Anterior vs Posterior Approach Provides No Significant Difference in Distal Biceps Repair Outcome

When a biceps tendon, the tissue that attaches the biceps muscle to the bone, becomes separated or torn away near the elbow, called a distal avulsion, this affects a person's ability to flex the elbow and to use the arm in ways such as twisting the forearm to use a screwdriver. Given the location of the tendon in relation to the bones, there have been two standard approaches to repairing the avulsion; some surgeons approach the surgery from the back (posterior), while others approach it from the front Ianterior).

The authors of this study investigated the effectiveness of both approaches, comparing them to evaluate if one approach was superior in the avusion repair. In order to do the study, the researchers obtained 11 matched pairs of cadaver arms that had intact biceps tendon, muscles and joints. Each specimen, tested in pairs, was examined with the tendon intact and then re-examined after the tendon had been avulsed and then repaired, one with the anterior approach, the other with the posterior approach.

The elbows were placed at a 90 degree angle and loads were applied and the effectiveness of the forearm was recorded, before and after repairs.

When analyzing the results, the researchers found that there were no statistical significant differences between either approach in terms of flexion or force, although the arms that had the anterior repair, did show a slightly lower force than did those with the posterior repair.

Historically, such surgical repair often included dissection of the soft tissue in the inside part of the elbow, or the cubital fossa. This, however, resulted in many complications. A two-incision approach was introduced in the early 1960s that reduced the need to dissect the soft tissue, and with modifications over the years, the surgery has proven to be quite successful. There is debate as to whether one incision or two is best, but this is the only study that investigated the results of posterior versus anterior approach and the effect on the elbow flexion and force.

The authors conclude that although the data are limited and more study is necessary, these findings indicate no functional differences between either approach.

References: Jon Henry, MD, et al. Biomechanical Analysis of Distal Biceps Tendon Repair Methods. In The American Journal o Sports Medicine. November 2007. Vol. 35. No. 11. Pp. 1949-1954