Investigating the single incision anterior transverse approach to the antecubital fossa for distal biceps tendon repair: a cadaver study

Abstract

Background; The aim of this study was to accurately establish the anatomy of the antecubital fossa in the context of distal biceps tendon repairs and to determine whether the leash of Henry (LoH) can be sacrificed to improve surgical exposure of the radial tuberosity.

Methods: Upper limb cadaveric specimens were dissected, and various measurements were taken to describe the positional anatomy of specific structures in the antecubital fossa. Specimens with previous injury or trauma to the antecubital fossa and gross variations of anatomical structures were excluded. Descriptive statistics were used to describe the data.

Results: A total of 20 specimens were included. The mean ± standard deviation (SD) distance from the elbow crease to the insertion of the distal biceps tendon into the radial tuberosity was 55.6 ± 8.7 mm (95% CI 51.5–59.6 mm). The distance between the elbow crease and the bifurcation of the brachial artery was 29.9 ± 9.3 mm (95% CI 25.5–34.2 mm), while the distance from the crease to the origin of the radial recurrent artery was 34.9 ± 7.9 mm (95% CI 31.2–38.6 mm). The distance from the elbow crease to the distal aspect of the deep venous plexus (LoH) was 47.4 ± 9.9 mm (95% CI 42.7–52.2 mm), with the crease to the cephalic vein anastomosis with the deep venous plexus being 27.2 ± 9.5 mm (95% CI 22.8–31.7 mm). Finally, the anterior interosseous nerve was located 9.9 ± 3.9 mm (95% CI 8.0–11.7 mm) medial to the insertion of the distal biceps tendon, while the median and radial nerves were 10.50 ± 5.2 mm (95% CI 8.07–12.93 mm) medial and 17.65 ± 3.54 mm (95% CI 15.99–19.31 mm) lateral to the insertion, respectively.

Conclusion: This descriptive cadaver study suggests that the distal aspect of the LoH may be sacrificed to increase exposure to the radial tuberosity. The radial nerve should be considered a lateral structure at risk while both the median and anterior interosseous nerves should be considered medial structures at risk during reinsertion of the distal biceps tendon. Additionally, the authors propose that the classical single transverse incision should be distalised when used for distal biceps tendon repair.

Level of evidence: 4