Rotura distal del bíceps de tipo tardías (6-10 semanas). Interés de una técnica endoscópica en doble fila. Presentación de 5 casos
P.Croutzet, J.Kany, R. Guinand
Société Européenne pour la Chirurgie de l'Epaule et du Coude – Istanbul, Septembre 2014
Endoscopic repair of distal biceps rupture was a major involvement in acute rupture. Unfortunately, diagnosis difficulties lead to delayed care.
Our goal was to use a double row endoscopic repair to improve delayed distal biceps rupture.
This case series concerns all the delayed ruptures operated from 6 to 10 weeks after the trauma, over a 2-year period. We used a 3 to 5cm volar incision, 4mm arthroscope, 2 anchors (3mm & 4mm) positioned in a “double row” position, splint in flexion-suppination for 6 weeks, passive physiotherapy after 3 weeks.
Physical examination were done after 3, 6 and 12 weeks. Analysis criteria were:
-peroperative: ability to release the tendon, gap distance between bone and tendon after repair
-post-operative: motion(F/E, P/S) at 3 months, pain, time without working and sports
- Peroperative : Releasing the tendon was the longest part of the procedure. In order to improve tendon reduction, the tourniquet had to be switched off during the repair. The gap distance was 0mm in 3 cases, 5mm in 4 cases and 1 cm in one case.
- Post-operative : Biceps tendon was always palpable after 3 months, no pain, full motion in 4 cases : one case had a lack of extension-pronation (30°).
Time without working was 7 weeks (3-10)
It was possible to repair the tendon in all cases. Tendon healing was always possible enabling functional motion in all cases. Considering the only case of partial stiffness, it is reliable to endeavour to repair delayed ruptures (up to 10 weeks) straight to the radius.