RUPTURE OF THE DISTAL TENDON OF THE BICEPS BRACHII - A REVIEW OF 43 CASES

Purpose of the study Rupture of the distal tendon of the biceps is an uncommon occurrence. 43 cases were analyzed in a multicentric study in order to define etiological factors and treatment of this lesion. Mat erial and methods 43 cases were reviewed from Fort de France, Paris, M arseille, Lyon and Suresnes. There were only male patients with an ave rage age of 50 years. The mechanism of injury, the clinical and radiog raphic features, the anatomical findings and the results of surgical t reatment were analyzed. 4 patients were treated conservatively and 39 surgically. In 28 cases, anatomical reattachment of the tendon was per formed. In 11 cases the tendon was simply attached to the brachialis a nterior muscle. Results The mechanism of injury in all patients was pa ssive extension against active flexion. 17 patients had sustained inju ry while engaged in sports activities and 17 during domestic activitie s. Most of the patients were diagnosed clinically, Ultrasound and CT s can was useful in cases seen a long time after injury. In 34 cases avu lsion of the bicipital tuberosity was found. Subjective results were g ood in 28 cases and poor in 5 cases. Objective testing was performed o ne year after injury using the criteria described by Baker: flexion an d suppination force (maximum force) and endurance (ability to perform repeated contractions). Following attachment to the brachialis anterio r, there was an average loss of 33 per cent of flexion strength and 52 per cent of supination strength. Following anatomical reattachment, t he loss was 5 per cent for flexion and 15 per cent for supination. The re were two cases of radial nerne palsies and 1 case of radio-ulnar sy nostosis. Discussion Attachment of the biceps brachialis tendon to the brachialis anterior muscle is unable to restore supination force. Com plications only occur following anatomical reattachment. Radial nerve palsies can be avoided by using two separate incisions as described by Boyd. Conclusion Surgical reinsertion onto the radial tuberosity rest ore more strength. Attachment to the brachialis muscle can be sued in cases seen a long time after injury.