gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Endoscopically assisted distal biceps tendon repair

Meeting Abstract

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  • presenting/speaker Paul Jarrett - Murdoch Orthopaedic Clinic, Murdoch, Australia

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-126

doi: 10.3205/19ifssh0086, urn:nbn:de:0183-19ifssh00867

Published: February 6, 2020

© 2020 Jarrett.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: This paper aims to describe a surgical technique for endoscopic distal biceps tendon repair and analyse the outcomes.

Methods: With the forearm supinated a 2 cm volar incision approximately 3 cm distal to the elbow crease, medial to the extensor mass is utilised. The fascia is incised, and the lateral cutaneous nerve of the forearm is protected. A Karl Storz Hopkins wide angle Forward- Oblique telescope with optical dissector with distal spatula was utilised with when required a Cottle speculum. The radial tubercle is located using blunt dissection. The passageway for the tendon is identified and enlarged if required.

A Zimmer Biomet Toggleloc anchor and placement equipment was create a bone tunnel and anchor for repair. The proximal end of the tendon is located via the single incision using the endoscope. The tendon end is delivered out of the incision, tendinopathic tissue removed and a healthy tendon end of appropriate dimensions created for repair. The tendon is sutured into the anchor and repaired into the radial tubercle tunnel.

Results: Over the last six years, 50 patient's distal biceps were repaired using this technique. The mean age was 52 years with 47 males and 3 female having surgery. Fourteen percent of patients were smokers. Time from injury to surgery was on average 3 weeks with 40% having surgery within one week of injury. Follow-up was for at least three months for all patients. All patients regained full extension and flexion. The mean DASH was 11 with an average grip strength of 47 kg. There were no permanent neurological injuries but 16% of patients suffered minor transient sensory disturbance of the lateral cutaneous nerve of the forearm. Two patient suffered re-avulsion of the tendon, both of whom were non-compliant with their restrictions, and who went on to revision surgery and gained an excellent result following their second operation. One patient suffered from a superficial wound infection which responded to oral antibiotics and one patient suffered from a wound haematoma which resolved spontaneously. The mean incision length was 19 mm.

Conclusions: The above procedure is a straightforward procedure with low rate of complication, high patient satisfaction and short operative time. The results seem to be similar to previous open surgical technique utilised by the author but with a lower lateral cutaneous nerve of forearm neuropraxia rate.