Distal Biceps Repair
Patient Selection
Single traumatic “pop” at time of rupture
Aching pain persisting weeks to months
Grossly palpable and visible signs of proximal retraction of the distal biceps
Weakness with elbow flexion and forearm supination
The O’Driscoll hook test can identify absence of the distal insertion; elbow is at 90° flexion with forearm supinated; if distal tendon is intact, examiner can hook finger underneath the tendon
Indications
Acute, complete rupture of distal biceps tendon
Typically seen in middle-aged active men
Failure of 3 to 4 weeks of physical therapy (PT), if patient does not initially want surgery
Contraindications
Partial ruptures
If pain continues despite physical therapy and weakness is unacceptable, then surgical repair is performed
Preoperative Imaging
Figure 1Sagittal MRI shows a torn biceps tendon (arrow) retracted 6 cm.
AP and lateral radiographs
MRI (Figure 1)
May help confirm diagnosis or be of use in the case of partial ruptures
Can identify amount of tendon retraction for preoperative planning
 | Video 8.1 Cadaveric Demonstration: Distal Biceps Tendon Fixation. Anthony A. Romeo, MD, Augustus D. Mazzocca, MS, MD (32 min) |
Procedure
Special Instruments/Equipment/Implants
Author preference: Cortical button with interference screw fixation using an 8 mm × 12 mm interference screw
Other options include bone tunnels, suture anchors, a cortical button, or interference screw alone
Surgical Technique
Anatomic technique—Reinsert the tendon to the radial tuberosity
Nonanatomic technique—Suture biceps tendon to brachialis
 | Video 8.2 Distal Biceps Repair. Steven M. Andelman, MD, Anthony A. Romeo, MD, Augustus D. Mazzocca, MS, MD, Robert A. Arciero, MD (6 min) |
Two-Incision Approach
Figure 2Illustrations demonstrate the two-incision approach for distal biceps repair. A, With the arm supinated, a clamp is advanced along the medial border of the radial tuberosity to the dorsolateral aspect of the proximal forearm. B, Exposure of the ulna should be avoided to reduce the risk of heterotopic ossification.
Historical approach is an anterior S-shaped incision, through which the tendon is identified, and a posterolateral incision, through which the lateral epicondylar extensor muscle group is detached from the radial tuberosity
Current incisions include the S incision, horizontal incision, and vertical incision
Make a transverse incision 2 to 4 cm long over anterior elbow
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