Graduate Theses, Dissertations, and Problem Reports 2010 Surgical repair of a biceps tendon rupture: A systematic review Josh Nelson West Virginia University Follow this and additional works at: https://researchrepository.wvu.edu/etd Recommended Citation Nelson, Josh, "Surgical repair of a biceps tendon rupture: A systematic review" (2010). Graduate Theses, Dissertations, and Problem Reports. 4636. https://researchrepository.wvu.edu/etd/4636 This Thesis is protected by copyright and/or related rights. It has been brought to you by the The Research Repository @ WVU with permission from the rights-holder(s). You are free to use this Thesis in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you must obtain permission from the rights-holder(s) directly, unless additional rights are indicated by a Creative Commons license in the record and/ or on the work itself. This Thesis has been accepted for inclusion in WVU Graduate Theses, Dissertations, and Problem Reports collection by an authorized administrator of The Research Repository @ WVU. For more information, please contact [email protected]. Surgical Repair of a Biceps Tendon Rupture: A Systematic Review Josh Nelson, BS, ATC Thesis submitted to the College of Physical Activity and Sport Sciences at West Virginia University in partial fulfillment of the requirements for the degree of Master of Science in Athletic Training Michelle A. Sandrey, Ph.D., ATC, Chair George Bal, MD Kevin Kotsko, MEd., ATC Damien Clement Ph.D., ATC College of Physical Activity and Sport Sciences Morgantown, WV 2010 Key words: Bicep tendon rupture, Surgical repair techniques, Long head of the biceps tendon ABSTRACT Surgical Repair of a Biceps Tendon Rupture: A Systematic Review Josh Nelson ATC Objective: To evaluate the methodological quality of Bicep tendon rupture surgical repair studies found in the current literature. Data Sources: Pubmed (1950-2009), CINAHL(1985-2009), SPORTdiscus( 1987-2009), MEDLINE, Google Scholar, SCIENCE DIRECT( 1980-2009) from December 2009 to January 2009 were searched using the terms Distal biceps tendon, Proximal Biceps tendon, Long head of the biceps tendon individually. Second the term biceps tendon rupture was combined with each of the following words: anatomy, surgical treatment, conservative treatment, imaging, conservative treatment, biomechanics, etiology, and epidemiology. Third, Citations were cross-referenced from studies to include literature not found in the original search. Study Selection: Studies were selected based on the following inclusion criteria: 1) The studies were written in or translated to English; 2) The term bicep tendon rupture must be present in the title; 3) The abstract must include the name of the surgical repair technique used; and 4) Bicep tendon pain or dysfunction must be the chief complaint. Exclusion criteria consisted of any study that included a surgical repair to a rotator cuff muscle. Data Extraction: All the studies that met the inclusion criteria were collected and evaluated using the Coleman Method scale. First each study was read completely without the use of the Coleman Method scoring checklist. Next, each article was read a second time using the Coleman Method scoring checklist by both evaluators. Based on the check list the studies were awarded points on whether the scored information was included. Finally when all of the studies were scored the two evaluators come together and compared their scores for each study and discrepancies were discussed until an agreement was reached. Data Synthesis: The ten studies that were collected varied in subject population, type of surgical procedure performed was either a tenotomy or tenodesis, and whether the study conducted was a prospective or retrospective design and level of methodological quality. The subject population of the studies varied from 12 to 307. The Methodological quality of the studies according to the Coleman Method score ranged from 12 to 76, with the average mean score of 63.9. Conclusion: There is a lack of high quality methodological studies in the current literature, although some quality studies do exist. However, the number of quality studies is small making it difficult to draw strong conclusions as to which surgical technique provides the best outcome for the patient. ACKNOWLEDGMENTS First I would like to thank my family, with out your support I would never have had the great opportunities that I have had in my life. With out you pushing me to be the best that I can be I would not have been able to achieve such a goal as graduate school. I would next like to thank all of my friends who have been there to support me over the last two years. Without your help in my moments of stress, the two years of graduate school would not have been such a highlight of my life. I would like to thank Dr. Bal and Kevin Kotsko for being on my thesis committee and for all the help and guidance you have given over the past year. I am very thankful for all of the time and energy you have given in order for me to complete this long process of writing a thesis. A special thanks to Dr. Michelle Sandrey, for giving me the opportunity to attend graduate school at West Virginia University. It has been a great experience and one that I will always remember for the rest of my life. Thank you also for the many hours you have worked to help me complete this thesis. I would also like to thank Damien Clement for his help in evaluating the studies. It made my thesis a lot less stressful having someone experienced with the Coleman Method assist in the evaluation. iii TABLE OF CONTENTS ACKNOWLEDGEMENTS...............................................................................................iii LIST OF TABLES..............................................................................................................v LIST OF FIGURES............................................................................................................vi INTRODUCTION.............................................................................................................1 METHODS.........................................................................................................................4 STUDY SELECTION…………………………………………………………….…..….8 DATA EXTRACTION…………………………………………………………….….....8 DATA SYNTHESIS…………………………………………………………………..…9 DISCUSSION…………………………………………………………………………..18 CONCLUSION…………………………………………………………………………22 REFERENCES.................................................................................................................23 APPENDICES..................................................................................................................27 APPENDIX A. THE PROBLEM.........................................................................28 APPENDIX B. LITERATURE REVIEW...........................................................34 APPENDIX C. ADDITIONAL METHODS.......................................................53 APPENDIX D. ADDITIONAL RESULTS………………………………….…59 APPENDIX E. RECOMMENDATIONS FOR FUTURE RESEARCH…….…78 ADDITIONAL REFERENCES.......................................................................................79 iv LIST OF TABLES Tables Page C1. Coleman Method Scale…………………………………………………………………..53 C2. Coleman Method Scale Checklist with Explanations…………………………..………..54 C3. Protocol for Determining Studies………………………………………………………..58 D1. Biceps Brachii Surgical Repair Studies………..……………………………………59, 60, 61 D2. Comparison of Studies Based on Coleman Method………………………………….....62 D3. Coleman Method Checklist for Kragh…...…………………………………………..…63 D4. Coleman Method Checklist for Kelly…………………...…………………………........64 D5. Coleman Method Checklist for Gill……………………………………………………..65 D6. Coleman Method Checklist for Boileau…………………………………………...….....66 D7. Coleman Method Checklist for Becker……………………………………………….....67 D8. Coleman Method Checklist for Mazzocca………………………………………………68 D9. Coleman Method Checklist for Checchia……………………………………………….69 D10. Coleman Method Checklist for Berlemann……………………………………………70 D11. Coleman Method Checklist for Boileau……………………………………………….71 D12. Coleman Method Checklist for Walch………………………………………………...72 v LIST OF FIGURES Figures Page B1. Interference Screw Technique………………………………………………….....47 B2. Suture Anchor Technique ……………………………..……………………..…..48 B3. Ligament Washer Technique…………………………………………………......48 B4. Keyhole Technique…………………………………………………………….....49 B5. Bone Tunnel Technique……………………………………………………….....49 D1. Figure of Studies Used: CINAHL………………………………………………73 D2. Figure of Studies Used: MEDLINE…………………………………………….74 D3. Figure of Studies Used: PUBMED……………………………………………...75 D4. Figure of Studies Used: SPORTSDiscus………………………………………..76 D5. Figure of Studies Used: Google Scholar………………………………………...77 D6. Figure of Studies Used: SCIENCE DIRECT……………………………….…..78 vi INTRODUCTION Ruptures of the biceps brachii can occur at four possible locations; the long head of the biceps (LHB), short head, distal attachment and the muscle belly. While all four locations can suffer damage and tissue failure, rupture of the long head of the biceps tendon accounts for 95% of bicep tendon ruptures, the distal bicep tendon makes up 3 % and the short head and muscle belly account for the remaining 2 % of bicep brachii ruptures. 1,2, 3 A rupture is typically seen in men who are over the age of forty and is typically seen in the dominant arm of individuals, with the most common site of rupture being the bone-tendon junction.