Clinical Professor of Orthopaedic Surgery University of Pittsburgh School of Medicine Orthopaedic Specialists UPMC Pittsburgh PA ID: 915431
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Slide1
Dean G. Sotereanos, MD Clinical Professor of Orthopaedic Surgery University of Pittsburgh School of Medicine Orthopaedic Specialists - UPMC Pittsburgh, PA
Distal Biceps Tendon Rupture
You
Need to Graft Every Time
to
Get Him Back to Competition,
Let
Me Show You the Way
Slide2NO consensus on timeframe in literature:
Chronic Distal Biceps Ruptures
3 weeks to 4 months
chronicity
up to 8 weeks: anatomic repair
> 8 weeks: much more difficult repair
Slide3RetractionScarringPoor tissue qualityEffective pain relief BUT Results compared to early repair
Chronic Biceps Ruptures Repair
Slide4cocoon Often a cocoon of connective tissue gives the impression of tendon continuity to the bicipital tuberosity
Chronic Biceps Ruptures Repair
Slide5Biceps mobilizationGradual tractionRelaxing incisions to the epimysiumDebride to healthy tendonAnatomic repairChronic Biceps Ruptures Repair
Slide6When the stump cannot be approximated to the bicipital tuberosity: Primary repair in extreme flexion Biceps to brachialis transfer Reconstruction w/ allograftChronic Ruptures Repair
Slide7criteria
Primary repair in extreme flexion
> 70
o
flexion
Tendon adequate length ( >4 cm) & substance
Decreased chronicity
Lacertus intact
Slide8Potential complicationsFlexion contracture ReruptureVascular compromise (> 90o flexion)
Primary repair in extreme flexion
> 70
o
flexion
Slide9criteria
Reconstruction with allograft
If someone requests supination strength:
electricians weekend warriors
Slide10criteria
Reconstruction with allograft
Decreased Tendon length ( <4 cm) / poor tissue
Increased chronicity
Lacertus not intact (greater retraction)
Slide11Our Preferred TechniqueReconstruction with Achilles Tendon AllograftDarlis & SotereanosJ Shoulder Elbow Surg 2006
Anterior Approach - One incision method
Slide12S-shaped incision antecubital fossaAnterior Approach – modified anterior Henry
forearm
fully
Supinated at all times!
Inability to approximate tendon stump to bicipital tuberosity with the elbow in less than 70
o
of flexion or poor tendon quality
Slide13Exposure of the radial tuberosity with the forearm in full supinationSurgical technique
Placement of 2 suture anchors
with #2 non-absorbable suture
Slide14The bone block is discardedThe allograft is separated to 2 stripsFresh-frozen Achilles tendon allograft
Slide15The sutures are passed through the distal part of the allograft in a modified Kessler sliding stitch
Allograft attached to radius first
Slide16The allograft is woven through the distal biceps stump in a Pulvertaft fashion
Slide17One Incision MethodBone anchors & Achilles tendon allograft 13 pts chronic distal biceps tendon rupture Darlis N, Sotereanos D. JSES 2006
mean supination strength 88%
mean flexion strength 100%
vs
contralateral arm
mean f-up
37
m (24-112m)
Synostosis
PIN injuries
complications from allograft
Sotereanos et al.
ASES
2012
chronicity
mean
31 w
(11- 47 w)
Slide181.7 cm of tendon
Would you be
comfortable to suture
that to the tuberosity in
> 70
o
flexion?
Slide19Thank you