All-endoscopic approach for distal biceps tendon pathology: analysis of long-term outcomes in partial and complete ruptures

Distal biceps tendon (DBT) pathology is a spectrum that ranges from tendinopathy to complete retracted ruptures, and surgical treatment is usually performed via open approaches. The purpose of this study was to analyze safety and long-term outcomes of all-endoscopic surgery for entire spectrum of pr...

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Bibliographic Details
Published in:Journal of shoulder and elbow surgery 2024-07, Vol.33 (7), p.1601-1614
Main Authors: Bhatia, Deepak N., Malviya, Parimal
Format: Article
Language:English
Subjects:
arthroscopy
bicipital tuberosity
bursa
bursitis
Distal biceps
elbow
tendon
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Summary:Distal biceps tendon (DBT) pathology is a spectrum that ranges from tendinopathy to complete retracted ruptures, and surgical treatment is usually performed via open approaches. The purpose of this study was to analyze safety and long-term outcomes of all-endoscopic surgery for entire spectrum of primary DBT pathology. The hypothesis was that at an all-endoscopic technique would result in satisfactory clinical outcomes and a low complication rate. Consecutive patients who underwent all-endoscopic surgery for primary isolated DBT pathology (bursitis, partial and acute/chronic complete tears) between January 2013 and December 2021 were assessed and analyzed retrospectively. Refractory bursitis and low-grade partial tears underwent endoscopic débridement, and high-grade partial tears and complete ruptures underwent all-endoscopic repair or graft reconstruction. Preoperative and follow-up assessment included functional assessment using Mayo Elbow Performance Score and a Patient-Reported Distal Biceps Score, and radiological assessment was performed using plain biplanar radiographs and sonography. Pre- and postoperative scores for the overall group, and for partial and complete tears, were compared using a paired t test. Overall, 26 male patients underwent an all-endoscopic surgery for DBT tears; the pathology was classified by endoscopic findings into 6 types, and follow-up period ranged from 21 to 125 months (mean 79.4 months). Nine chronic partial tears (35%) included predominantly bursitis (type I, n = 2) and predominantly partial tears (type IIA and B, n = 7). The complete tear group (65%) included isolated short or long head tears (type IIIA and IIIB, n = 2) and complete tendon ruptures (types IV, V, and VIA-C, n = 15). Endoscopic débridement of the bursitis/low-grade tears and repair of the high-grade and complete ruptures resulted in complete resolution of symptoms and significant improvement in both Mayo Elbow Performance Score and Patient-Reported Distal Biceps Score (P 
ISSN:1058-2746
1532-6500
DOI:10.1016/j.jse.2024.01.020