There are many ways to repair distal biceps tendon ruptures with no outcome studies demonstrating superiority of a specific technique. There are few studies reporting on the repair of acute and chronic distal biceps tendon ruptures using the EndoButton via an anterior single-incision approach. We report on 27 patients who underwent distal biceps tendon repair with an EndoButton. The average age was 50.1 years (range, 36–78). There were 17 acute repairs (within 4 weeks of injury), nine chronic repairs (greater than 4 weeks), and one revision of a previous acute repair. All chronic repairs were repaired without the need for graft augmentation. Patients were assessed postoperatively using the ASES elbow outcome instrument and isokinetic flexion and supination strength and endurance testing. Eight control subjects were also tested for comparison. At an average follow-up of 30.9 months, 26 of 27 patients returned to their previous employment and activity level. The average ASES elbow score was 98.2 (range, 81–100). Compared with the contralateral extremity, there was no loss of motion. Average flexion strength recovery was 101% and mean supination strength recovery was 99%. There was no significant difference in function or strength with repair of acute versus chronic ruptures. Using the EndoButton technique, acute and chronic distal biceps tendon ruptures can be repaired safely with excellent clinical results.
Distal biceps tendon ruptures; Acute; Chronic; Single incision
The EndoButton technique of distal biceps tendon repair provides strong biomechanical fixation. This strength of fixation may allow earlier postoperative range of motion (ROM). A retrospective review of 15 male patients undergoing single incision EndoButton repairs was used. Six subjects participated in conventional supervised postoperative rehabilitation while nine subjects were allowed unrestricted ROM after 2 weeks. Final ROM, time to full ROM, and Disabilities of Arm Shoulder and Hand (DASH) scores were compared. There was a significant difference for time to full ROM (p < 0.05). The mean time to full ROM was 8.67 weeks for the supervised therapy group and 4.38 weeks for the unrestricted group. There were no reruptures in either group. There were no significant differences in final ROM or DASH scores. These data suggest that unrestricted ROM results in a quicker return to full ROM without an increased risk of rerupture.
Distal biceps tendon; EndoButton; Therapy; Tendon repair
Surgical repair of distal biceps tendon rupture is a technically challenging procedure that has the potential for devastating and permanently disabling complications. We report two cases of posterior interosseous nerve (PIN) injury following successful biceps tendon repair utilizing both the single-incision and two-incision approaches. We also describe our technique of posterior interosseous nerve repair using a medial antebrachial cutaneous nerve graft (MABC) and a new approach to the terminal branches of the posterior interosseous nerve that makes this reconstruction possible. Finally, we advocate consideration for identification of the posterior interosseous nerve prior to reattachment of the biceps tendon to the radial tuberosity.
Posterior interosseous nerve; Biceps tendon repair; Nerve graft; Nerve reconstruction; Radial nerve
Distal biceps tendon rupture is a relatively uncommon occurrence in the general female population, and to our knowledge, has not been reported in association with a supinator muscle tear. We report a case of 51-year-old woman who experienced sharp pain in her forearm and elbow after lifting a heavy object. History and physical examination raised suspicion for a distal biceps tendon rupture. MRI imaging determined a combined distal biceps tendon tear with a supinator muscle tear with subsequent confirmation at surgery. Surgical repair was performed for the distal biceps tendon only through a single incision approach using the Endobutton technique.
An injured tendinous attachment of the distal biceps brachii to the radial tuberosity was diagnosed in fifteen male patients. One additional patient sustained a first-degree strain of the distal biceps musculotendinous junction. Conservative treatment was effective for the two patients representing first-degree strains. Five patients with second-degree, partial tears were treated conservatively and experienced an average recovery time of over one year. Two patients with partial tears required a surgical reattachment of the biceps to the radial tuberosity for relief of symptoms. The Boyd-Anderson technique was used on six patients with complete ruptures. One complete separation was repaired three years post-injury by reattaching the distal biceps tendon to the brachialis. Post-operative Cybex evaluation demonstrated return to near-normal levels of strength, endurance, and total work in both flexion and supination following early reattachment to the radial tuberosity.
We herein describe a surgical technique for the repair of complete tear of the pectoralis major (PM) tendon using endobuttons to strengthen initial fixation.
Five male patients (3 judo players, 1 martial arts player, and 1 body builder) were treated within 2 weeks of sustaining complete tear of the PM tendon. Average age at surgery and follow-up period were 28.4 years (range, 23-33) and 28.8 months (range, 24-36). A rectangular bone trough (about 1 × 4 cm) was created on the humerus at the insertion of the distal PM tendon. The tendon stump was introduced into this trough, and fixed to the reverse side of the humeral cortex using endobuttons and non-absorbable suture. Clinical assessment of re-tear was examined by MRI. Shoulder range of motion (ROM), outcome of treatment, and isometric power were measured at final follow-up.
There were no clinical re-tears, and MRI findings also showed continuity of the PM tendon in all cases at final follow-up. Average ROM did not differ significantly between the affected and unaffected shoulders. The clinical outcomes at final follow-up were excellent (4/5 cases) or good (1/5). In addition, postoperative isometric power in horizontal flexion of the affected shoulder showed complete recovery when compared with the unaffected side.
Satisfactory outcomes could be obtained when surgery using the endobutton technique was performed within 2 weeks after complete tear of the PM tendon. Therefore, our new technique appears promising as a useful method to treat complete tear of the PM tendon.
Complete distal biceps tendon ruptures require prompt surgical management for optimal functional and aesthetic outcome. The need exists for a valid and reliable diagnostic tool to expedite surgical referral. We hypothesized complete distal biceps tendon ruptures result in an objectively measurable anatomic landmark (the distance between the antecubital crease of the elbow and the cusp of distal descent of the biceps muscle, or the biceps crease interval), as a result of proximal retraction of the musculotendinous complex. We established normal biceps crease interval values and biceps crease ratios between dominant and nondominant arms in 80 men with no history of biceps injury (average age, 43 years). The mean (± standard deviation) biceps crease interval for dominant and nondominant arms was 4.8 ± 0.6 cm. The mean biceps crease ratio was 1.0 ± 0.1. We measured the biceps crease interval and biceps crease ratio on 29 consecutive patients presenting with a possible complete distal biceps tendon rupture. Using a diagnostic threshold of a biceps crease interval greater than 6.0 cm or biceps crease ratio greater than 1.2, the biceps crease interval test had a sensitivity of 96% and a diagnostic accuracy of 93% for identifying complete distal biceps tendon ruptures, making it a valid and reliable tool for clinicians to identify cases requiring urgent surgical referral.
Level of Evidence: Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Serous bursae consist of a synovial membrane enveloping a film of liquid. They are located at interfaces between moving structures where friction must be reduced. The bicipitoradial bursa lies between the distal tendon of the biceps brachii, which it surrounds, and the radial tuberosity. It is a relatively large bursa, with dimensions ranging from 2.4 to 3.9 cm. It sometimes presents septation. It does not communicate with the joint cavity, but it may communicate with the interosseous bursa of the elbow. Regardless of its cause, bicipitoradial bursitis presents as a mass in the cubital fossa and/or with neurological symptoms (sensorial and/or motorial) caused by compression of the radial nerve. On ultrasonography, the inflamed bursa is visualized as an anechoic formation surrounding the distal biceps tendon. In addition to its role in diagnosing the bursitis, sonography can provide information about radial nerve injury (in the presence of macroscopic damage), and it can also be used for guidance during intrabursal injections.
Bicipitoradial bursa; Distal tendon of the biceps brachii; Ultrasonography
To provide health care personnel with guidelines for the management of a distal biceps tendon rupture.
Traumatic ruptures of the biceps tendon are rare, but serious, and usually involve the long head of the proximal insertion. Ruptures of the distal tendon account for only 3% of all biceps tendon ruptures. A history of tendinitis, overuse, or anabolic steroid abuse may predispose tendons to rupture. Surgical repair, followed by a comprehensive rehabilitation program, is indicated to regain full strength and range of motion in both flexion and supination.
Rupture of the distal head of the biceps brachii muscle at the insertion on the radial tuberosity.
After the injury, the athlete continued to compete for the remainder of the collegiate football season. He then underwent surgery to repair the tendon at its insertion. Post- operatively, the athlete was immobilized in a cast and then a brace to prevent any movement of the muscle. Rehabilitation proceeded with isometric exercises and manual resistive exercises of the shoulder and wrist. At 16 weeks, the athlete was cleared for biceps curls and wrist supination. At 6 months, the athlete had regained full use of the muscle.
This is a relatively rare injury, usually occurring at the proximal tendon insertion and in those who are middle aged (30 to 50 years old). Also, the surgical intervention in this case was delayed without detrimental effects to the patient.
This study shows that, while surgical intervention to repair a ruptured distal biceps tendon is necessary, appropriate conservative measures can be taken to allow surgery to be delayed without harm to the patient. The athletic trainer should be aware of how to recognize and treat this injury.
biceps brachii; upper extremity; tendinitis
We aimed to compare cross-pin fixation and Endobutton femoral fixation for hamstring anterior cruciate ligament (ACL) reconstruction with respect to clinical and radiographic results, including tunnel widening and the progression of knee osteoarthritis (OA).
Materials and Methods
Between August 2002 and August 2005, 126 autogenous hamstring ACL reconstructions were performed using either cross pins or Endobutton for femoral fixation. Fifty-six of 75 patients in the cross-pin group and 35 of 51 patients in the Endobutton group were followed up for a minimum of 4 years. We compared the clinical and radiological results between the groups using the International Knee Documentation Committee (IKDC) evaluation form, the KT-2000 arthrometer side to side difference, the amount of tunnel widening and the advancement of OA on radiographs.
There were no significant differences in the IKDC grades between the groups at the 4 year follow-up. There was no significant difference in the side to side difference according to KT-2000 arthrometer testing. Also, there were no significant differences in terms of tunnel widening or advancement of OA on radiographs.
Endobutton femoral fixation showed good results that were comparable to those of cross pins fixation in hamstring ACL reconstruction.
Anterior cruciate ligament reconstruction; Hamstring tendon; Graft fixation; Tunnel widening
There are several techniques that have been described for distal biceps tendon repair but there is still controversy regarding the optimal technique. Our hypothesis is that the single-incision technique will have a similar complication rate and functionally equivalent restoration of function compared with the two-incision approach. A retrospective review of consecutive biceps tendon repairs was performed at one institution over a 5-year period. Thirty-six patients met the inclusion criteria and 26 were available for follow-up including subjective assessment, physical examination, and strength testing. Patients were divided into two groups based on the surgical approach utilized: 12 patients underwent single-incision repair and 14 had a two-incision repair. The average follow-up was 33 months (minimum 13; maximum 75). There were no statistically significant differences in regards to flexion strength or endurance, supination strength or endurance, or complication rates between the two techniques. In conclusion, both surgical techniques led to adequate restoration of strength with a low complication rate. Both techniques are safe to perform and should be guided by surgeon comfort with the approach.
The bicipital groove of the proximal humerus is formed by the medial and lateral tuberosities and serves to retain the long biceps tendon in its proper place as the arm moves. Bicipital root and proximal tendon disorders are an important symptom generator in the shoulder. The accuracy of the diagnosis of many shoulder disorders visually without quantitative shape analysis is limited, motivating a clinical need for some ancillary method to assess the proximal biceps. In previous studies, measurements of bicipital groove shape were 2-dimensional (2D), taken from a single axial slice. Because of significant variations in groove shape from one axial slice to another in a single patient, such approaches risk overlooking shape features important to long biceps tendon pathology. In this paper, we present a study of the relationship between bicipital groove shape and long biceps tendon pathology using a novel 3-dimensional (3D) shape descriptor for the bicipital groove. In addition to providing quantitative measures of the shape of the groove and its relation to tendopathy, the new descriptor allows for intuitive, descriptive visualization of the shape of the groove.
Bicipital groove; intertubercular sulcus; long biceps tendon; musculoskeletal disorder; 3D shape analysis
The biceps brachii muscle, which inserts proximally onto the scapula and distally onto the forearm, has several tendons with numerous anatomic peculiarities, which render their sonographic examination highly variable. Proximally, the tendon of the short head of the biceps inserts onto the coracoid process and that of the long head on the superior aspect of the glenoid. The distal biceps tendon is bifurcated, and it generally inserts on the radial tuberosity, around which it rolls during pronation/supination. There is a third distal structure, the Lacertus fibrosus, an aponeurosis that branches off from the medial aspect of the tendon, crossing the median artery and median nerve, and inserting on the superficial aponeurosis of the flexor muscles. The sonographic examination of these tendons focuses on nine separate zones of interest: the glenoid insertion of the long head, its extension to the upper pole of the humeral head, the rotator interval, the reflection to the upper bicipital groove, the bicipital groove, the upper myotendinous junction, the lower myotendinous junction, the distal tendon(s), and the inferior enthesis. Because of their morphological and topographical characteristics, the biceps tendons are subject to a variety of lesions, some of which are frequently misdiagnosed on the basis of clinical findings. Ultrasound plays an important role in detecting and characterizing these lesions. Proper examination of the biceps (the distal portion in particular) is a difficult task that cannot be improvised.
Ultrasonography; Biceps; Biceps Tendon
A 42-year-old female nurse presented in March 2008 with a left proximal hamstring tendon injury sustained while playing hockey. At surgery, the proximal biceps femoris tendon and semitendonosus were found to be ruptured and were repaired. The patient made a good recovery but sustained a further hockey injury in January 2010 involving a complete tear and rupture of the biceps femoris tendon distally. This was managed conservatively and the patient was able to return to playing hockey 10 months later. Biceps femoris tendon injuries have been reported in sport but this is the first documented case of the injury occurring while playing hockey and is also the first reported case of a biceps tendon rupture proximally (hamstring tendon) followed by distal biceps femoris rupture at the knee in the same leg.
A 50 year old rock climber sustained a bilateral rupture of the distal biceps brachii tendons. He retained some flexion power in both arms but minimal supination, being weaker on the non-dominant right side. As the patient presented late, with retraction and shortening of the biceps muscle bellies, reconstruction was carried out using fascia lata grafts on both sides. Because of residual weakness on the left (dominant) side, three further surgical procedures had to be carried out to correct for elongation of the graft. A functionally satisfactory outcome, comparable with that on the right side, was eventually obtained. In summary, bilateral fascia lata grafts to bridge the gap between the retracted biceps bellies and the radial tuberosities were successful in restoring function and flexion power to the elbow. Despite being the stronger side, the dominant arm did not respond as well to the initial surgery. This may be due to overuse of this arm after the operation.
The best location for biceps tenodesis is controversial as surgeons have begun to question whether tenodesis location affects the incidence of residual bicipital postoperative pain. An open distal tenodesis technique has been previously proposed to eliminate remaining symptoms at the bicipital groove.
We asked the following questions: (1) Does a higher tenodesis in the biceps groove result in postoperative pain? And (2) can the tenodesis location be successfully moved more distally (“suprapectoral tenodesis”) by an arthroscopic technique?
We retrospectively reviewed 17 patients undergoing arthroscopic biceps tenodesis and evaluated their tenodesis location, either within the upper half of the groove (five) or in the lower half of the groove or shaft (12). Patient outcomes were assessed with visual analog scale scores for pain, American Shoulder and Elbow Surgeons scores, and Constant-Murley scores. Minimum followup was 12 months (mean, 28 months; range, 12–69 months).
Two patients had persistent pain at 12 months; both had a tenodesis in the upper half of the groove. The overall American Shoulder and Elbow Surgeons and Constant-Murley scores were improved at latest followup.
Arthroscopic suprapectoral biceps tenodesis represents a new technique for distal tenodesis. Our preliminary observations suggest a more distal tenodesis location may decrease the incidence of persistent postoperative pain at the bicipital groove, although additional research is needed to definitively state whether the proximal location is in fact more painful.
Level of Evidence
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Numerous procedures have been described for the operative management of acromioclavicular (AC) joint injuries. Some of these techniques, including hardware fixation and non-anatomical reconstructions, are associated with serious complications and high failure rates. Recently, AC joint reconstruction techniques have focused on anatomical restoration of the coracoclavicular ligaments to achieve optimal clinical outcomes. We used a triple endobutton technique to separately reconstruct the trapezoid and the coronoid portions of the coracoclavicular ligament. We evaluated the preliminary clinical and radiological results of this technique in patients with acute complete dislocation of the AC joint. All patients achieved a significant improvement in the pain and function of shoulder at a mean follow-up interval of 12 months (range, 8–14 months). Excellent reduction of the AC joint was maintained. The triple endobutton technique may be safe and effective for the treatment of acute complete AC joint dislocations.
Anatomic anterior cruciate ligament (ACL) reconstruction has been presented as a means to more accurately restore the native anatomy of this ligament. This article describes a new method that uses a double bundle to perform ACL reconstruction and to evaluate the clinical outcome.
Grafts are tibialis anterior tendon allograft for anteromedial bundle (AMB) and hamstring tendon autograft without detachment of the tibial insertion for posterolateral bundle (PLB). This technique creates 2 tunnels in both the femur and tibia. Femoral fixation was done by hybrid fixation using Endobutton and Rigidfix for AMB and by biointerference screw for PLB. Tibial fixations are done by Retroscrew for AMB and by native insertion of hamstring tendon for PLB. Both bundles are independently and differently tensioned. We performed ACL reconstruction in 63 patients using our new technique. Among them, 47 participated in this study. The patients were followed up with clinical examination, Lysholm scales and International Knee Documentation Committee (IKDC) scoring system and radiological examination with a minimum 12 month follow-up duration.
Significant improvement was seen on Lachman test and pivot-shift test between preoperative and last follow-up. Only one of participants had flexion contracture about 5 degrees at last follow-up. In anterior drawer test by KT-1000, authors found improvement from average 8.3 mm (range, 4 to 18 mm) preoperatively to average 1.4 mm (range, 0 to 6 mm) at last follow-up. Average Lysholm score of all patients was 72.7 ± 8.8 (range, 54 to 79) preoperatively and significant improvement was seen, score was 92.2 ± 5.3 (range, 74 to 97; p < 0.05) at last follow-up. Also IKDC score was normal in 35 cases, near normal in 11 cases, abnormal in 1 case at last follow-up.
Our new double bundle ACL reconstruction technique used hybrid fixation and Retroscrew had favorable outcomes.
KAnterior cruciate ligament reconstruction; Double bundle; Anatomical; Hybrid fixation; Retroscrew
The purpose of this paper was to determine the extent to which the technique used in ACL reconstruction and fixation influences graft placement.
This is a Comparative Radiographic cohort study.
Precise graft placement is one of the most crucial components of a successful anterior cruciate ligament (ACL) reconstruction. Two commonly used techniques of ACL reconstruction are arthroscopic bone-patellar tendon-bone (B-PT-B) autograft with interference screw fixation and semitendinosus and gracilis (ST + G) tendon autograft with endobutton femoral and multiple staple belt buckle tibial fixation. Using radiographic measurements of bone tunnel position following ACL reconstruction this study quantified the extent to which these techniques influenced graft placement.
Femoral and tibial tunnel position in ACL reconstruction was determined using the post-operative radiographs of 40 male patients who had undergone ACL reconstruction (20 B-PT-B and 20 ST+ G). The primary outcome measure was location of bone tunnel position following ACL reconstruction. Measurements were based on the guidelines of Amis et al.
Femoral tunnel position of B-PT-B grafts was an average of 9.36% more anterior in the sagittal plane than with ST + G grafts. The mean position of B-PT-B grafts was at 31.11% (SD= 5.45%). The mean position of the ST + G grafts was 21.76% (SD= 6.62%). This difference between the two was found to be significant (p<.001).
As demonstrated by this study, placement and orientation may vary to accommodate technique and fixation. Clinical outcomes measured were similar in both groups.
Lubricin is a lubricant for diarthrodial joint tissues and has antiadhesion properties; its presence in the (caprine) rotator cuff suggests it may have a role in intrafascicular lubrication.
To preliminarily address this role, we asked: (1) What is the distribution of lubricin in human ruptured supraspinatus and biceps tendons? (2) What are the potential cellular sources of lubricin?
We obtained seven torn rotator cuff samples and four torn biceps tendon samples from 10 patients; as control tissues, we obtained the right and left supraspinatus tendons from each of six cadavers. Specimens were fixed in formalin and processed for immunohistochemical evaluation using a monoclonal antibody for lubricin.
We found lubricin as a discrete layer on the torn edges of all of the ruptured supraspinatus and biceps tendon samples. None of the transected edges of the tissues produced during excision of the tissues showed the presence of lubricin. Lubricin was found in 3% to 10% of the tendon cells in the cadaveric controls and in 1% to 29% of the tendon cells in the torn supraspinatus and biceps tendon samples.
The lubricin layer on the torn edges of ruptured human supraspinatus and biceps tendons may interfere with the integrative bonding of the torn edges necessary for repair.
Surgical repair of symptomatic, retracted rotator cuff tears unresponsive to non-operative treatments requires closure of the tear without undue tension and reattaching the torn tendon to its former insertion site. In this study, the length of the torn tendon edge was hypothesized to be longer than the length of the humeral insertion site. The objective of this study was to quantify the discrepancy in length of the torn tendon edge and the length of the avulsed humeral insertion site.
Materials and methods
Full thickness, rotator cuff tears that were found in twelve fresh frozen cadaver shoulders was studied. The length of the torn tendon edge, the length of the avulsed humeral insertion site and the retraction were measured using digital calipers.
Each tear involved the supraspinatus and the infraspinatus was additionally torn in six. The size of the tear was medium in eight and large in four. The length of the torn tendon edge was always longer than the length of the avulsed humeral insertion site. Retraction was 29.9 ± 9.3 mm (range 21–48 mm). The repair ratio, defined as the ratio of length of torn tendon edge to the length of avulsed humeral insertion site, was 2.6 ± 0.4 (range 2.1–3.5).
As only the length of the torn tendon edge equal to the length of the avulsed humeral insertion site can be repaired to bone, a repair ratio more than one precludes a simple repair and an additional repair technique such as margin convergence would be necessary for the remaining unapproximated torn tendon edge in rotator cuff tears. Repair ratio may aid in selection of the surgical repair technique of these rotator cuff tears.
Rotator cuff tear; Repair; Retraction; Insertion
The clinical outcome of hemiarthroplasty for proximal humeral fractures is not satisfactory. Secondary fragment dislocation may prevent bone integration; the primary stability by a fixation technique is therefore needed to accomplish tuberosity healing. Present technical comparison of surgical fixation techniques reveals the state-of-the-art approach and highlights promising techniques for enhanced stability.
A classification of available fixation techniques for three- and four part fractures was done. The placement of sutures and cables was described on the basis of anatomical landmarks such as the rotator cuff tendon insertions, the bicipital groove and the surgical neck. Groups with similar properties were categorized.
Materials used for fragment fixation include heavy braided sutures and/or metallic cables, which are passed through drilling holes in the bone fragments. The classification resulted in four distinct groups: A: both tuberosities and shaft are fixed together by one suture, B: single tuberosities are independently connected to the shaft and among each other, C: metallic cables are used in addition to the sutures and D: the fragments are connected by short stitches, close to the fragment borderlines.
A plurality of techniques for the reconstruction of a fractured proximal humerus is found. The categorisation into similar strategies provides a broad overview of present techniques and supports a further development of optimized techniques. Prospective studies are necessary to correlate the technique with the clinical outcome.
Complete rupture of the distal tendon of the biceps brachii is relatively rare and there is little information to guide therapists in rehabilitation after this injury. The purposes of this case report are to review the rehabilitation concepts used for treating such an injury, and discuss how to modify exercises during rehabilitation based on patient progression while adhering to physician recommended guidelines and standard treatment protocols.
The patient was an active 38‐year old male experienced in weight‐training. He presented with a surgically repaired right distal biceps tendon following an accident on a trampoline adapted with a bungee suspension harness. The intervention focused on restoring range of motion and strengthening of the supporting muscles of the upper extremity without placing undue stress on the biceps brachii.
The patient was able to progress from a moderate restriction in ROM to full AROM two weeks ahead of the physician's post‐operative orders and initiate a re‐strengthening protocol by the eighth week of rehabilitation. At the eighth post‐operative week the patient reported no deficits in functional abilities throughout his normal daily activities with his affected upper extremity.
The results of this case report strengthen current knowledge regarding physical therapy treatment for a distal biceps tendon repair while at the same time providing new insights for future protocol considerations in active individuals. Most current protocols do not advocate aggressive stretching, AROM, or strengthening of a surgically repaired biceps tendon early in the rehabilitation process due to the fear of a re‐rupture. In the opinion of the authors, if full AROM can be achieved before the 6th week of rehabilitation, initiating a slow transition into light strengthening of the biceps brachii may be possible.
Level of evidence:
4‐Single Case report
Distal biceps tendon surgical repair; rehabilitation guidelines
The purpose of this study was to investigate the outcome of surgical management of acute complete proximal hamstring tendon tears. This was a prospective review of a case series from a tertiary referral centre. Ten patients presenting with complete proximal hamstring tendon tears were confirmed on MRI. All patients underwent surgical exploration and repair of the torn tendons with the aim of returning to normal activities and sports. Isokinetic muscle testing was performed using a dynamometer. The Cybex dynamometer (Cybex International, Ronkonkowa, NY) testing revealed almost comparable readings for the operated versus the non-operated side. An average peak torque of the operated hamstring muscles of 82.78% (range 47.16–117.88%), compared to the contralateral leg, was noted at six months. An excellent outcome was found in terms of return to normal activities and sports. Early surgical repair and physiotherapy has been noted to be associated with a good outcome and enables an early return to high level sports after complete tear of the proximal hamstring tendons.
Five patients with recurrent dislocation of the extensor carpi ulnaris (ECU) tendon resulting from an athletic injury were treated by reconstruction of the ECU tendon sheath, and each had a satisfactory result. Two types of disruption of the fibro-osseous sheath were found. In two cases in which the fibro-osseous sheath ruptured radially, the torn sheath lay on its ulnar groove beneath the ECU tendon. These patients were treated by direct suture of the sheath over the ECU tendon. In three cases in which the fibro-osseous sheath ruptured ulnarly, the torn sheath lay superficial to the ECU tendon. These patients were treated by reconstruction of the sheath using a piece of the extensor retinaculum. We believe that surgical reconstruction of the fibro-oseous sheath of the ECU tendon should be considered for symptomatic dislocation of the ECU tendon, even in an acute case.