Anatomy, Biomechanics, and Pathology of the Distal Biceps Tendon

Abstract

Distal biceps tendon ruptures occur in 3%-12% of M. biceps brachii injuries. The most frequent mechanism of injury is an eccentric loading force against the flexed elbow. Men are at a higher risk of injury with the dominant arm mainly involved. Furthermore, weight training and nicotine and anabolic steroid abuse are associated with distal biceps tendon ruptures. For anatomical reconstruction, a standard surgical approach has not been established. Two-point fixation restores the native footprint more closely compared to single-point fixation, which might be biomechanically inferior. A hypovascularized zone and mechanical impingement are supposed to be predisposing for distal biceps ruptures and are discussed as 2 possible causes of distal biceps tendon pathology. This article presents anatomical conditions with 2 distinct and functional bundles of the distal biceps tendon and their insertion to the radial tuberosity. Potential structures at risk are highlighted. Native biomechanical properties and current principles of repair techniques of the distal biceps tendon are mentioned.