Anatomic single-incision footprint reconstruction of the distal biceps tendon: an accuracy analysis of 31 men including force measurements

Background Anatomic reconstruction of distal biceps tendon ruptures may prevent loss of strength and the associated restrictions in everyday life. We investigated whether an anterior single-incision approach is effective in anatomically reconstructing the tendon footprint using a bicortical endobutton and whether this affects postoperative force development. Methods All adult patients (≥ 18 years of age) with at least 1 year of follow-up after acute distal biceps tendon rupture treated by bicortical endobuttons using the single-incision technique were eligible for inclusion. Radiographic assessment included analysis of the anatomic footprint. Functional follow-up included range of motion, objective and subjective performance measures, flexion and supination forces, complications, and rates of return to sport and to work. Mean flexion and supination forces were statistically compared between the affected and unaffected side. Results After a mean follow-up of 31.5 ± 16.6 months, satisfactory results were obtained for 31 male patients (mean age: 50 ± 9 years). Postoperatively, supination strength measures (starting force, maximum force, terminal force, and average force) were significantly lower on the affected side vs. the unaffected side. This involved the dominant arm in 58% of cases. The tendon was anatomically reconstructed in 4 out of 31 cases (12.9%). On average, return to work was 6.2 ± 4.3 weeks and return to sports was 5.0 ± 2.9 months. The return-to-work and return-to-sports rates amounted to 100%. Conclusion Supination strength suffers after distal biceps tendon reconstruction relative to the unaffected side. In most cases (87.1%), the distal biceps tendon could not be reattached to its anatomic footprint via an anterior single-incision approach. Intraoperative radiographic control might improve anatomic positioning of the refixation and remains to be evaluated.