging. A single incision approach was the most common surgical technique, and tendon fixation with suspensory cortical buttons was frequently preferred. Most surgeons did not explore or repair the bicipital aponeurosis. Interest in participating in a future RCT varied for different surgical controversies.
This survey provides valuable insights into surgeons' preferences and practices for DBT injury management. The study highlights the need for standardization in the work-up process and the use of evidence-based guidelines. Current practices may be influenced by factors such as training, implant availability, and costs. The survey also identified surgeons and centers interested in collaboration for future multicenter trials, allowing for equitable access to surgical collaboration opportunities and addressing the lack of evidence in DBT rupture treatment.
Level V, expert-opinion.
肱二头肌远端肌腱（DBT）损伤相对不常见。关于最佳治疗方法存在争议，导致治疗方式各异。本研究旨在了解骨科医生在DBT损伤管理方面的偏好和实践，同时评估未来开展一项初步随机对照试验（RCT）以评估各种手术因素对患者预后影响的可行性。
对治疗DBT损伤患者的外科医生进行了一项横断面国际调查。该调查包括有关治疗偏好、手术技术、病例数量以及参与未来RCT兴趣的问题。
获得了来自26个国家/地区的491名骨科医生的回复。大多数医生处理DBT断裂的经验有限。在检查过程中观察到差异，一些医生仅依靠临床检查，而另一些医生则使用诊断性影像学检查。单切口方法是最常见的手术技术，并且经常首选使用悬吊皮质纽扣进行肌腱固定。大多数医生未探查或修复肱二头肌腱膜。对于不同的手术争议，参与未来RCT的兴趣各不相同。
这项调查为外科医生在DBT损伤管理方面的偏好和实践提供了有价值的见解。该研究强调了在检查过程中进行标准化以及使用循证指南的必要性。当前的实践可能受到培训、植入物可用性和成本等因素的影响。该调查还确定了有兴趣参与未来多中心试验合作的外科医生和中心，从而能够公平地获得手术合作机会，并解决DBT断裂治疗中缺乏证据的问题。
V级，专家意见。
