Distal Biceps Tendon Injuries: Treatment of Partial and Complete Tears

Abstract

Most distal bicep tendon ruptures occur in middle-aged men (fourth decade). The most common mechanism of distal biceps tears is sudden eccentric loading of an actively contracting biceps (lifting or pushing heavy load) resulting in tendon failure usually at the tendon-bone junction. The indications for surgical reconstruction, type of surgical approach, and the fixation techniques for the distal biceps tendon are areas of ongoing debate. Nonoperative treatment results in modest loss of elbow strength in supination. Primary repair of a complete distal biceps tear in acute stages results in a predictable recovery of elbow supination and flexion strength but carries a risk of heterotopic ossification and neurologic injury. Heterotopic ossification is more commonly described with a 2-incision technique. Nerve palsy is common with single-incision approach and is usually transient and self-limiting. Primary repair in a chronic distal biceps tear is difficult and often requires augmentation with an autograft or allograft. Biomechanical cadaveric studies demonstrate that cortical button provides a consistent higher load to failure compared with other techniques for fixation of distal biceps. Our preferred method for the repair of acute distal biceps tendon tear is a single anterior skin incision technique with hybrid fixation, which combines a cortical button using a tension slide technique and interference screw fixation. Improvement in fixation techniques of the torn tendon to bone allows for early active range of motion and is our preferred mode of rehabilitation.