Distal Biceps Tendon Repair

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Distal biceps tendon rupture

  • Serious medical condition that increases anesthesia risk
  • Inability of unwillingness of the patient to comply with postoperative limitations and rehabilitation program
  • Chronic rupture (relative contraindication because this injury may require additional procedures, such as augmentation with a free autogenous graft)
  • Heavy nonabsorbable suture
  • ¼-inch osteotome
  • Drill and small (2 mm) drill bit
  • Suture passers
  • Tendon carrier
  • Hemostats
  • Biceps brachii muscle: powerful supinator and elbow flexor
    • Two proximal attachments: short head on the coracoid process and long head on the superior glenoid fossa
    • One distal attachment: radial tuberosity
    • Innervation: musculocutaneous nerve
  • Neurovascular structures of the antecubital fossa:
    • Lateral antebrachial cutaneous nerve: between the biceps and brachialis, passes laterally in the subcutaneous tissues, supplies sensation to the lateral forearm
    • Median nerve, brachial artery, and brachial vein pass medial to the biceps tendon.
    • Brachial artery divides into the radial and ulnar arteries at the level of the radial head.
    • Radial nerve: passes laterally, deep branch through the supinator muscle to become the posterior interosseous nerve lateral to the radius

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  • Place the arm in a posterior plaster splint with the elbow flexed to 110 degrees and the forearm in moderate supination.
  • Remove sutures at 2 weeks and apply a new splint for an additional 3 to 4 weeks.
  • Progress range of motion to full by 6 to 8 weeks after surgery.
  • Delay full return to activity until at least 12 weeks.
  • Infection
  • Neurovascular injury
  • Repair failure
  • Heterotopic ossification or synostosis

The Boyd and Anderson two-incision technique for distal biceps repair provides a relatively safe and reliable method for reattaching the tendon. It restores the important supination power of the elbow and allows functional return to activity.

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