Biceps Tendon Repair - Endobutton

Eight Year Experience with EndoButton-assisted Repairof Distal Biceps Tendon Ruptures

Eight Year Experience with EndoButton-assisted Repairof Distal Biceps Tendon Ruptures C. Noel Henley, MD and Jeffery A. Greenberg, MD May 18, 2006

Summary of the near future

Summary of the near future• Clinical overview

Summary of the near future• Clinical overview• Study Objective

Summary of the near future• Clinical overview• Study Objective• Materials and Methods

Summary of the near future• Clinical overview• Study Objective• Materials and Methods• Results

Summary of the near future• Clinical overview• Study Objective• Materials and Methods• Results• Conclusion

Summary of the near future• Clinical overview• Study Objective• Materials and Methods• Results• Conclusion• Future work

Introduction

Introduction• e injury

Introduction• e injury – 3% of biceps tendon ruptures

Introduction• e injury – 3% of biceps tendon ruptures – Complete avulsion from bone

Introduction• e injury – 3% of biceps tendon ruptures – Complete avulsion from bone – Common mechanism(s)

Introduction• e injury – 3% of biceps tendon ruptures – Complete avulsion from bone – Common mechanism(s) – Examination • Swelling, ecchymosis if acute • Contour, palpable defect • Weakness in supination • Squeeze test* *Ruland. CORR. 2005.

Introduction

Introduction• Treatment Results – Nonoperative • Decreased supination strength • Decreased supination, exion endurance

Introduction• Treatment Results – Nonoperative • Decreased supination strength • Decreased supination, exion endurance – Operative • Repair advocated by a majority • Necessary for return of maximum function in active patients

Introduction

Introduction• Method of repair - history – Traditional single incision technique • Extensive volar dissection • Association with PIN, radial nerve palsy

Introduction• Method of repair - history – Traditional single incision technique • Extensive volar dissection • Association with PIN, radial nerve palsy – Boyd, Anderson modi cation = two incisions • Goal to avoid above complications • Reports of HO problems became more frequent

Introduction• Method of repair - history – Traditional single incision technique • Extensive volar dissection • Association with PIN, radial nerve palsy – Boyd, Anderson modi cation = two incisions • Goal to avoid above complications • Reports of HO problems became more frequent – Recent use of single incision method • Possible with anchors, screw, button devices • May minimize problems with earlier techniques

Introduction

Introduction• EndoButton-assisted repair

Introduction• EndoButton-assisted repair – A titanium button secured with suture

Introduction• EndoButton-assisted repair – A titanium button secured with suture – Bain, et al: rst report in 2000

Introduction• EndoButton-assisted repair – A titanium button secured with suture – Bain, et al: rst report in 2000 – Greenberg, et al: biomechanical, anatomic study 2003 • Pullout strength superior to anchors or bone tunnels

Study Objective

Study Objective• To report long-term clinical results of EndoButton-assisted distal biceps tendon repairs, re ected by both patient-centered outcome measures and objective testing

Materials and Methods

Materials and Methods• 48 patients identi ed (1996-2004)

Materials and Methods• 48 patients identi ed (1996-2004)• Records reviewed, patients contacted

Materials and Methods• 48 patients identi ed (1996-2004)• Records reviewed, patients contacted• Evaluation – DASH – Physical examination – BTE (strength, endurance) testing – Radiographs

Materials and Methods• 48 patients identi ed (1996-2004)• Records reviewed, patients contacted• Evaluation – DASH – Physical examination – BTE (strength, endurance) testing – Radiographs• Opposite extremity served as control

Demographics

Demographics• 17 patients returned for follow up

Surgery Summary

Surgery Summary• Single anterior Henry approach

Surgery Summary• Single anterior Henry approach• Tendon secured with No. 5 suture, threaded through EndoButton

Surgery Summary• Single anterior Henry approach• Tendon secured with No. 5 suture, threaded through EndoButton• Button, suture passed through radius

Surgery Summary• Single anterior Henry approach• Tendon secured with No. 5 suture, threaded through EndoButton• Button, suture passed through radius• Button locked on posterior radius

Surgery

Rehabilitation

Rehabilitation• AROM, AAROM, PROM of the elbow begun at 3-4 days postoperatively

Rehabilitation• AROM, AAROM, PROM of the elbow begun at 3-4 days postoperatively• Splinting limits extension to 30°, discontinued at 4 weeks

Rehabilitation• AROM, AAROM, PROM of the elbow begun at 3-4 days postoperatively• Splinting limits extension to 30°, discontinued at 4 weeks• Full use encouraged at 10-12 weeks after surgery

Objective Testing

Objective Testing• Range of motion

Objective Testing• Range of motion• Grip strength

Objective Testing• Range of motion• Grip strength• PIN function

Objective Testing• Range of motion• Grip strength• PIN function• LABCN function

Objective Testing• Range of motion• Grip strength• PIN function• LABCN function• Wound evaluation

Objective Testing• Range of motion• Grip strength• PIN function• LABCN function• Wound evaluation• BTE testing for strength, endurance – Flexion – Supination

Heterotopic Ossification

Heterotopic Ossification• Grade 0 – No HO seen

Heterotopic Ossification• Grade 0 – No HO seen• Grade 1 – Slight mushrooming extending anteriorly – Or small islands of bone < 1 cm dimension

Grade 0

Grade 1

Heterotopic Ossification

Heterotopic Ossification• Grade 2 – Moderate mushrooming – Or bone islands < 1 cm dimension

Heterotopic Ossification• Grade 2 – Moderate mushrooming – Or bone islands < 1 cm dimension• Grade 3 – Large area aﬀecting functional forearm rotation

Grade 2

Subjective Assessment

Subjective Assessment• DASH questionnaire

Subjective Assessment• DASH questionnaire – An upper extremity-speci c patient-centered outcomes instrument

Subjective Assessment• DASH questionnaire – An upper extremity-speci c patient-centered outcomes instrument – Score range = 0-100 (DASH1)

Subjective Assessment• DASH questionnaire – An upper extremity-speci c patient-centered outcomes instrument – Score range = 0-100 (DASH1) – Higher scores suggest greater disability – 2 subscores (DASH2 and DASH3) • Work • Recreational activities

Subjective Assessment• DASH questionnaire – An upper extremity-speci c patient-centered outcomes instrument – Score range = 0-100 (DASH1) – Higher scores suggest greater disability – 2 subscores (DASH2 and DASH3) • Work • Recreational activities – Recent correlation with SF-36

Results

Results• 17 patients examined

Results• 17 patients examined• Mean follow up time = 51 months (4.25 years) (range = 13 to 130 months)

Results

Results• All incisions well-healed – no wound complications

Results• All incisions well-healed – no wound complications• Four patients - persistent numbness of LABCN

Results• All incisions well-healed – no wound complications• Four patients - persistent numbness of LABCN• Signi cantly less supination in injured extremity (5.3° less, p = 0.034)

Results• All incisions well-healed – no wound complications• Four patients - persistent numbness of LABCN• Signi cantly less supination in injured extremity (5.3° less, p = 0.034)• No other signi cant diﬀerences in ROM, strength, endurance between dominant- nondominant or injured-uninjured sides

Results

Results• DASH scores – DASH1 reported for all patients – Mean DASH1 = 9.5 – Mean DASH2 (n = 14) = 5.4 – Mean DASH3 (n = 12) = 10.4

Results

Results• Radiographic examination

Results• Radiographic examination – 2/17 patients had grade 2 HO – no functional limitation

Results• Radiographic examination – 2/17 patients had grade 2 HO – no functional limitation – 11/17 had grade 1 HO

Results• Radiographic examination – 2/17 patients had grade 2 HO – no functional limitation – 11/17 had grade 1 HO – Remainder (4) had no HO

Results

Results• Work, recreation status – One patient retired – One patient (worker’s comp) disabled after several surgeries – Of 15 patients giving a history of pre-surgical recreational activity, 14 patients returned to that activity

Conclusions

Conclusions• Technique appears safe – No motor nerve palsies – No functionally limiting HO/synostosis

Conclusions• Technique appears safe – No motor nerve palsies – No functionally limiting HO/synostosis• EndoButton strength allows early motion

Conclusions• Technique appears safe – No motor nerve palsies – No functionally limiting HO/synostosis• EndoButton strength allows early motion• Return to normal upper extremity functional level is a reasonable expectation – DASH scores approach normals for a non-clinical population* *Jester, A., et al. J Hand Surg [Am], 2005. 30(5): p. 1074 e1-1074 e10.

Future work

Future work• Number of patients – More to follow up, repeat contacts – Incentives

Future work• Number of patients – More to follow up, repeat contacts – Incentives• Endpoint: longest, largest follow up of EndoButton-assisted repairs

Biceps Tendon Repair - Endobutton

by C Noel Henley MD on Feb 28, 2011

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Biceps Tendon Repair - Endobutton — Presentation Transcript