Grewal single vs double incision

Single versus double-incision technique for the repair of acute distal biceps tendon ruptures: a randomized clinical trial.

Grewal R, Athwal GS, MacDermid JC, et al. The Journal of bone and joint surgery. American volume 2012 · PMID 22760383 · doi:10.2106/jbjs.k.00436

Question

In acute distal biceps rupture, does a two-incision repair give better outcomes than a single anterior incision?

Design

Randomised controlled trial comparing two surgical techniques with two-year follow-up.

Patients

Adults (all men in the final cohort) with acute distal biceps tendon ruptures.

Intervention

Single anterior incision repair with suture anchors

Comparison

Double-incision repair with transosseous sutures

Primary outcome

ASES elbow score over 2 years

Key result

No significant difference in patient-reported outcome between techniques; the double-incision group had a small gain in flexion strength. Lateral antebrachial cutaneous nerve neuropraxia was more frequent with the single anterior incision.

Limitations

Fixation method differed between arms (suture anchors versus transosseous tunnels), so whole techniques rather than incision alone were compared; an all-male cohort limits generalisability.

Impact on practice

Either approach is acceptable; surgeons should counsel on the different complication profiles (LABCN palsy with anterior, heterotopic ossification and PIN risk with two-incision).