distal biceps tendon rupture

- Inzidenz 1,2/100000 pro Jahr

- Männer zw. 40-50j

- conservative management can result in flexion an supination weakness or fatigue

Op Technik: single Incision/Endobutton

anterior approach distal to the antecubital fossa

internervous plane

- distal:

- proximal:

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Does immediate elbow mobilization after distal biceps tendon repair carry the risk of wound

breakdown, failure of repair, or patient dissatisfaction?

James R.A. Smith, MBBS, BSC, MRCS*, Rouin Amirfeyz, MD, MSc, FRCS Bristol Royal Infirmary

Rehabilitation protocols after distal biceps repair are highly variable

Often immobilisation for at least two weeks

The authors report their results using a cortical button technique and immediate postoperative mobilisation

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Methods

retrospectiv

09/2012 – October 2014: 22 distal biceps tendon repairs in 20 patients

OP: cortical button system / activ mobilisation from day of surgery

Physiotherapy

clinical diagnosis: observation of the attitude of the biceps muscle belly, presence of a bruise in the proximal ulnar aspect of the forearm, lack of movement of the bicep with supination, o’driscoll hook test

no routinely mri or xray (prä und postop)

primary outcome: clinical integrity of the tendon at the final follow up

secondary outcome: clinician based an patient reported outcome measures

- ROM elbow, wound complications, neurologic complications

- QuickDASH, Mayo Elbow Perfomance Index, Oxford Elbow Score, Time to work

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Methods

Postoperativ regimen

no brace

aktiv flex/ex an pro/supination from day of operation

wound check after 2 weeks

1kg weight restricion for 6 weeks

review after 8 weeks

sport permitted 12 weeks

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Results

Patient population:

all male; mean age 40,6y

mean time to surgery 17 days

time to return work: 70day (4-179)

mean follow-up 16,6 months (range, 3,8 - 29 months)

All patients had an intact tendon at follow-up

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Results

Movement and patient outcome scores:

99% of the ROM arc of the uninjured elbow

30% mild subjective flexion weakness (not objectively measured)

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Results

Complications

2/3 transient nerve paresthesia

- superficial radial nerve in 6 Patients (27%)

- lateral antebrachial cutaneous nerve in 8 patients (36%)

all nerve palsies had resolved completely by the 8-week follow up

no wound complications

no fixation failures

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Discussion

surgical reattachment of the biceps tendon after rupter is associated with good outcome

Various OP techniques

Gupta et al (8 patients) and Peeters et al (26 patients) : single anterior incision and cortical button device

complication of nerve palsy greater than anticipated

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Discussion

Limitations

small number of patients

absence of comparison group/ no randomization

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Nachbehandlungsschema

Woche 1-6: Pro/Supination frei in 90°, Passiv/aktiv-assistiv ohne Belastung.

Ruhigstellung in der Ellenbogengelenksorthese mit folgenden Bewegungslimiten:

Woche 0-2: 45° Extensionsdefizit aus der Orthese heraus

Woche 2-4: 30° Extensionsdefizit aus der Orthese heraus

Woche 4-6: 20° Extensionsdefizit aus der Orthese heraus

Woche 6: Freigabe der Beweglichkeit ohne Orthese, passive Dehnungsübungen unter physiotherapeutischer Supervision, keine Gewichtsbelastung

Woche 9-12: Erweiterung der Dehnungs- und Bewegungsübungen, Gewichtsbelastung bis 5 kg

Ab Woche 12: Beginn Kräftigungsübungen Schulter/Ellenbogen, Kraftsport frühestens ab Woche 20.

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