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The Journal of Bone and Joint Surgery 82:1575 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

Complications of Repair of the Distal Biceps Tendon with the Modified Two-Incision Technique*{dagger}

Edward W. Kelly, M.D.{ddagger}, Bernard F. Morrey, M.D.{ddagger} and Shawn W. O'Driscoll, Ph.D., M.D.{ddagger}

Investigation performed at the Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.
{dagger}Read in part on Specialty Day of the American Shoulder and Elbow Surgeons and at the Annual Meeting of the American Academy of Orthopaedic Surgeons, Anaheim, California, February 8, 1999.
{ddagger}Department of Orthopedics, Mayo Clinic, 200 First Street S.W., Rochester, Minnesota 55905. E-mail address for B. F. Morrey: morrey.bernard{at}mayo.edu E-mail address for S. W. O'Driscoll: odriscoll.shawn@mayo.edu.

Background: The purpose of this paper is to describe the complications that we encountered after using a muscle-splitting two-incision technique to repair avulsed distal biceps tendons.

Methods: We conducted a retrospective review of the results of seventy-eight consecutive anatomical repairs of the distal biceps tendon performed through a muscle-splitting two-incision technique at our institution between 1981 and 1998. Four of the patients required a graft to restore length. The seventy-four tendons that were repaired primarily through the modified Boyd-Anderson approach were analyzed in detail and form the basis of this report.

Results: Complications developed after twenty-three (31 percent) of the seventy-four repairs. The complications included five sensory nerve paresthesias (three lateral antebrachial cutaneous and two superficial radial nerve paresthesias) in five patients. A temporary palsy of the posterior interosseous nerve developed in one patient; it resolved in six months. Six patients complained of persistent anterior elbow pain. Heterotopic ossification that did not limit forearm rotation developed in four patients, a superficial wound infection developed in three, one tendon reruptured, three patients lost forearm rotation, and reflex sympathetic dystrophy developed in one patient. No radioulnar synostoses were observed in our series. Complications developed after ten (24 percent) of the forty-one acute repairs (performed fewer than ten days after the injury), six (38 percent) of the sixteen subacute repairs (performed ten to twenty-one days after the injury), and seven (41 percent) of the seventeen delayed repairs (performed more than twenty-one days after the injury). The surgeon's experience with this procedure had no apparent effect on complication rates.

Conclusions: Most of the morbidity from repair of the distal biceps tendon can be attributed primarily to a delay in the timing of the repair and secondarily to an extensive anterior exposure. More importantly, radioulnar synostosis is rare following the muscle-splitting modification of the two-incision technique, which can be performed safely even by surgeons with limited experience with this procedure.


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thank you
Michael J. Brennan, MD
JBJS Online, 16 Jul 2001 [Full text]