Purpose
To evaluate the incidence, etiology, and clinical outcomes after revision distal biceps
tendon repair. We hypothesized that re-ruptures are rare and can be reattached with
satisfactory results.
Methods
Cases were identified from the case log of the senior author. Demographic information,
details regarding the primary repair and subsequent injury, time between reinjury
and reattachment, and operative findings were recorded. Clinical outcomes were assessed
using the Disabilities of the Arm, Shoulder, and Hand (DASH) and American Shoulder
and Elbow Surgeons–Elbow (ASES-E) functional outcome scoring systems. Range of motion,
strength, and ability to return to work were recorded.
Results
We identified 10 patients with re-rupture, all of whom were men. Average age was 46
years (range, 35–57 years). Four ruptures occurred in the dominant arm. Three patients
had a history of bilateral ruptures. Incidence of primary failure was 1.1%. In 6 patients,
re-rupture occurred 6 days to 11 months after the primary surgery. Three patients
described a sense of ripping or tearing after a specific traumatic event. Four others
had persistent pain after the primary reattachment. Re-rupture resulted from the loss
of fixation owing to technical error, the suture pulling out from the tendon, or suture
breakage. Two patients required an allograft. The hook test was abnormal in 3 patients.
Magnetic resonance imaging results did not affect the operative plan. Nine patients
returned to their former occupation. Five returned for follow-up evaluation and completion
of the DASH and ASES-E self-assessment examinations. Average DASH score was 4.4 (range,
0–19) and average ASES-E was 93.2 (range, 74–100). Postoperative average elbow flexion
was 141° (range, 135° to 145°), elbow extension was –12° (range, –5° to –30°), pronation
was 70°, and supination was 80°. Postoperative average supination strength was 87.8%
of the nonsurgical arm (range, 79% to 106%); average pronation strength was 79.2%
of the nonsurgical arm (range, 50% to 110%).
Conclusions
Revision reattachment resulted in acceptable functional outcomes.
Type of study/level of evidence
Therapeutic V
Key words
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Article info
Publication history
Published online: June 24, 2019
Accepted:
May 3,
2019
Received:
August 20,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
