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 ΒΌ-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
