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Background: Distal biceps tendon repair to the radial tuberosity can be conducted by means of an interference screw in combination with a transosseous button. Bioabsorbable interference screws have been associated with complications such as severe osteolytic reactions. We questioned whether patients with a distal biceps tendon repair with bioabsorbable poly-L-lactide (PLLA) screws had different functional, clinical, and radiologic outcome than patients with nonabsorbable poly-ether ether ketone (PEEK) screws. Methods: Between 2010 and 2014, 23 patients with an acute distal biceps tendon rupture were treated with reinsertion of the distal biceps tendon in a bone tunnel at the radial tuberosity through a single anterior incision using a transosseous button combined with an interference screw. A PLLA screw was used in 12 patients and a PEEK screw in 11 patients. All patients were retrospectively evaluated with a minimal follow-up of 1 year clinically and by means of the visual analog scale for pain, Mayo Elbow Performance Score, and Disabilities of Arm, Shoulder and Hand Outcome Measure score. Bone tunnel volume was measured with computed tomography segmentation. Results: Elbow mobility and arm and forearm circumference were symmetric for all patients. The visual analog scale for pain was 0.2 in the PLLA group and 0.7 in the PEEK group. The Disabilities of Arm, Shoulder and Hand score and Mayo Elbow Performance Score were 5.4 and 98.7 in the PLLA group vs. 3.1 and 95.9 in the PEEK group. Bone tunnel enlargement of 43% in the PLLA and 38% in the PEEK group was noted. Conclusions: Clinical and functional outcome at more than 1 year after distal biceps tendon repair was excellent in both groups. Bone tunnel widening occurred in all patients.

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The optimal treatment for isolated posterior cruciate ligament (PCL) injuries is an ongoing debate among orthopaedic surgeons. Improved understanding of the anatomy and biomechanics of the PCL, advances in surgical techniques and an ever more active population, has led to a trend towards surgical management. However, good-quality evidence to support this trend is lacking. Our objective was to evaluate the evidence for different treatment strategies (including surgical and non-operative management) of isolated PCL injuries. Using Pubmed, EMBASE and Cochrane databases we conducted a systematic review of studies investigating the treatment of PCL injuries published until July 2020. Quality assessment was performed with the Cochrane risk of bias tool (level I), the Newcastle-Ottowa Scale (level II-III) and the National Institute of Health quality assessment tool (level IV). Clinical outcome measures included residual instability, return to sports, patient reported outcome measures, subsequent articular degeneration and complications. Twenty-seven studies (23 case-series, 2 case-control, 1 cohort study and 1 randomized controlled trial (RCT)) including 5,197 patients (5,199 knees) with a mean age of 29.5 ± 3.6 years (range, 15-68) fulfilled the study requirements. Significantly less residual instability was found after posterior cruciate ligament reconstruction (PCLR) compared to non-operative management (3.43 vs 5.47 mm, CI: 1.84 to 2.23, p<0.001). Both treatment modalities yielded satisfying functional outcomes and a high return to sports (64-77%, mean: 70.3, CI: 67.8-72.2). Osteoarthritis occurred less frequently following PCLR (21.5 vs 44.1%, p<0.001) In the absence of level I RCTs, our systematic review suggests that surgical management for selected isolated PCL injuries is a reasonable option to consider, especially when the surgeon aims at minimizing residual instability and/or secondary osteoarthritis. Keywords: systematic review, posterior cruciate ligament, reconstruction, non-operative treatment, PCL injury, PCLR