Intramedullary Cortical Button Repair for Distal Biceps Tendon Rupture: A Single-Center Experience

Purpose The aim of this retrospective study was to evaluate the clinical outcome and complication rate of intramedullary cortical button repair for distal biceps tendon rupture (partial and complete tears). Methods Between 2010 and 2014, a total of 28 patients with an acute distal biceps tendon rupture underwent intramedullary cortical button repair. Twenty-four patients (mean age, 49 years) with a mean follow-up of 28 months were included in the study. Twenty patients were examined clinically and by maximum isometric strength testing in flexion (at 90 degrees) and supination of both arms. Twenty-four patients completed functional scores including the Mayo Elbow Performance Score (MEPS), the Andrews-Carson-Score (ACS) and the shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Furthermore, follow-up radiographs of 24 patients were analyzed. Results Compared with the contralateral elbow, the active range of motion (ROM) was the same. The mean strength for flexion was 100.8% +/- 14% and for supination 93.1% +/- 22% compared with the uninjured side. The mean MEPS for all patients was 95.6 +/- 8.2, the mean ACS 194.2 +/- 9.4 and the QuickDASH 3.8 +/- 7.6. Heterotopic ossification (HO) was seen on radiographs in 46% of patients, but was symptomatic in only 1 patient. One patient suffered a tendon rerupture, and 1 asymptomatic button migration was seen in the follow-up. Conclusions Intramedullary cortical button repair provides good results with respect to strength, ROM, and functional outcomes. Because the posterior cortex is not violated, the risk of iatrogenic posterior interosseous nerve injury is minimized. However, the patient should be warned of a high prevalence of postoperative HO. Copyright (C) 2019 by the American Society for Surgery of the Hand. All rights reserved.