Abstract
Objective
Distal biceps brachii tendon (DBBT) rupture is an uncommon but functionally significant injury given the loss of supination, flexion strength and pain that often result. Prompt surgical repair is preferred in most patients. Clinicoradiological post-operative follow-up is typically performed to assess DBBT repair integrity and function, frequently using ultrasound, though to date, no studies have described post-operative DBBT repair sonographic appearances. The purpose of this study was to evaluate post-operative DBBT sonographic appearances in the context of Endobutton repair with the following aims:
- i.
Establish typical ultrasound appearances 12 months post-surgery
- ii.
Establish the relationship between ultrasound appearances and clinical/functional outcomes.
Materials and methods
Sixty patients between February 2016 and October 2017 undergoing DBBT repair were prospectively recruited, all undergoing clinical and sonographic assessment 12 months post-surgery. Ultrasound data was collected on tendon integrity, tendon calibre and presence of intratendinous calcification, peritendinous fluid and peritendinous soft tissue/scarring. Clinical data was collected on active range of motion (ROM) (flexion, extension, supination, pronation) and strength (flexion and supination).
Results
A total of 57/60 patients had intact DBBT repairs identified sonographically and clinically at 12 months. DBBT repairs had significantly increased cross-sectional area (mean 260%, 95% CI: 217%, 303%) compared with non-operated DBBT. Ninety-three percent of DBBT repairs were hypoechoic. Thirty percent contained intratendinous calcification. Peritendinous fluid/soft tissue was rarely observed. There was no significant correlation between DBBT calibre and strength/ROM parameters.
Conclusion
Normal post-operative sonographic appearances of Endobutton DBBT repair comprise a hypoechoic tendon significantly increased in calibre compared with non-operated tendon ± intratendinous calcification. DBBT repair calibre varies greatly, but is not associated with any significant difference in strength/ROM.
Similar content being viewed by others
References
Mazzocca AD, Spang JT, Arciero RA. Distal biceps rupture. Orthop Clin N Am. 2008;39:237–49.
Morrey BF, Askew LJ, An KN, Dobyns JH. Rupture of the distal tendon of the biceps brachii. A biomechanical study. J Bone Joint Surg Am. 1985;67:418–21.
Baker BE, Bierwagen D. Rupture of the distal tendon of the biceps brachii. Operative versus non-operative treatment. J Bone Joint Surg Am. 1985;67:414–7.
Safran MR, Graham SM. Distal biceps tendon ruptures: incidence, demographics, and the effect of smoking. Clin Orthop Rel Res. 2002;404:275–83.
Vidal AF, Drakos MC, Allen AA. Biceps tendon and triceps tendon injuries. Clin Sports Med. 2004;23:707–22.
Rineer CA, Ruch DS. Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures. J Hand Surg. 2009;34:566–76.
Bain GI, Prem H, Heptinstall RJ, Verhellen R, Paix D. Repair of distal biceps tendon rupture: a new technique using the Endobutton. J Shoulder Elb Surg. 2000;9:120–6.
Sutton KN, Dodds SD, Ahmad AS, Sethi PM. Surgical treatment of distal biceps rupture. J Am Acad Orthop Surg. 2010;18:139–48.
Kelly EW, Steinmann S, O’Driscoll SW. Surgical treatment of partial distal biceps tendon ruptures through a single posterior incision. J Shoulder Elb Surg. 2003;12:456–61.
Marshall NE, Keller RA, Okoroha K, et al. Radiostereometric evaluation of tendon elongation after distal biceps repair. Orthop J Sports Med. 2016;4(11):2325967116672620.
Legg AJ, Stevens R, Oakes NO, Shahane SA. A comparison of nonoperative vs. Endobutton repair of distal biceps ruptures. J Shoulder Elb Surg. 2016;25:341–8.
Snir N, Hamula M, Wolfson T, Meislin R, Strauss EJ, Jazrawi LM. Clinical outcomes after chronic distal biceps reconstruction with allografts. Am J Sports Med. 2013;41:2288–95.
Hinchey JW, Aronowitz JG, Sanchez-Sotelo J, Morrey BF. Re-rupture rate of primarily repaired distal biceps tendon injuries. J Shoulder Elb Surg. 2014;23:850–4.
Suda AJ, Prajitno J, Grützner PA, Tinelli M. Good isometric and isokinetic power restoration after distal biceps tendon repair with anchors. Arch Orthop Trauma Surg. 2017;137:939–44.
Jockel CR, Mulieri PJ, Belsky MR, Leslie BM. Distal biceps tendon tears in women. J Shoulder Elb Surg. 2010;19:645–50.
Alemann G, Dietsch E, Gallinet D, Obert L. Repair of distal biceps brachii tendon assessed with 3-T magnetic resonance imaging and correlation with functional outcome. Skelet Radiol. 2015;44:629–39.
Schmidt CC, Diaz VA, Weir DM, Latona CR, Miller MC. Repaired distal biceps magnetic resonance imaging anatomy compared with outcome. J Should Elb Surg Am Should Elb Surg. 2012;21:1623–31.
Marnitz T, Spiegel D, Hug K, et al. MR imaging findings in flexed abducted supinated (FABS) position and clinical presentation following refixation of distal biceps tendon rupture using bioabsorbable suture anchors. Rofo. 2012;184:432–6.
Roger B, Saillant G. Imagerie par résonance magnétique du tendon patellaire opéré Getroa Opus XXX: Sauramps Medical. 2003:389–94.
Maffulli N, Thorpe AP, Smith EW. Magnetic resonance imaging after operative repair of Achilles tendon rupture. Scand J Med Sci Sports. 2001;11:156–62.
Walton C, Li Z, Pennings A, Agur A, Elmaraghy A. A 3-dimensional anatomic study of the distal biceps tendon: implications for surgical repair and reconstruction. Orthop J Sports Med. 2015;3(6):2325967115585113. https://doi.org/10.1177/2325967115585113.
Freeman CR, McCormick KR, Mahoney D, Baratz M, Lubahn JD, Nesterenko S. Nonoperative treatment of distal biceps tendon ruptures compared with a historical control group. Elbow strength and endurance in patients with a ruptured distal biceps tendon. J Bone Joint Surg Am. 2009;91:2329–34.
Nesterenko S, Domire ZJ, Morrey BF, Sanchez-Sotelo J. Elbow strength and endurance in patients with a ruptured distal biceps tendon. J Should Elb Surg Am Should Elb Surg. 2010;19:184–9.
Thomopoulos S, Williams GR, Soslowsky LJ. Tendon to bone healing: differences in biomechanical, structural, and compositional properties due to a range of activity levels. J Biomech Eng. 2003;125:106–13.
Caekebeke P, Vermeersch N, Duerinckx J, van Riet R. Radiological and clinical evaluation of the transosseous cortical button technique in distal biceps tendon repair. J Hand Surg Am. 2016;41:e447–52.
Potapov A, Laflamme YG, Gagnon S, Canet F, Rouleau DM. Progressive osteolysis of the radius after distal biceps tendon repair with the bioabsorbable screw. J Shoulder Elb Surg. 2011;20:819–26.
Mazzocca AD, Burton KJ, Romeo AA, Santangelo S, Adams DA, Arciero RA. Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair. Am J Sports Med. 2007;35:252–8.
Spang JT, Weinhold PS, Karas SG. A biomechanical comparison of EndoButton versus suture anchor repair of distal biceps tendon injuries. J Shoulder Elb Surg. 2006;15:509–14.
Acknowledgements
The authors thank the MSK radiologists, sonographers and Medical Imaging Consultants (MIC), Edmonton, Canada for their contributions.
Funding
The study was sponsored by the Workers Compensation Board—Alberta.
Author information
Authors and Affiliations
Consortia
Corresponding authors
Ethics declarations
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Conflict of interest
The authors declare no further conflicts of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Mandegaran, R., Crowther, S., Jhangri, G.S. et al. Clinical and sonographic evaluation of Endobutton distal biceps brachii tendon repair: what constitutes normal post-operative appearances?. Skeletal Radiol 49, 1081–1088 (2020). https://doi.org/10.1007/s00256-020-03384-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-020-03384-1