Patients treated with double-incision repair using transosseous drill holes for acute distal biceps rupture may see fewer complications than those treated with single-incision repair using suture anchors, according to the results of a prospective, randomized clinical trial presented by Ruby Grewal, MD, MSc, FRCSC, at the 2010 ASSH annual meeting.

The researchers randomized 90 male patients to receive either single-incision repair (n = 48) or double-incision repair (n = 42). The two groups had no significant differences in patient age, dominant hand, or number of workers compensation cases. Overall mean American Shoulder and Elbow Society pain scores were similar in both groups at all follow-up points (3, 6, 12, and 24 months).

At 24 months, no significant differences were found between the treatment groups in final extension, pronation, or supination. The research team noted a marginal advantage in mean isometric flexion strength regained among participants in the double-incision group (double: 104 percent; single: 94 percent; p = 0.01).

Overall, 19 of 48 patients in the single-incision group had complications, compared to 3 of 42 in the double-incision group (p < 0.01)—primarily due to a high number of early transient neuropraxias in the single-incision group. Three neuropraxias in the single-incision group remained symptomatic after 6 months. The researchers noted four tendon ruptures, all of which were due to noncompliance or reinjury in the early postoperative period. None of the ruptures was related to fixation technique.

Dr. Grewal’s coauthors include George S. Athwal MD, FRCSC; Joy C. McDermid, BScPT, MSc, PhD; Kenneth J. Faber, MD, FRCSC; Darren S. Drosdowech, MD, FRCSC; Graham J.W. King, MD, MSc, FRCSC.

Disclosure information—Drs. Grewal and McDermid—no conflicts; Dr. Athwal—Wright Medical Technologies, Arthrosurface, ConMed Linvatec, Tornier, Arthrex; Dr. Faber—Tenet Medical, Zimmer; Dr. Drosdowech—DePuy; Dr. King—Wright Medical Technology, Inc.; Tornier; Tenet Medical.

Bottom line
No overall differences in functional outcomes were found between distal biceps ruptures treated with either a single or double incision repair technique; however flexion strength was slightly greater with a two-incision technique.

• The single-incision group had a greater incidence of complications.