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2 incision Boyd Anderson Distal Biceps Tendon Repair

Principles

• in complete distal biceps tendon ruptures up to 50% supination power is loss
• concern is heterotropic ossification
• radio ulnar synostosis

Options

• 2 incision
• Common extensor origin splitting approach with forearm in maximum pronation
• Less radial ulnar synostosis
• 1 incision with suture bone anchors
• Less radial ulnar synostosis
• Weaker repair

Procedure

• Make a 3- to 4-cm incision over the anterior aspect of the elbow
• Incise the deep fascia & locate the distal tendon of the biceps; usually it is retracted 5 to 7.5 cm proximal to the elbow
• Protect the lateral antebrachial cutaneous nerve during this dissection
• Pass a heavy nonabsorbable suture through the tendon so that its ends emerge on the avulsed surface
• Then with a blunt instrument locate the tunnel between the radius & ulna through which the tendon originally passed
  • May have to ligate radial recurrent vessels
• Flex the elbow & make a second incision on the posterolateral aspect of the elbow (Boyd approach)
• Detach the muscles from the lateral surface of the olecranon
  • Anconeus & supinator
• retract them laterally along the plane of the interosseous membrane, & expose the head & neck of the radius
  • PIN is thus protected as it enters the forearm in the substance of the supinator muscle
• Then pronate the forearm & bring the radial tuberosity into view.
• Now use a ¼-inch osteotome to make a trapdoor in the tuberosity & drill two holes opposite its hinge
• With a tendon carrier or a hemostat pass the ends of the nonabsorbable suture in the biceps tendon between the radius & ulna & bring them out through the second incision; use traction on the sutures to pull the tendon through into the posterolateral incision
• Now thread the ends of the suture into the trapdoor & bring them out through the holes in the bone
• Flex the elbow & insert the end of the tendon into the trapdoor; hold it in position with forceps & securely tie the suture
• Place reinforcing sutures through the tendon into the adjacent soft tissues & close both incisions

Postoperative

• Immobilise in 90 flexion with full supination for 7-10/7
• Hinged brace with 30 extension block until 8/52
• Unrestricted motion & progressive strengthening
• Unrestricted activity after 6/12

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