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Biomechanical evaluation of distal biceps tendon repair using tension slide technique and knotless fixation technique

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Abstract

Background

Acute distal biceps tendon ruptures are uncommon injuries that often affect young active males, typically resulting from an eccentric load on their dominant extremity. The purpose of this study was to compare pullout strength and tendon gapping in the tension slide technique (TST) versus a knotless fixation technique (KFT).

Methods

Two sets of experiments were performed using cadaveric elbow specimens. In the first experiment, eight elbows from different cadavers were tested to compare TST with a standard locking whipstitch with KFT, four elbows in each group, using a standard locking whipstitch. In the second experiment, 12 elbows were used to study the differences between TST with a standard locking whipstitch with KFT using suture tape reinforced whipstitch (RKFT), using the TST data from the first and second experiment. Each experiment evaluated gapping after cyclic loading and the second experiment also tested the construct to load to failure.

Results

Gapping for KFT with a standard locking whipstitch was 10.64 mm versus 2.69 mm for the TST after 1000 cycles (P = 0.016). A reinforced whipstitch significantly improved the failure to gap on the KFT with no significant difference in gapping when compared to TST after 3000 cycles (P = 0.36). The resultant gapping for TST and KST was 2.08 mm and 2.99 mm (P = 0.91), respectively. Load to failure for TST and KFT were 282 Nm and 328 Nm (P = 0.20), respectively.

Conclusion

Bone-tendon gap resistance of a KFT repair of a torn distal biceps tendon is limited by suture technique. Using a tape reinforced locking whipstitch, the repair is as strong as TST repair.

Levels of Evidence: Basic Science.

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References

  1. Athwal GS, Steinmann SP, Rispoli DM (2007) The distal biceps tendon: footprint and relevant clinical anatomy. J Hand Surg 32:1225–1229. doi:10.1016/j.jhsa.2007.05.027

    Article  Google Scholar 

  2. Kelly MP, Perkinson SG, Ablove RH, Tueting JL (2015) Distal biceps tendon ruptures: an epidemiological analysis using a large population database. Am J Sports Med. doi:10.1177/0363546515587738

  3. Safran MR, Graham SM (2002) Distal biceps tendon ruptures: incidence, demographics, and the effect of smoking. Clin Orthop 275–283. doi: 10.1097/00003086-200211000-00042

  4. Watson JN, Moretti VM, Schwindel L, Hutchinson MR (2014) Repair techniques for acute distal biceps tendon ruptures: a systematic review. J Bone Joint Surg Am 96:2086–2090. doi:10.2106/JBJS.M.00481

    Article  PubMed  Google Scholar 

  5. Siebenlist S, Buchholz A, Zapf J et al (2015) Double intramedullary cortical button versus suture anchors for distal biceps tendon repair: a biomechanical comparison. Knee Surg Sports Traumatol Arthrosc 23:926–933. doi:10.1007/s00167-013-2590-0

    Article  PubMed  Google Scholar 

  6. Mazzocca AD, Burton KJ, Romeo AA et al (2007) Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair. Am J Sports Med 35:252–258. doi:10.1177/0363546506294854

    Article  PubMed  Google Scholar 

  7. Idler CS, Montgomery WH, Lindsey DP et al (2006) Distal biceps tendon repair: a biomechanical comparison of intact tendon and 2 repair techniques. Am J Sports Med 34:968–974. doi:10.1177/0363546505284185

    Article  PubMed  Google Scholar 

  8. Sethi P, Obopilwe E, Rincon L et al (2010) Biomechanical evaluation of distal biceps reconstruction with cortical button and interference screw fixation. J Shoulder Elb Surg 19:53–57. doi:10.1016/j.jse.2009.05.007

    Article  Google Scholar 

  9. Sethi PM, Tibone JE (2008) Distal biceps repair using cortical button fixation. Sports Med Arthrosc Rev 16:130–135. doi:10.1097/JSA.0b013e31818247cb

    Article  Google Scholar 

  10. Bain GI, Prem H, Heptinstall RJ et al (2000) Repair of distal biceps tendon rupture: a new technique using the EndoButton. J Shoulder Elb Surg 9:120–126

    Article  CAS  Google Scholar 

  11. Greenberg JA, Fernandez JJ, Wang T, Turner C (2003) EndoButton-assisted repair of distal biceps tendon ruptures. J Shoulder Elb Surg 12:484–490. doi:10.1016/S1058274603001733

    Article  Google Scholar 

  12. Spang JT, Weinhold PS, Karas SG (2006) A biomechanical comparison of EndoButton versus suture anchor repair of distal biceps tendon injuries. J Shoulder Elb Surg 15:509–514. doi:10.1016/j.jse.2005.09.020

    Article  Google Scholar 

  13. Siebenlist S, Lenich A, Buchholz A et al (2011) Biomechanical in vitro validation of intramedullary cortical button fixation for distal biceps tendon repair: a new technique. Am J Sports Med 39:1762–1768. doi:10.1177/0363546511404139

    Article  PubMed  Google Scholar 

  14. Rose DM, Archibald JD, Sutter EG et al (2011) Biomechanical analysis suggests early rehabilitation is possible after single-incision EndoButton distal biceps repair with FiberWire. Knee Surg Sports Traumatol Arthrosc 19:1019–1022. doi:10.1007/s00167-010-1348-1

    Article  PubMed  Google Scholar 

  15. Hahn JM, Inceoğlu S, Wongworawat MD (2014) Biomechanical comparison of Krackow locking stitch versus nonlocking loop stitch with varying number of throws. Am J Sports Med 42:3003–3008. doi:10.1177/0363546514550989

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank Arthrex for supplying the implants and sutures used in this study. We also thank the University of Illinois at Chicago for its support and for supplying cadavers and necessary lab equipment. The authors, their immediate family, and any research foundation with which they are affiliated did not receive any financial payment or other benefits from any commercial entity related to the subject of this article.

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Correspondence to David D. Savin.

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The authors declare that they have no conflict of interest.

Funding

Surgical implants and suture were provided by Arthrex using an approved Arthrex research grant. No financial awards or incentives were given to any of the authors.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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This article does not contain any studies with living human participants that necessitates informed consent.

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Per institutional policy, IRB is not needed for cadaveric work.

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Savin, D.D., Piponov, H., Watson, J.N. et al. Biomechanical evaluation of distal biceps tendon repair using tension slide technique and knotless fixation technique. International Orthopaedics (SICOT) 41, 2565–2572 (2017). https://doi.org/10.1007/s00264-017-3559-2

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  • DOI: https://doi.org/10.1007/s00264-017-3559-2

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