If you have torn your biceps tendon at the elbow, and elect surgical repair, should you have a SINGLE or a DOUBLE INCISION technique?

 This is a great question--since both techniques are well-reported in the surgical literature. In fact, my nephew recently ruptured his tendon and saw an Orthopaedist near his home in Massachussets, who advised repair using a DOUBLE INCISION TECHNIQUE.

The double incison technique has been more utilized for years to avoid the complication rate of performing repair through one incision. Occasionally heterotopic bone formation may complicate the outcome by resulting in loss of forearm rotation. As advances in repair techniques have evolved, so too has the popularity of SINGLE INCISION techniques increased.

Although I was trained during my residency and fellowship using the two-incison technique, my preference over the past 15 years has been the SINGLE INCISION TECHNIQUE for a couple of reasons. First, one less incision is required--and for many patients, this is appealing. Secondly, with contemporary fixation options---I use an endobutton and biotenodesis screw--immobilization is really not required after 7-10 days-----which is also appealing to patients.

And so, I recommended to my nephew that he ask his Doctor why he preferred the two-incision technique, how many he performs in a given year, and what his outcomes have been. I advocated considering getting a second opinion given my own preference for a SINGLE INCISION repair.

This prompted me to review the surgical literature!!  Although we regard published papers as "evidence"---and they certainly are that--my bias was tempered by the absence of any compelling proof that there is  any difference between these two alternatives---at least based on what has been published.

Complication rate and functional outcome were similar. The only caveat is that the literature does not clearly distinguish between postoperative protocols----and it's my contention that the two incision technique may necessitate a longer period of immobilization after surgery in oprder to ensure tendon healing.

The take home message here, as in other situatiuons when several potential techniques exist for addressing the same problem, and dispite my preferences and bias which are the basis for my use of the SINGLE INCISION TECHNIQUE---understand why your Dr recommends their technique. Ask what their bias is, and whether it is because of their experience and results---as is the basis for my preference----or whether the Evidence clearly supports one procedure over another. And, understand the outcome that your surgeon has observed so that your expectations for after surgery are in keeping with their expecatations!

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