Distal Biceps Tendon Reconstruction with Achilles Tendon Allograft: A Case-Series

Abstract

Background: Chronic, complete ruptures of the distal biceps tendon are often difficult to surgically repair due to significant fibrosis and retraction. The use of a graft is recommended, with recent literature suggesting that an Achilles tendon allograft leads to superior clinical outcomes. The purpose of this study is to present the surgical technique and retrospectively review the clinical outcomes of a distal biceps reconstruction technique that utilizes an Achilles tendon allograft with an Endobutton bicortical fixation system through a single S-shaped incision. Methods: Seven male patients and eight cases of distal biceps reconstruction with Achilles tendon allograft were identified between January 2017 and March 2022. The mean age was 48.3 ± 8.9 years with a mean time from initial injury to surgery of 6.1 ± 3.8 months. Charts were retrospectively reviewed for patient demographics, procedural technique, preoperative and postoperative evaluation, and complications. Results: The cohort had a mean follow-up of 4.6 ± 2.0 months (range, 1.4-8.2). At the final office visit, full range of motion had returned for all patients except one, who had a persistent 10° extension deficit. Flexion strength had returned to equal preoperative and preinjury gross strength out of 5 (4.7 ± 0.5 preoperatively vs. 4.4 ± 0.5 postoperatively) and supination improved from preoperative strength (2.2 ± 1.1 preoperatively vs. 3.6 ± 1.2 postoperatively). Four out of eight cases resulted in a new neuropraxia identified in postoperative care: two lateral antebrachial cutaneous nerves, one superficial branch of radial nerve, and one ulnar nerve, with insufficient follow-up duration to determine resolution. One patient reported excessive scar formation; otherwise, there were no major complications. Conclusion: Reconstruction of the distal biceps tendon using an Achilles tendon allograft is a technically challenging, yet effective approach for the treatment of complete distal biceps tendon ruptures that are chronic in nature, resulting in an improvement in preoperative disability with few postoperative complications.