Purpose
We sought to determine the safest drill trajectory to avoid injury to the posterior
interosseous nerve (PIN) when performing a repair of a distal biceps tendon to an
anatomic location through an anterior, single-incision approach using cortical button
fixation.
Methods
A standard anterior approach was performed in 10 cadaveric specimens to expose the
distal biceps attachment. Three drill holes were made in the radial tuberosity from
the center of the anatomic footprint for the distal biceps tendon insertion with the
forearm fully supinated. Holes were made in 30° distal, transverse, and 30° proximal
directions. Each hole was made by angling the trajectory from an anterior to posterior
and ulnar to radial direction, leaving adequate bone on the ulnar side to accommodate
an 8-mm tunnel for the purpose of docking the biceps tendon into bone. The proximity
of each drill trajectory to the PIN was determined by making a second incision on
the dorsum of the proximal forearm. A K-wire was passed through each hole, and the
distance between the PIN and K-wire was measured for each trajectory.
Results
The distally directed drill hole placed the trajectory wire closest to the PIN (mean
distance, 5.4 mm), contacting the K-wire in 3 cases. The transverse drill trajectory
resulted in contact with the PIN in 1 case (mean distance, 7.6 mm). The proximal drill
trajectory appeared safest, with no PIN contact (mean distance, 13.3 mm).
Conclusions
In this cadaveric study, the proximal drill trajectory resulted in the widest clearance
from the PIN.
Clinical relevance
When performing repair of a distal biceps tendon to the anatomic location on the tuberosity,
the drill trajectory from the center of the biceps footprint should be radial and
proximal to provide the greatest separation between the drill guide and the PIN.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Distal biceps tendon ruptures: incidence, demographics, and the effect of smoking.Clin Orthop Relat Res. 2002; 404: 275-283
- Distal biceps tendon ruptures: an epidemiological analysis using a large population database.Am J Sports Med. 2015; 43: 2012-2017
- Rupture of the distal tendon of the biceps brachii. Operative versus non-operative treatment.J Bone Joint Surg Am. 1985; 67: 414-417
- Rupture of the distal tendon of the biceps brachii. A biomechanical study.J Bone Joint Surg Am. 1985; 67: 418-421
- Avulsion of the distal biceps brachii tendon in middle-aged population: is surgical repair advisable? A comparative study of 22 patients treated with either nonoperative management or early anatomical repair.Injury. 2008; 39: 753-760
- A method for reinsertion of the distal biceps brachii tendon.J Bone Joint Surg. 1961; 43: 1041-1043
- Repair of distal biceps tendon rupture: a new technique using the endobutton.J Shoulder Elbow Surg. 2000; 9: 120-126
- Repair of the distal biceps tendon using suture anchors and an anterior approach.Clin Orthop Relat Res. 1996; 322: 116-119
- Treatment of distal biceps tendon ruptures using a single-incision technique and a bio-tenodesis screw.Orthopedics. 2010; 33: 477
- Reconstruction of posterior interosseous nerve injury following biceps tendon repair: case report and cadaveric study.Hand (N Y). 2009; 4: 134-139
- Prognosis for recovery of posterior interosseous nerve palsy after distal biceps repair.J Shoulder Elbow Surg. 2013; 22: 70-73
- Posterior interosseous nerve incarceration with endobutton repair of distal biceps.Orthopedics. 2015; 38: e68-e71
- Anatomical evaluation of a cortical button for distal biceps tendon repairs.Hand (N Y). 2013; 8: 201-204
- The effect of drill trajectory on proximity to the posterior interosseous nerve during cortical button distal biceps repair.Arthroscopy. 2011; 27: 1048-1054
- Proximity of the posterior interosseous nerve during cortical button guidewire placement for distal biceps tendon reattachment.J Hand Surg Am. 2015; 40: 534-536
- Surgical approach to the proximal end of the radius and its use in fractures of the head and neck of the radius.J Bone Joint Surg. 1941; 23: 86-92
- Distal biceps tendon repair: a cadaveric analysis of suture anchor and interference screw restoration of the anatomic footprint.Am J Sports Med. 2009; 37: 2214-2221
- Anatomic repair of the distal biceps tendon cannot be consistently performed through a classic single-incision suture anchor technique.J Shoulder Elbow Surg. 2014; 23: 1898-1904
- Repaired distal biceps magnetic resonance imaging anatomy compared with outcome.J Shoulder Elbow Surg. 2012; 21: 1623-1631
- Innervation of the supinator muscle and its relationship to two-incision distal biceps tendon repair: an anatomic study.Clin Anat. 2010; 23: 413-419
- Factors that determine supination strength following distal biceps repair.J Bone Joint Surg Am. 2016; 98: 1153-1160
- Intramedullary cortical button repair for distal biceps tendon rupture: a single-center experience.J Hand Surg Am. 2019; 44: 418.e1-418.e7
- The intramedullary cortical button technique for distal biceps tendon repair.Oper Tech Sports Med. 2018; 26: 126-129
- Distal biceps repair using a unicortical intramedullary button technique: a case series.J Hand Surg Glob Online. 2019; 1: 178-184
- The distal biceps tendon: footprint and relevant clinical anatomy.J Hand Surg Am. 2007; 32: 1225-1229
- Cross-sectional anatomy of the bicipital tuberosity and biceps brachii tendon insertion: relevance to anatomic tendon repair.J Shoulder Elbow Surg. 2008; 17: 522-526
Article info
Publication history
Published online: June 04, 2022
Accepted:
April 6,
2022
Received:
June 10,
2020
Publication stage
In Press Corrected ProofFootnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
