What is the current literature on distal biceps tendon (DBT) repair?

From the Guidelines

The current literature recommends the use of MRI, specifically the flexion-abduction-supination (FABS) view, for the assessment of distal biceps tendon (DBT) pathology, as it provides improved sensitivity and interrater reliability for the diagnosis of partial and complete DBT tears 1. The FABS view, which involves imaging the patient in the prone position with the elbow flexed at 90, abducted at the shoulder, and with the forearm supinated, allows for the visualization of the entirety of the distal biceps tendon on a single image.

• This view has been shown to have better interrater reliability and accuracy in grading the extent of DBT pathology compared to traditional MRI views 1.
• A study by Schenkels et al. in 2020 found that the FABS view had no significant difference in sensitivity and specificity for the diagnosis of partial DBT tears, but had better interrater reliability and accuracy in grading the extent of pathology 1.
• Another study by Tiegs-Heiden et al. in 2021 found that the FABS sequences changed the radiologist's impression of the DBT in a minority of cases and did not significantly change the diagnostic accuracy, but may have a benefit in challenging cases of high-grade partial versus complete tendon tears 1. In addition to MRI, ultrasound (US) has also been shown to be useful in the detection of biceps tendon abnormalities, including distal biceps brachii tendon tears, with reports showing 95% sensitivity, 71% specificity, and 91% accuracy for the diagnosis of complete versus partial DBT tears 1.
• US has been found to perform similar to or slightly better than MRI for the diagnosis of distal biceps brachii tendon tears, making it a viable alternative for diagnosis 1. Overall, the current literature suggests that MRI, specifically the FABS view, and US are both useful imaging modalities for the assessment of DBT pathology, and can provide accurate diagnoses and guide treatment decisions. The use of these imaging modalities can help improve patient outcomes by providing accurate diagnoses and guiding treatment decisions, ultimately reducing morbidity, mortality, and improving quality of life 1.

From the Research

Current Literature on Distal Biceps Tendon (DBT) Repair

The current literature on DBT repair highlights various surgical techniques and fixation methods, with no consensus on the optimal approach. Some of the key findings include:

• Surgical repair of DBT remains the most effective means to restore maximal strength of forearm supination and elbow flexion with relief of antecubital pain 2.
• Multiple techniques are accepted, including 1- and 2-incision approaches and tendon fixation with suture anchors, transosseous sutures, interference screws, and cortical buttons 2, 3, 4.
• A single-incision approach with bicortical, tensionable suspensory button fixation has been demonstrated as a viable technique for DBT repair 2.
• A novel suturing technique utilizing a hemi-Krackow locking stitch at the tendon-bone interface has shown satisfactory functional outcomes at early follow-up 3.
• A modified double-incision technique has been reported to provide excellent patient-reported long-term outcomes, with a low complication rate 5.

Surgical Techniques and Fixation Methods

Different surgical techniques and fixation methods have been described in the literature, including:

• Single-incision technique with suture anchor fixation using a hemi-Krackow stitch 3.
• Double-incision technique with transosseous suture fixation 5, 4.
• Use of cortical buttons, interference screws, and bone tunnels for fixation 6.
• Reconstruction techniques, including Achilles allograft, pedicled latissimus transfer, and the use of a free innervated gracilis, for chronic tears 6.

Outcomes and Complications

The literature reports various outcomes and complications associated with DBT repair, including:

• Excellent patient-reported long-term outcomes with a low complication rate using a modified double-incision technique 5.
• Satisfactory functional outcomes at early follow-up using a single-incision technique with suture anchor fixation 3.
• Complications, such as painless limitation in forearm rotation, reduced flexion and forearm rotation strength, synostosis, and transient wrist drop, have been reported 5.