statistically significant values were not found associated with both approaches as far as the number of complications are concerned . 6 , 9 The development of these approaches to smaller ( and minimally invasive ) incisions , associated with a better understanding of the anatomy , with the improvement of the fixation techniques and greater care with the placement of the retractors , allowed the minimization of complications for the techniques of anatomical approach . 6 , 9
For distal tendon biceps fixation there are several options : fixation with Locking Loop ( through a bony tunnel from the radial tuberosity to the opposite cortical , with a doubleincision approach 6 , 7 ); fixation with anchors of suture ( at the level of the ulnar border of the radial tuberosity , through a single anterior incision 6-8 ); fixation with a bone screw ( with a single anterior approach 6 ); or by endobutton fixation ( suspended button on the opposite cortical , with a single anterior approach 7 , 10 ). It is recommended the X-ray control on all fixation techniques in order to get the intraoperative confirmation of the positioning of the fixation tendon . 6-10
With regard to the option by the fixation technique there is also some diversity . The option for locking loop through the bone tunnel is historically the standard technique of treatment 6 , but there are reports about failures because of the rupture of the suture at the interface with the bone tissue . 6 The fixation with suture anchor may also fail due to the pull-out of the anchor or rupture of the suture . 6 Some authors argue that double anchor fixation allows even greater stability and lower risk of failure compared to locking loop technique . 6 The fixation with intraosseous screw is common , although cases of failure are also described due to pullout . 6 The option for endobutton has shown more recently a high degree of reliability , even higher than the techniques previously described . 9 , 10 In the literature is possible to see that most failures are not primarily associated with the type of fixation , but rather associated with early pistonning of the tendon insertion after the surgical treatment , and the failure of the fixation right after the surgery is unusual . 9 , 10 The most documented surgical complication is the paresthesia of the lateral cutaneous antebrachial nerve 6 , 7 , which usually results from the aggressive use of surgical retractors . The fracture of the radius neck may occur if the insertion was too proximal . 6 Other complications include sensorial motor neuropraxia of the radial nerve 6 , 9 , infection 6 , 9 , synostosis and heterotopic ossification . 6 , 7 , 9
With regard to the rehabilitation period , the actual trends point to an early return of joint mobility : immobilization of the upper limb with a plaster for two weeks , the time when
Revista de Medicina Desportiva informa july 2018 ยท 9