Management of acute distal bicepsbrachii tendon ruptures: single versus two incision technique

Abstract

Disruption of the distal tendon of the biceps brachii is an uncommon injury that is now being recognized more frequently. Patients treated without surgery cannot be assured restoration of full function of the elbow tendon. Anatomic reinsertion of the distal biceps tendon portends a good prognosis if performed within 3 weeks from the time of injury. Reinsertion of the distal biceps tendon may be performed using a single anterior incision or by adding a posterior incision. The benefit of the anterior incision is the simple approach and a reduced risk of proximal radioulnar synostosis. The disadvantage of the single incision technique is that it places the radial nerve at risk for injury. Techniques to help avoid injury to the radial nerve using the single incision technique are to perform an extensile anterior approach, carefully visualize the radial nerve, limit traction placed on the nerve, and release the arcade of Frohse. The two incision technique has the advantage of virtually eliminating the likelihood of injury to the radial nerve. However, there has been a report of proximal radioulnar synostosis complicating the repair using the two incision technique. A limited muscle-splitting modification of this technique may help eliminate this complication by eliminating subperiosteal exposure of the ulna