Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Classification system for partial distal biceps tendon tears: a descriptive 3-Tesla magnetic resonance imaging study of tear morphology

  • Received : 2023.06.08
  • Accepted : 2023.07.16
  • Published : 2023.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: There is minimal literature on the morphology of partial distal biceps tendon (DBT) tears. We sought to investigate tear morphology by retrospectively reviewing 3-Tesla magnetic resonance imaging (3T MRI) scans of elbows with partial DBT tears and to propose a basic classification system. Methods: 3T MRI scans of elbows with partial DBT tears were retrospectively reviewed by two experienced observers. Basic demographic data were collected. Tear morphology was recorded including type, presence of retraction (>5 mm), and presence of discrete long-head and short-head tendons at the DBT insertion. Results: For analysis, 44 3T MRI scans of 44 elbows with partial DBT tears were included. There were 9 isolated long-head tears (20%), 13 isolated short-head tears (30%), 2 complete long-head tears with a partial short-head tear (5%), 5 complete short-head tears with a partial long-head tear (11%), and 15 peel-off tears (34%). Retraction was seen in 5 or 44 partial tears (11%), and 13 of the 44 DBTs were bifid tendons at the insertion (30%). Conclusions: Partial DBT tears can be classified into five sub-types: long-head isolated tears, short-head isolated tears, complete long-head tears with partial short-head involvement, complete short-head tears with partial long-head involvement, and peel-off tears. Classification of tears may have implications for operative and non-operative management. Level of evidence: III.

Keywords

References

  1. Bain GI, Johnson LJ, Turner PC. Treatment of partial distal biceps tendon tears. Sports Med Arthrosc Rev 2008;16:154-61. https://doi.org/10.1097/JSA.0b013e318183eb60
  2. Caekebeke P, Duerinckx J, van Riet R. Acute complete and partial distal biceps tendon ruptures: what have we learned? A review. EFORT Open Rev 2021;6:956-65. https://doi.org/10.1302/2058-5241.6.200145
  3. Boyle AB, George CM, MacLean SB. Anatomic factors associated with partial distal biceps tendon tears: a comparative control study. J Shoulder Elbow Surg 2022;31:1224-30. https://doi.org/10.1016/j.jse.2022.01.149
  4. Alemann G, Dietsch E, Gallinet D, Obert L, Kastler B, Aubry S. Repair of distal biceps brachii tendon assessed with 3-T magnetic resonance imaging and correlation with functional outcome. Skeletal Radiol 2015;44:629-39. https://doi.org/10.1007/s00256-014-2079-z
  5. Miyamoto RG, Elser F, Millett PJ. Distal biceps tendon injuries. J Bone Joint Surg Am 2010;92:2128-38. https://doi.org/10.2106/JBJS.I.01213
  6. Sutton KM, Dodds SD, Ahmad CS, Sethi PM. Surgical treatment of distal biceps rupture. J Am Acad Orthop Surg 2010;18:139-48. https://doi.org/10.5435/00124635-201003000-00003
  7. de la Fuente J, Blasi M, Martinez S, et al. Ultrasound classification of traumatic distal biceps brachii tendon injuries. Skeletal Radiol 2018;47:519-32.
  8. Festa A, Mulieri PJ, Newman JS, Spitz DJ, Leslie BM. Effectiveness of magnetic resonance imaging in detecting partial and complete distal biceps tendon rupture. J Hand Surg Am 2010;35:77-83. https://doi.org/10.1016/j.jhsa.2009.08.016
  9. Le Huec JC, Moinard M, Liquois F, Zipoli B, Chauveaux D, Le Rebeller A. Distal rupture of the tendon of biceps brachii. Evaluation by MRI and the results of repair. J Bone Joint Surg Br 1996;78:767-70. https://doi.org/10.2106/00004623-199605000-00017
  10. Athwal GS, Steinmann SP, Rispoli DM. The distal biceps tendon: footprint and relevant clinical anatomy. J Hand Surg Am 2007;32:1225-9. https://doi.org/10.1016/j.jhsa.2007.05.027
  11. Boyle AB, Uri Ke J, Ragg A, MacLean SB. Anatomy of the distal biceps tendon: an in vivo 3-T magnetic resonance imaging study. J Shoulder Elbow Surg 2022;31:1316-22. https://doi.org/10.1016/j.jse.2021.11.015
  12. Cho CH, Song KS, Choi IJ, et al. Insertional anatomy and clinical relevance of the distal biceps tendon. Knee Surg Sports Traumatol Arthrosc 2011;19:1930-5. https://doi.org/10.1007/s00167-011-1586-x
  13. Eames MH, Bain GI, Fogg QA, van Riet RP. Distal biceps tendon anatomy: a cadaveric study. J Bone Joint Surg Am 2007;89:1044-9.
  14. Bhatia DN, Kandhari V, DasGupta B. Cadaveric study of insertional anatomy of distal biceps tendon and its relationship to the dynamic proximal radioulnar space. J Hand Surg Am 2017;42:e15-23. https://doi.org/10.1016/j.jhsa.2016.11.004
  15. Mazzocca AD, Cohen M, Berkson E, et al. The anatomy of the bicipital tuberosity and distal biceps tendon. J Shoulder Elbow Surg 2007;16:122-7. https://doi.org/10.1016/j.jse.2006.04.012
  16. Jarrett CD, Weir DM, Stuffmann ES, Jain S, Miller MC, Schmidt CC. Anatomic and biomechanical analysis of the short and long head components of the distal biceps tendon. J Shoulder Elbow Surg 2012;21:942-8. https://doi.org/10.1016/j.jse.2011.04.030
  17. Morrey BF, Askew LJ, An KN, Dobyns JH. Rupture of the distal tendon of the biceps brachii: a biomechanical study. J Bone Joint Surg Am 1985;67:418-21. https://doi.org/10.2106/00004623-198567030-00011
  18. Mosher TJ. Musculoskeletal imaging at 3T: current techniques and future applications. Magn Reson Imaging Clin N Am 2006;14:63-76. https://doi.org/10.1016/j.mric.2005.12.002
  19. Kulshreshtha R, Singh R, Sinha J, Hall S. Anatomy of the distal biceps brachii tendon and its clinical relevance. Clin Orthop Relat Res 2007;456:117-20. https://doi.org/10.1097/BLO.0b013e31802f78aa
  20. Tagliafico A, Michaud J, Capaccio E, Derchi LE, Martinoli C. Ultrasound demonstration of distal biceps tendon bifurcation: normal and abnormal findings. Eur Radiol 2010;20:202-8. https://doi.org/10.1007/s00330-009-1524-1
  21. Davis WM, Yassine Z. An etiological factor in tear of the distal tendon of the biceps brachii: report of two cases. J Bone Joint Surg Am 1956;38:1365-8. https://doi.org/10.2106/00004623-195638060-00019
  22. Rausch V, Krieter JP, Leschinger T, et al. The radioulnar distance at the level of the radial tuberosity. Clin Anat 2020;33:661-6. https://doi.org/10.1002/ca.23483
  23. Schmidt CC, Brown BT, Williams BG, et al. The importance of preserving the radial tuberosity during distal biceps repair. J Bone Joint Surg Am 2015;97:2014-23. https://doi.org/10.2106/JBJS.N.01221
  24. Bauer TM, Wong JC, Lazarus MD. Is nonoperative management of partial distal biceps tears really successful. J Shoulder Elbow Surg 2018;27:720-5. https://doi.org/10.1016/j.jse.2017.12.010
  25. Tomizuka Y, Schmidt CC, Davidson AJ, et al. Partial distal biceps avulsion results in a significant loss of supination force. J Bone Joint Surg Am 2021;103:812-9. https://doi.org/10.2106/JBJS.20.00445
  26. Bourne MH, Morrey BF. Partial rupture of the distal biceps tendon. Clin Orthop Relat Res 1991;143-8.
  27. Nielsen K. Partial rupture of the distal biceps brachii tendon: a case report. Acta Orthop Scand 1987;58:287-8. https://doi.org/10.3109/17453678709146488