Revista de Medicina Desportiva (English) July 2018 - Page 11

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 · 9
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 double- incision approach 6,7 ); fixation with anchors of suture (at the level of the ulnar border of the radial tuberos- ity, through a single anterior inci- sion 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 lock- ing loop through the bone tunnel is historically the standard technique of treatment 6 , but there are reports about failures because of the rup- ture 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 stabil- ity and lower risk of failure com- pared to locking loop technique. 6 The fixation with intraosseous screw is common, although cases of failure are also described due to pull- out. 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 retrac- tors. The fracture of the radius neck may occur if the insertion was too proximal. 6 Other complications include sensorial motor neuro- praxia of the radial nerve 6,9 , infec- tion 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: immo- &ƗFbFRWW"Ɩ"vF7FW"f"GvvVV2FRFRvV&Wf7FFRVF6FW7'Fff&Vǒ# +r