Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair.

BACKGROUND: Recent technical improvements have led the way to a resurgence of the single-incision approach for repair of distal biceps tendon injuries. There has been no biomechanical evaluation of all these techniques with comparison to the standard 2-incision bone tunnel technique. HYPOTHESIS: There will be no difference under cyclic loading and ultimate failure between the 2-incision bone tunnel technique, suture anchor repair, interference screw, and EndoButton techniques for the repair of distal biceps tendon ruptures. STUDY DESIGN: Controlled laboratory study. METHODS: Sixty-three fresh-frozen cadaveric elbows were randomly assigned to 4 treatment groups (bone tunnel, EndoButton, suture anchor, interference screw). Cyclic loading was then performed from 0 degrees to 90 degrees at 0.5 Hz for 3600 cycles with a 50-N load. A differential variable reductance transducer was placed between the radius and distal tendon to determine displacement. The construct was then pulled to failure at 120 mm/min. RESULTS: A multiple analysis of variance revealed no statistically significant difference for displacement among the 4 repair techniques. Displacement using the bone tunnel was 3.55 mm, EndoButton was 3.42 mm, suture anchor was 2.33 mm, and interference screw was 2.15 mm. There was a statistically significant greater load to failure with EndoButton (440 N) than suture anchor (381 N), bone tunnel (310 N), or interference screw (232 N) (P < .001). CONCLUSION: The EndoButton technique had the highest load to failure. CLINICAL RELEVANCE: These data demonstrate the EndoButton to be the strongest repair technique, with no failures during cycling at physiologic loads and with the largest load to failure. These findings are important in maximizing surgical results and stability and suggest that the construct can tolerate early postoperative active range of motion.

Articular cartilage injuries of the capitellum interposed in radial head fractures: a report of ten cases.

Ten cases of Mason type I and type II isolated radial head fractures are reported, in which an unexpected cartilaginous fragment of the capitellum trapped within the radial head fracture was identified at the time of surgery. In no case was this injury pattern identified on preoperative imaging, including computed tomography in 2 cases. Five patients did have preoperative mechanical findings with forearm rotation. At surgery, all capitellar fragments were found to originate from the posterolateral capitellum. Excision of the capitellar fragment and internal fixation of the radial head fracture were performed in all cases. No sequelae were identified on short-term follow-up. This series highlights an injury pattern that should be considered in isolated nondisplaced and minimally displaced fractures of the radial head. The natural history of this finding, when treated conservatively, is unknown.

Lateral compression injuries in the pediatric elbow: Panner's disease and osteochondritis dissecans of the capitellum.

Lateral compression injuries of the elbow typically occur in throwing athletes and gymnasts. In the preadolescent and adolescent patient, these injuries predominantly include Panner's disease and osteochondritis dissecans. Panner's disease, an osteochondrosis of the capitellum, is a rare disorder that usually affects the dominant extremity in individuals younger than age 10 years. Symptomatic management of Panner's disease consisting of reduction of stressful activities of the elbow is usually sufficient to allow resolution. Although a prolonged period is required for healing, most patients demonstrate excellent long-term results. Osteochondritis dissecans of the capitellum typically occurs in adolescents and is associated with loose body formation. Panner's disease and osteochondritis dissecans likely represent a continuum of disordered endochondral ossification with presentation and prognosis dependent primarily on age at onset.