A RARE COMPLICATION AFTER DISTAL BICEPS TENODESIS WITH AN ANCHOR: A CASE REPORT

Introduction: Distal biceps tendon rupture is an uncommon injury, affecting more often the dominant hand of males in their 40s and leading to pain and loss of strength in supination and flexion. There are several techniques of repairing and reattaching the tendon on the tuberosity with good results and some well-presented complications. However, we encountered a rare complication of tenodesis failure with anchor placement through the radius and friction on the ulna causing pain and difficulty in supination-pronation and a clicking noise.

Aim: Our case aims to present this rare complication of friction of the anchor to the ulna and the surgical technique that was followed in order to extract the anchor safely.

Material-Methods: A 51-year-old male who had undergone distal biceps tenodesis with an anchor 6 months ago presented to us complaining of pain and a clicking noise during supination-pronation. After a posterolateral approach (Kocher) was done we removed the immersed anchor with a glass drill from posterior to anterior. Subsequently, bone graft was placed to the bone deficit before wound closure.

Results: Patient symptoms were immediately subsided after surgery with no residual pain or friction during supination-pronation. In addition, utilizing this posterior minimal technique, we protected neurovascular structures in the region. Identifying the end of the anchor, choosing the correct size glass drill and grasping the end of the anchor with a Kocher are key steps for the success of this revision procedure. One month postoperatively the patient has returned to his job while in six month’s radiological evaluation there is no bone defect or heterotopic ossification.

Conclusion: Anchor immersion through the radius during distal biceps repair to the tuberosity is a rare complication in the literature. Glass drill utilization after a posterolateral approach (Kocher approach) to the elbow is a minimally invasive surgical option for removal of the anchor without risking neurovascular damage.