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Anatomical repair of distal biceps brachial tendon lesions using double-incision surgical approach
Reparación anatómica de las lesiones del tendón distal del bíceps braquial utilizando la técnica quirúrgica de doble incisión
E. Ibáñeza, E. Araizaa, E. Rodríguez-Iñigob, P. Guillén-Garcíaa,b, J.M. López-Alcorochob,
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jm.lopez@amplicel.com

Corresponding author.
a Departamento de Traumatología y Cirugía Ortopédica, Clínica CEMTRO, Madrid, Spain
b Unidad de Investigación, Clínica CEMTRO, Madrid, Spain
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Due to proximal retraction of the muscle&#44; an aesthetic deformity often appears&#44; which may go unnoticed in patients with little muscle or a degree of obesity&#46; O&#8217;Driscoll et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> described the hook test&#44; which shows high sensitivity and specificity&#44; as well as the squeeze test&#44; for the diagnosis of complete distal biceps brachii rupture&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Chronic injuries lead to loss of arm strength in flexion and supination&#44; combined with asymmetry with respect to the contralateral arm&#46; Irritation of the lateral cutaneous nerve may cause pain&#58; surgical reconstruction is advisable in these patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;11</span></a> Boyd and Anderson<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> first described the two-incision approach to avoid the risk of posterior interosseous nerve injury&#46; Morrey et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> published a modification of this double approach technique with the aim of reducing any potential heterotopic calcification after incising the musculature of the external aspect of the olecranon&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this paper we assess the return to sports and clinical outcome of patients with biceps brachii tendon rupture who underwent surgical reconstruction of the tendon using our own modified double-approach technique&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0025" class="elsevierStylePara elsevierViewall">This is a retrospective study conducted in 20 patients&#44; with 21 cases of biceps brachii tendon rupture &#40;one patient had rupture in both arms&#41;&#44; treated in our unit from 2008 to 2017&#46; The study was conducted in accordance with the ethical principles approved in the 1964 Declaration of Helsinki&#44; revised in 2013&#46; The study was approved by the institution&#39;s ethics committee and patients signed their informed consent to participate&#46; At the time of injury&#44; the patients had a mean age of 44&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;6 years &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&#46; The injury was in the right arm in 14 cases &#40;66&#46;7&#37;&#41; and the in the left in the other 7 &#40;33&#46;3&#37;&#41;&#46; All the patients practised sports and the injury occurred during sports&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Surgical procedure</span><p id="par0030" class="elsevierStylePara elsevierViewall">The surgical technique consisted of a series of modifications to existing surgical procedures&#46; Locoregional anaesthesia of the limb is used with the patient in the supine position and with the aid of a hand table&#46; A tourniquet is used on the arm and the surgical field is prepared&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A limited transverse incision of 2&#8211;3<span class="elsevierStyleHsp" style=""></span>cm is made just above the ulnar crease&#59; the avulsed tendon is sought and located with blunt dissection&#59; we carry out a thorough inspection of the avulsed tendon and the last 5&#8211;6<span class="elsevierStyleHsp" style=""></span>mm of the degenerated tendon is resected&#46; We then place 2 two non-absorbable number 5 Ethibond Bunnell sutures in the avulsed tendon&#46; This suture allows us to traction the tendon in its entirety up to its bony insertion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">We then palpate the radial tuberosity and make a second incision in the radial tuberosity&#44; transmuscularly&#44; separating the common and supinator extensor muscle&#44; with the forearm in maximum pronation&#46; We never expose the ulna&#46; We prepare the bed of the radial tuberosity with high-speed burs in a trench 1<span class="elsevierStyleHsp" style=""></span>cm wide and several millimetres deep and leave a bone anchor with the threads&#44; which will be used to anchor the tendon &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">We pass a curved&#44; blunt haemostasis forceps from the forearm towards the arm&#44; sliding it under the radial tuberosity and advancing proximally&#44; between the radius and ulna&#44; using flexion-extension manoeuvres until we reach the arm&#58; the blunt tip of the forceps emerges from the transverse incision&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We insert the Ethibond threads into the tip of the forceps and pull it distally until the threads pass into the forearm&#46; Once the threads have been passed&#44; we pull on them using flexion-extension manoeuvres until the avulsed tendon is completely extracted through the distal incision of the forearm&#59; we remove the Ethibond suture and re-suture the tendon with Bunnell type stitches with the threads belonging to the transosseous anchor that has been previously placed in the radial tuberosity&#44; knot and tightly tension the suture until the avulsed tendon is completely attached to the radial tuberosity with the arm in a neutral position&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We then check for full elbow motion&#44; in supination-pronation&#44; flexion and full extension&#44; free and without anomalies throughout the range of motion&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">We close in layers&#44; release the tourniquet for adequate haemostasis&#44; leave no drain and place a splint with a compressive bandage in 90&#176; elbow flexion with the forearm in a neutral position&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">To minimise any ectopic calcifications&#44; we avoid passing the dissecting forceps between the ulna and the anconeus or between the anconeus and the ECU &#40;Kocher&#39;s interval&#41;&#46; As a fixation system we used a transosseous suture using a non-absorbable&#44; 5&#46;5<span class="elsevierStyleHsp" style=""></span>mm Healix anchor &#40;DePuy Synthes&#44; Madrid&#44; Spain&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; After suturing &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>D&#41;&#44; patients are immobilised for 4 weeks in a splint and sling and then follow a 6-week rehabilitation programme&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Evaluation of clinical progress</span><p id="par0070" class="elsevierStylePara elsevierViewall">One year after surgery&#44; the functional progression of the injured arm was assessed using the Mayo Elbow Performance Score &#40;MEPS&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Muscle strength was assessed using the Medical Research Council &#40;MRC&#41; questionnaire&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Pain was assessed using the Visual Analogue Scale &#40;VAS&#41;&#46; Range of motion &#40;ROM&#41; was determined by measuring degrees of extension and flexion&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">The data were analysed using IBM&#174; SPSS&#174; Statistics&#44; version 22 &#40;New York&#44; USA&#41;&#46; Qualitative variables were expressed in counts or percentages&#46; Relationships between these variables were studied using contingency tables and analysed using Pearson&#39;s <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span> test&#46; Quantitative variables were expressed with the mean or median as a measure of central tendency and the standard deviation or minimum and maximum values as a measure of dispersion&#46; The mean and the 95&#37; confidence interval &#40;95&#37; CI&#41; of the mean were estimated for ROM&#46; Normality was analysed with the Kolmogorov&#8211;Smirnov test&#46; The distribution of quantitative variables within the different categories of qualitative variables was tested using the non-parametric Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> &#40;2 categories&#41; or Kruskal&#8211;Wallis &#40;more than 2 categories&#41; test&#46; Spearman&#39;s correlation coefficient was used to identify possible relationships between variables&#46; All statistical comparisons were bilateral&#44; with a significance level of 5&#37;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">The median time until the patients underwent biceps brachii tendon reattachment was 7 days &#40;minimum&#58; 1 day&#59; maximum&#58; 30 days&#41;&#46; After surgery&#44; one patient developed neuroapraxia&#44; which resolved spontaneously&#46; After surgery&#44; the mean recovery time &#40;time between surgery and discharge&#41; was 4&#46;43<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;21 months&#46; All patients returned to their previous level of sporting activity&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">One year after surgery&#44; the patient&#39;s clinical and functional progression was assessed&#46; The median pain measured using the VAS scale was 1&#46;90<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#46;89 &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41; and the median MEPS scale was 90 &#40;80&#8211;100&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; Muscle power evaluated using the MRC scale is shown in <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#46; The results of the MRC scale assessment showed the maximum score &#40;score 5&#41; in 16 cases &#40;76&#46;2&#37;&#41; while in the remaining 5 cases &#40;23&#46;8&#37;&#41; the score was 4&#43;&#46; Regarding assessment of ROM one year after surgery&#44; patients had 136&#46;67&#176; mean extension &#40;mean 95&#37; CI 134&#46;14&#8211;139&#46;19&#41; and &#8722;7&#46;38&#176; mean flexion &#40;mean 95&#37; CI&#58; &#8722;10&#46;04 to &#8722;4&#46;72&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; As expected&#44; flexion and extension degrees were highly correlated &#40;<span class="elsevierStyleItalic">&#1009;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;&#46;726&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Likewise&#44; a statistically significant correlation was found between degrees of flexion and the MEPS scale &#40;<span class="elsevierStyleItalic">&#1009;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;470&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;032&#41; and the MRC score &#40;<span class="elsevierStyleItalic">&#1009;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;581&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;006&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the epidemiological factors that could influence the clinical outcomes of surgical treatment&#46; Eight patients had a medical history of interest&#44; including severe allergies&#44; asthma&#44; hepatitis C virus infection&#44; hypertension&#44; thalassaemia minor&#44; dyslipidaemia&#44; or psoriasis&#46; Of these&#44; 6 patients with a medical history were under pharmacological treatment&#59; 4 patients had undergone surgery for trauma&#44; such as anterior cruciate ligament reconstruction&#44; disc herniation&#44; knee prosthesis or frontal bone reconstruction &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; A statistically significant relationship was only found between the MEPS scale and pharmacological treatment in those with a medical history of interest&#46; Thus&#44; the median MEPS in the patients without treatment was 100 &#40;80&#8211;100&#41;&#44; significantly higher than in the patients with treatment&#44; whose median MEPS was 90 &#40;80&#8211;90&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;010&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">The present study evaluated the benefits of an anatomical repair technique for distal biceps brachial tendon rupture using a double-incision surgical approach&#46; The results were evaluated in terms of clinical outcome and the patients&#8217; return to their previous level of physical activity&#46; Distal biceps brachial tendon rupture is a relatively rare injury affecting 1&#46;2 per 100&#44;000 patients&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> primarily middle-aged men aged 40&#8211;50 years&#46; Our results are in line with the literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;15</span></a> Thus&#44; the patients included in the present study were all men with a mean age of 44&#46;5 years and practised high-intensity sport&#46; We found one bilateral case in a patient who trained with weights and simultaneously ruptured both distal biceps brachii tendons&#46; In this regard&#44; there are publications that indicate that the risk of rupture of the biceps brachii tendon in the contralateral arm may be increased by 8&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The injury was in the dominant arm in the other patients and occurred while practising a medium- or high-intensity sporting activity&#44; in competition or training&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">There was only one complication in our series of patients&#44; a neuroapraxia probably caused by the placement of intraoperative spacers and which resolved spontaneously&#46; According to our results&#44; there are clear advantages in terms of few postoperative complications and the athlete&#39;s full recovery&#46; They were able to return to physical activity at the same level as before the injury&#46; In this regard&#44; Lang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> conclude&#44; in a retrospective study of 47 patients&#44; that a double incision approach in the hands of an experienced surgeon is a simple and inexpensive method with satisfactory clinical results&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In our technique&#44; we used a 5&#46;5<span class="elsevierStyleHsp" style=""></span>mm &#8220;Healix&#8221; anchor&#44; and found no cases of radioulnar synostosis&#46; In addition&#44; surgical exposure using our double incision technique allows excellent visualisation of the anatomical areas&#46; This proves it to be a very convenient technique&#46; Once the tendon is anchored&#44; we perform all possible movements of the elbow to check for full range of motion&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">One year after surgery&#44; the mean pain score on the VAS scale was almost 2&#46; Similar results have been published by other authors using other methods&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> However&#44; we found that assessing pain to evaluate the benefits of this technique is irrelevant&#44; since the patients presented hardly any pain&#44; including the patient with a posterior interosseous injury&#44; who&#44; despite presenting neuroapraxia&#44; had no pain&#46; We find that other parameters are more useful to evaluate this surgical procedure&#46; Indeed&#44; pain&#44; along with motion&#44; stability&#44; and function&#44; was assessed with the MEPS scale&#46; The patients included in this study showed a median score of 90 out of 100 at 12 months&#44; which we consider an excellent result and in line with that published by other authors&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> We observed a statistically significant difference in MEPS score between the patients who had received some form of treatment for another medical reason and those who had received no treatment at all&#59; the MEPS score was lower in the former than in the latter&#46; Although we have no clear explanation for this&#44; one could speculate that drug treatments might influence patients&#8217; ability to heal or their own perception of their ability to heal&#44; which could be reflected in the MEPS score&#46; We believe that the MRC scale is another useful parameter to assess the benefits of this technique&#44; used to measure muscle strength after surgery&#46; The results obtained with respect to the MRC scale showed that most of the patients &#40;73&#46;9&#37;&#41; had full motion against resistance &#40;score 5&#41; and the rest &#40;26&#46;1&#37;&#41; had almost full motion against gravity and against resistance compared to the healthy contralateral side at 12 months after surgical treatment&#46; These results demonstrate that after surgery the patients had regained their muscle function and were able to return to sport and reach the same sporting levels as before the injury&#46; Finally&#44; ROM was measured to evaluate the patient&#39;s progress&#46; Here&#44; we found that 12 months after surgery&#44; the patients presented almost normal levels of motion &#40;137&#46;17&#176; mean extension and &#8722;6&#46;96&#176; average flexion&#44; considering that 145&#176; and 0&#176;&#44; respectively&#44; are the normal ROM of the elbow&#41;&#46; These results show that our technique can restore full arm function&#44; which helps patients return to sport&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A major advantage of the two-incision approach is that it allows more anatomical reinsertion of the avulsed distal biceps brachii tendon over its insertion in the radial tuberosity compared to the single anterior incision&#46; Rollo et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> using their own modification of the two-incision approach&#44; conclude that the technique gives very good results because the anatomical structures are preserved&#46; Tarallo et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> in a study of the advantages and disadvantages of anatomical repair using the two-incision technique in 63 patients&#44; concluded that&#44; although the most serious complications that can occur are nerve palsy and reduced motion&#44; the technique is a valid treatment option&#44; especially in young active patients&#44; in whom flexion and supination strength are restored thanks to the anatomical reinsertion&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Although there are studies and series that speak of the benefits of early mobilisation of the reinserted tendon&#44;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;21</span></a> we agree with Prof&#46; Bernard F&#46; Morrey<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> that&#44; when reinsertion is performed using suture anchors&#44; we doubt that it is strong enough to allow early mobilisation&#46; In our series we had no cases of stiffness and mobilisation in all the cases treated was satisfactory&#46; Therefore&#44; for our own peace of mind we opt for joint mobilisation and starting rehabilitation treatment after 4 weeks of immobilisation if we have used the two-incision approach for reconstruction&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">This study&#39;s main limitation is its retrospective design&#46; In its favour is that all the patients followed the same treatment and follow-up protocol&#46; Another limitation of the study is its small sample size&#46; However&#44; considering the very low incidence of this type of injury and the consistency of the results&#44; this relatively small number of patients included should not be a serious limitation of the study&#46; The main strength of the study is the consistency of the results obtained&#46; Indeed&#44; the small degree of variation found among the patients included in the study strongly supports the conclusions of the paper&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In conclusion&#44; the double incision surgical approach for anatomical repair of distal biceps brachii tendon rupture is safe&#44; provides good clinical results and allows patients to return to sport at pre-injury levels&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Level of evidence</span><p id="par0135" class="elsevierStylePara elsevierViewall">Level of evidence IV<span class="elsevierStyleSmallCaps">&#46;</span></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding</span><p id="par0140" class="elsevierStylePara elsevierViewall">This work was funded by the <span class="elsevierStyleGrantSponsor" id="gs0000">Fundaci&#243;n Dr&#46; Pedro Guill&#233;n</span>&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interests</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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      "en" => array:3 [
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">and objective The aim of this work was to evaluate clinical outcomes of patients with biceps brachii tendon rupture who underwent a surgical tendon reconstruction using our own modified double approach technique&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The study was performed in 20 patients &#40;21 cases&#41; with biceps brachii tendon rupture&#46; Patients were treated with our own double-approach surgical technique consisting of 2 minimum incisions&#46; After one year follow-up&#44; functional evaluation was assessed using the mayo Elbow Performance Score&#44; muscle strength was estimated with the Medical Research Council questionnaire and pain was evaluated with the Visual Analogic Scale&#46; Range of motion was determined by measuring extension and flexion&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">One year after surgery all patients had returned to sports at the same level they had previously&#46; Visual Analogic Scale was 1&#46;90<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;89 &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#41; and median Mayo Elbow Performance Score was 90 &#40;minimum&#8211;maximum&#58; 80&#8211;100&#41;&#46; Of them&#44; 16 patients &#40;76&#46;2&#37;&#41; showed the highest Medical Research Council score&#44; score 5&#44; while 6 cases &#40;26&#46;1&#37;&#41; still scored 4&#43;&#46; Patients had a mean of 136&#46;67&#176; flexion &#40;95&#37; CI&#58; 134&#46;14&#176;&#8211;139&#46;19&#176;&#41; and &#8722;7&#46;38&#176; extension &#40;95&#37; CI&#58; &#8722;10&#46;04&#176; to &#8722;4&#46;72&#176;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Double-incision surgical approach for distal biceps brachial tendon rupture anatomical repair is a safe technique&#44; providing results that allow patients muscle recovery and return to sports&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Patients"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">En este trabajo se estudi&#243; la evoluci&#243;n cl&#237;nica de pacientes con rotura de tend&#243;n del b&#237;ceps braquial tratados mediante reconstrucci&#243;n quir&#250;rgica seg&#250;n nuestra propia t&#233;cnica de doble incisi&#243;n&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 20 pacientes &#40;21 casos&#41; de rotura de tend&#243;n del b&#237;ceps braquial tratados mediante nuestra propia t&#233;cnica quir&#250;rgica de doble abordaje modificada&#44; consistente en 2<span class="elsevierStyleHsp" style=""></span>incisiones m&#237;nimas&#46; La evaluaci&#243;n funcional se determin&#243; mediante la escala <span class="elsevierStyleItalic">Mayo Elbow Performance Score</span>&#44; la fuerza muscular se determin&#243; con el cuestionario <span class="elsevierStyleItalic">Medical Research Council</span> y el dolor mediante la Escala Anal&#243;gica Visual a los 12 meses de seguimiento&#46; Se determin&#243; el rango de movilidad midiendo los grados de flexi&#243;n y extensi&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Un a&#241;o despu&#233;s de la cirug&#237;a todos los pacientes hab&#237;an vuelto al deporte al mismo nivel que ten&#237;an previamente&#46; La puntuaci&#243;n de Escala Anal&#243;gica Visual fue de 1&#44;90<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;89 &#40;media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar&#41; y la mediana de la escala <span class="elsevierStyleItalic">Mayo Elbow Performance Score</span> de 90 &#40;m&#237;nimo-m&#225;ximo&#58; 80-100&#41;&#46; Del total&#44; 16 &#40;76&#44;2&#37;&#41; presentaron la m&#225;xima puntuaci&#243;n en la escala <span class="elsevierStyleItalic">Medical Research Council</span> &#40;puntuaci&#243;n 5&#41;&#44; mientras que 5<span class="elsevierStyleHsp" style=""></span>casos &#40;23&#44;81&#37;&#41; tuvieron una puntaci&#243;n de 4&#43;&#46; La media de extensi&#243;n fue de 136&#44;67&#176; &#40;IC 95&#37;&#58; 134&#44;14&#176;-139&#44;19&#176;&#41; y &#8722;7&#44;38&#176; de flexi&#243;n &#40;IC 95&#37;&#58; &#91;&#8722;10&#44;04&#176;&#93;-&#91;&#8722;4&#44;72&#176;&#93;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">El abordaje quir&#250;rgico de la doble incisi&#243;n para la reparaci&#243;n anat&#243;mica de las roturas de tend&#243;n distal del b&#237;ceps braquial es seguro y proporciona resultados que permiten la recuperaci&#243;n muscular y la vuelta al deporte de los pacientes&#46;</p></span>"
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          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivo"
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            "identificador" => "abst0030"
            "titulo" => "Pacientes"
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            "identificador" => "abst0035"
            "titulo" => "Resultados"
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            "identificador" => "abst0040"
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Ib&#225;&#241;ez E&#44; Araiza E&#44; Rodr&#237;guez-I&#241;igo E&#44; Guill&#233;n-Garc&#237;a P&#44; L&#243;pez-Alcorocho JM&#46; Reparaci&#243;n anat&#243;mica de las lesiones del tend&#243;n distal del b&#237;ceps braquial utilizando la t&#233;cnica quir&#250;rgica de doble incisi&#243;n&#46; Rev Esp Cir Ortop Traumatol&#46; 2021&#59;65&#58;305&#8211;311&#46;</p>"
      ]
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Preparation and isolation of the distal tendon&#46; &#40;B&#41; Lateral approach and exposure of the radial tuberosity&#46; &#40;C&#41; Tendon anchoring&#46; &#40;D&#41; Final suturing&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Box plot one year after the intervention&#46; &#40;A&#41; Showing pain measured using the Visual Analogue Scale &#40;VAS&#41;&#46; &#40;B&#41; Functional assessment of the injured arm measured using the MEPS &#40;Mayo Evaluation Performance Scale&#41;&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Number of patients with scores 4&#43; and 5 on the MRC &#40;Medical Research Council&#41; scale&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Range of motion at one year follow-up shown in a box plot&#46; &#40;A&#41; Degrees of extension&#46; &#40;B&#41; Degrees of flexion&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Medical history&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;60&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">8 &#40;40&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pharmacological treatment for ongoing diseases&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">Previous surgeries&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Smoker&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">4 &#40;20&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Epidemiological factors of the patients included in the study&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:21 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Distal biceps tendon rupture&#58; current concepts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46; Sarda"
                            1 => "A&#46; Qaddori"
                            2 => "F&#46; Nauschutz"
                            3 => "L&#46; Boulton"
                            4 => "R&#46; Nanda"
                            5 => "N&#46; Bayliss"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.injury.2012.10.029"
                      "Revista" => array:6 [
                        "tituloSerie" => "Injury"
                        "fecha" => "2013"
                        "volumen" => "44"
                        "paginaInicial" => "417"
                        "paginaFinal" => "420"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23199755"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rupture of the distal tendon of the biceps brachii&#58; a biomechanical study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "B&#46;F&#46; Morrey"
                            1 => "L&#46;J&#46; Askew"
                            2 => "K&#46;N&#46; An"
                            3 => "J&#46;H&#46; Dobyns"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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                        "fecha" => "1985"
                        "volumen" => "67A"
                        "paginaInicial" => "418"
                        "paginaFinal" => "421"
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937813002251"
                          "estado" => "S300"
                          "issn" => "00029378"
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                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rupture of the distal tendon of the biceps brachii&#58; operative versus non-operative treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "B&#46;E&#46; Baker"
                            1 => "D&#46; Bierwagen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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Article information
ISSN: 19888856
Original language: English
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2022 February 13 6 19
2022 January 8 7 15
2021 December 16 8 24
2021 November 21 9 30
2021 October 21 11 32
2021 September 18 10 28
2021 August 27 9 36
2021 July 43 12 55
2021 June 11 5 16
2021 May 3 4 7
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos