Clinical Evaluation of the Reconstruction of the Biceps Brachii using Triceps Graft

Storti, Thiago Medeiros; Dias, Rafael Gomes; Dantas, Gabriel Cesar Dias; Faria, Rafael Salomon Silva; Simionatto, João Eduardo; Paniago, Alexandre Firmino

doi:10.1055/s-0041-1729566

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Revista Brasileira de Ortopedia

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Sumário

Original Article • Rev. bras. ortop. 56 (5) • Nov-Dec 2021 • https://doi.org/10.1055/s-0041-1729566 copy

Clinical Evaluation of the Reconstruction of the Biceps Brachii using Triceps Graft^* * Work performed at Hospital Ortopédico e Medicina Especializada (HOME), Brasília, DF, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

Clinical and functional evaluation of the surgical treatment for chronic injury of the distal biceps brachii applying a surgical technique with grafting of the distal triceps brachii tendon.

Methods

A study based on a review of the medical records and clinical evaluation of the patients submitted to surgical treatment for chronic injury to the distal insertion of the biceps brachii between February 2015 and February 2017. In a 12-month-minimum postoperative follow-up, 7 patients were evaluated regarding the range of motion of the operated and non-operated elbows, flexion, upper-limb extension and supination with a digital dynamometer, the hook test, the satisfaction index, and the Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Elbow Performance Score (MEPS) intruments.

Results

During the postoperative functional evaluation, no patient reported dissatisfaction with the esthetic outcome of the incisions, and all of them were satisfied/very satisfied with the range of motion and strength of the operated limb. No neurovascular complications, surgical site infection or tendon rupture were observed. On the MEPS and DASH scales, all patients scored 100 and 0 respectively. The mean flexion was of 133.5° on the operated side, versus 139.2° on the non-operated side. The mean extension was of 5° on the operated side versus 0° on the non-operated side. The supination was of 86.5° versus 90°, and the pronation, 80° versus 80°, when comparing the operated and non-operated sides respectively. The mean flexion, extension and supination corresponded respectively to 92.5%, 96.4% and 86.8% of those of the nonoperated limb.

Conclusion

Recosntruction of the distal biceps brachii with triceps grafting seems to be an effective and safe option for the treatment of chronic distal biceps injuries.

Keywords:
autografting; elbow; orthopedic procedures; tendon injuries; upper extremity

	Patient 1	Patient 2	Patient 3	Patient 4	Patient 5	Patient 6	Patient 7
Affected limb and dominance	Left non-dominant	Left dominant	Right dominant	Left non-dominant	Right dominant	Left non-dominant	Left non-dominant
Gender and age	Male, 47 years	Male, 51 years	Male, 60 years	Male, 57 years	Male, 40 years	Male, 30 years	Male, 32 years
Injury duration	3 months	6 weeks	6 weeks	5 months	4 weeks	5 months	3 months
Use of anabolic steroids	No	No	No	No	Yes	Yes	Yes
Follow-up	18 months	36 months	24 months	24 months	12 months	12 months	12 months
Force: operated side	Flexion: 22.4 N; extension: 19.2 N; eupination: 3.1 N	Flexion: 22.4 N; extension: 18.7 N; supination: 3.9 N	Flexion: 17.3 N; extension: 13.4 N; supination: 2.2 N	Flexion: 14.3 N; extension: 13 N; supination: 1.9 N	Flexion: 24.8 N; extension: 24,8 N; supination: 3.3 N	Flexion: 30.7 N; extension: 28.4 N; supination: 4.7 N	Flexion: 33.9 N; extension: 31.9 N; supination: 4.5 N
Force: non-operated side	Flexion: 22.6 N; extension: 20 N; supination: 3.6 N	Flexion: 22.6 N; extension: 18.8 N; supination: 4N	Flexion: 18.6 N; extension: 15.3 N; supination: 2.5 N	Flexion: 21.5 N; extension: 13.1 N; supination: 2.5 N	Flexion: 26 N; extension: 25.5 N; supination: 3.9 N	Flexion: 31.6 N; extension: 29.5 N; supination: 5.3 N	Flexion: 34.8 N; extension: 32.3 N; supination: 5.2 N
Comparison (%)	Flexion: 99.1%; extension: 96%; supination: 86%	Flexion: 99.1%; extension: 99.4%; supination: 97.5%	Flexion: 93%; extension: 87.5%; supination: 88%	Flexion: 66.5%; extension: 99.2%; supination: 76%	Flexion: 95.3%; extension: 97.2%; supination: 84.6%	Flexion: 97.1%; extension: 96.2%; supination: 88.6%	Flexion: 97.4%; extension: 98.7%; supination: 86.5%
Flexion: operated side	140°	130°	130°	140°	135°	135°	140°
Extension: operated side	5°	0°	0°	10°	0°	0°	0°
Supination: operated side	85°	80°	90°	90°	90°	85°	90°
Pronation: operated side	80°	80°	80°	80°	80°	80°	80°
Score on the MEPS	100	100	100	100	100	100	100
Score on the DASH	0	0	0	0	0	0	0
Satisfaction	Satisfied	Satisfied	Very satisfied	Satisfied	Very satisfied	Very satisfied	Satisfied

Flexion	Average, Minimum, Maximum
Operated limb	133.5°, 130°, 140°	95.9%
Non-operated limb	139.2°, 135°, 140°	95.9%
Extension
Operated limb	3.5°, 10°, 0°	97.5%
Non-operated limb	0°, 0°, 0°	97.5%
Supination
Operated limb	86.5°, 80°, 90°	96%
Non-operated limb	90°, 90°, 95°	96%
Pronation
Operated limb	80°, 80°, 80°	100%
Non-operated limb	80°, 80°, 80°	100%

Flexion	Average, Median, Interquartile Range	p
Operated side	23.7 N, 22.4 N, 17.3-30.7	0.48
Non-operated side	25.4 N, 22.6 N, 21.5-31.6
%	92.5, 97.2, 93.0-99.1
Supination
Operated side	3.4 N, 3.3 N, 2.2-4.5	0.37
Non-operated side	3.9 N, 3.9 N, 2.5-5.2
%	86.8, 86.5, 84.6-88.7
Extension
Operated side	21.3 N, 19.2 N, 13.4-28.4	0.65
Non-operated side	22.1 N, 20.0 N, 15.3-29.5
%	96.4, 97.3, 96.0-99.2

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[1] Address for correspondence Rafael Salomon Silva Faria, Quadra 102 norte, praça Perdiz, Lote 05, Condomínio Residencial Matisse Antares, Águas Claras, DF, 71.907-000, Brazil (e-mail: thiago_storti@hotmail.com).

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Clinical Evaluation of the Reconstruction of the Biceps Brachii using Triceps Graft* * Work performed at Hospital Ortopédico e Medicina Especializada (HOME), Brasília, DF, Brazil.

Abstract

Objective

Methods

Results

Conclusion

Clinical Evaluation of the Reconstruction of the Biceps Brachii using Triceps Graft^* * Work performed at Hospital Ortopédico e Medicina Especializada (HOME), Brasília, DF, Brazil.