Abstract
Rupture of the distal biceps tendon from its insertion on the bicipital tuberosity of the radius results in decreased forearm supination and flexion strength and range of motion. Due to this, primary repair of distal biceps ruptures are generally indicated in healthy and active individuals. Acute ruptures of the distal biceps tendon, defined as those diagnosed within 4 weeks of the index injury, tend to be amenable to “mini-incision” surgical repair. Both one- and two-mini-incision techniques have been well described in the literature, with each approach having its own unique drawbacks and benefits. Furthermore, there are multiple means by which to secure the distal biceps tendon to its insertion point on the radial tuberosity including suture fixation through transosseous tunnels, suture anchor fixation, interference screw fixation, and usage of cortical buttons. There has been significant debate in the literature regarding both the “best” approach and “strongest” method for fixation. This chapter will present an overview of acute ruptures of the distal biceps tendon and, in doing so, will describe in detail both the one-incision and two-incision techniques. This chapter will also review the current literature regarding outcomes for both the one- and two-incision techniques as well as the various methods for tendon reattachment and fixation.
Similar content being viewed by others
References
Safran MR, Graham SM. Distal biceps tendon ruptures: incidence, demographics, and the effect of smoking. Clin Orthop Relat Res. 2002;404:275–83.
Kron SD, Satinsky VP. Avulsion of the distal biceps brachii tendon. Am J Surg. 1954;88(4):657–9.
Baker BE, Bierwagen D. Rupture of the distal tendon of the biceps brachii. Operative versus non-operative treatment. J Bone Joint Surg Am. 1985;67(3):414–7.
D’Alessandro DF, Shields Jr CL, Tibone JE, Chandler RW. Repair of distal biceps tendon ruptures in athletes. Am J Sports Med. 1993;21(1):114–9.
Morrey BF, Askew LJ, An KN, Dobyns JH. Rupture of the distal tendon of the biceps brachii. A biomechanical study. J Bone Joint Surg Am. 1985;67(3):418–21.
Ramsey ML. Distal biceps tendon injuries: diagnosis and management. J Am Acad Orthop Surg. 1999;7(3):199–207.
Rantanen J, Orava S. Rupture of the distal biceps tendon. A report of 19 patients treated with anatomic reinsertion, and a meta-analysis of 147 cases found in the literature. Am J Sports Med. 1999;27(2):128–32.
Bourne MH, Morrey BF. Partial rupture of the distal biceps tendon. Clin Orthop Relat Res. 1991;271:143–8.
Kelly EW, Steinmann S, O’Driscoll SW. Surgical treatment of partial distal biceps tendon ruptures through a single posterior incision. J Shoulder Elbow Surg. 2003;12(5):456–61.
Norman WH. Repair of avulsion of insertion of biceps brachii tendon. Clin Orthop Relat Res. 1985;193:189–94.
Rokito AS, McLaughlin JA, Gallagher MA, Zuckerman JD. Partial rupture of the distal biceps tendon. J Shoulder Elbow Surg. 1996;5(1):73–5.
Frazier MS, Boardman MJ, Westland M, Imbriglia JE. Surgical treatment of partial distal biceps tendon ruptures. J Hand Surg Am. 2010;35(7):1111–4.
Schamblin ML, Safran MR. Injury of the distal biceps at the musculotendinous junction. J Shoulder Elbow Surg. 2007;16(2):208–12.
Boyd HB, Anderson LD. A method for reinsertion of the distal biceps brachii tendon. J Bone Joint Surg Am. 1961;43:1041–3.
Berlet GC, Johnson JA, Milne AD, Patterson SD, King GJ. Distal biceps brachii tendon repair. An in vitro biomechanical study of tendon reattachment. Am J Sports Med. 1998;26(3):428–32.
Greenberg JA, Fernandez JJ, Wang T, Turner C. EndoButton-assisted repair of distal biceps tendon ruptures. J Shoulder Elbow Surg. 2003;12(5):484–90.
Idler CS, Montgomery III WH, Lindsey DP, Badua PA, Wynne GF, Yerby SA. Distal biceps tendon repair: a biomechanical comparison of intact tendon and 2 repair techniques. Am J Sports Med. 2006;34(6):968–74.
Lemos SE, Ebramzedeh E, Kvitne RS. A new technique: in vitro suture anchor fixation has superior yield strength to bone tunnel fixation for distal biceps tendon repair. Am J Sports Med. 2004;32(2):406–10.
Pereira DS, Kvitne RS, Liang M, Giacobetti FB, Ebramzadeh E. Surgical repair of distal biceps tendon ruptures: a biomechanical comparison of two techniques. Am J Sports Med. 2002;30(3):432–6.
Recordon JA, Misur PN, Isaksson F, Poon PC. Endobutton versus transosseous suture repair of distal biceps rupture using the two-incision technique: a comparison series. J Shoulder Elbow Surg. 2015;24(6):928–33.
Olsen JR, Shields E, Williams RB, Miller R, Maloney M, Voloshin I. A comparison of cortical button with interference screw versus suture anchor techniques for distal biceps brachii tendon repairs. J Shoulder Elbow Surg. 2014;23(11):1607–11.
Grewal R, Athwal GS, Macdermid JC, et al. Single versus double-incision technique for the repair of acute distal biceps tendon ruptures: a randomized clinical trial. J Bone Joint Surg Am. 2012;94(13):1166–74.
El-Hawary R, Macdermid JC, Faber KJ, Patterson SD, King GJ. Distal biceps tendon repair: comparison of surgical techniques. J Hand Surg (Am). 2003;28(3):496–502.
Kelly EW, Morrey BF, O’Driscoll SW. Complications of repair of the distal biceps tendon with the modified two-incision technique. J Bone Joint Surg Am. 2000;82-A(11):1575–81.
Lintner S, Fischer T. Repair of the distal biceps tendon using suture anchors and an anterior approach. Clin Orthop Relat Res. 1996;322:116–9.
Sotereanos DG, Pierce TD, Varitimidis SE. A simplified method for repair of distal biceps tendon ruptures. J Shoulder Elbow Surg. 2000;9(3):227–33.
Shields E, Olsen JR, Williams RB, Rouse L, Maloney M, Voloshin I. Distal biceps brachii tendon repairs: a single-incision technique using a cortical button with interference screw versus a double-incision technique using suture fixation through bone tunnels. Am J Sports Med. 2015;43(5):1072–6.
Eames MH, Bain GI, Fogg QA, Van Riet RP. Distal biceps tendon anatomy: a cadaveric study. J Bone Joint Surg Am. 2007;89(5):1044–9.
Seiler III JG, Parker LM, Chamberland PD, Sherbourne GM, Carpenter WA. The distal biceps tendon. Two potential mechanisms involved in its rupture: arterial supply and mechanical impingement. J Shoulder Elbow Surg. 1995;4(3):149–56.
Hutchinson HL, Gloystein D, Gillespie M. Distal biceps tendon insertion: an anatomic study. J Shoulder Elbow Surg. 2008;17(2):342–6.
Mazzocca AD, Cohen M, Berkson E, et al. The anatomy of the bicipital tuberosity and distal biceps tendon. J Shoulder Elbow Surg. 2007;16(1):122–7.
Prud’homme-Foster M, Louati H, Pollock JW, Papp S. Proper placement of the distal biceps tendon during repair improves supination strength – a biomechanical analysis. J Shoulder Elbow Surg. 2015;24(4):527–32.
Saldua N, Carney J, Dewing C, Thompson M. The effect of drilling angle on posterior interosseous nerve safety during open and endoscopic anterior single-incision repair of the distal biceps tendon. Arthroscopy. 2008;24(3):305–10.
Louis DS, Hankin FM, Eckenrode JF, Smith PA, Wojtys EM. Distal biceps brachii tendon avulsion. A simplified method of operative repair. Am J Sports Med. 1986;14(3):234–6.
Snir N, Hamula M, Wolfson T, Meislin R, Strauss EJ, Jazrawi LM. Clinical outcomes after chronic distal biceps reconstruction with allografts. Am J Sports Med. 2013;41(10):2288–95.
Morrey ME, Abdel MP, Sanchez-Sotelo J, Morrey BF. Primary repair of retracted distal biceps tendon ruptures in extreme flexion. J Shoulder Elbow Surg. 2014;23(5):679–85.
Kettler M, Lunger J, Kuhn V, Mutschler W, Tingart MJ. Failure strengths in distal biceps tendon repair. Am J Sports Med. 2007;35(9):1544–8.
Spang JT, Weinhold PS, Karas SG. A biomechanical comparison of EndoButton versus suture anchor repair of distal biceps tendon injuries. J Shoulder Elbow Surg. 2006;15(4):509–14.
Siebenlist S, Lenich A, Buchholz A, et al. Biomechanical in vitro validation of intramedullary cortical button fixation for distal biceps tendon repair: a new technique. Am J Sports Med. 2011;39(8):1762–8.
Chavan PR, Duquin TR, Bisson LJ. Repair of the ruptured distal biceps tendon: a systematic review. Am J Sports Med. 2008;36(8):1618–24.
Bisson LJ, De Perio JG, Weber AE, Ehrensberger MT, Buyea C. Is it safe to perform aggressive rehabilitation after distal biceps tendon repair using the modified 2-incision approach? A biomechanical study. Am J Sports Med. 2007;35(12):2045–50.
Cil A, Merten S, Steinmann SP. Immediate active range of motion after modified 2-incision repair in acute distal biceps tendon rupture. Am J Sports Med. 2009;37(1):130–5.
McKee MD, Hirji R, Schemitsch EH, Wild LM, Waddell JP. Patient-oriented functional outcome after repair of distal biceps tendon ruptures using a single-incision technique. J Shoulder Elbow Surg. 2005;14(3):302–6.
Failla JM, Amadio PC, Morrey BF, Beckenbaugh RD. Proximal radioulnar synostosis after repair of distal biceps brachii rupture by the two-incision technique. Report of four cases. Clin Orthop Relat Res. 1990;253:133–6.
Dobbie R. Avulsion of the lower biceps brachii tendon. Analysis of fifty-one previously unreported cases. Am J Surg. 1941;51:662–83.
Friedmann E. Rupture of the distal biceps brachii tendon. Report on 13 cases. JAMA. 1963;184:60–3.
Meherin JH, Kilgore Jr BS. The treatment of ruptures of the distal biceps brachii tendon. Am J Surg. 1960;99:636–40.
Watson JN, Moretti VM, Schwindel L, Hutchinson MR. Repair techniques for acute distal biceps tendon ruptures: a systematic review. J Bone Joint Surg Am. 2014;96(24):2086–90.
Hinchey JW, Aronowitz JG, Sanchez-Sotelo J, Morrey BF. Re-rupture rate of primarily repaired distal biceps tendon injuries. J Shoulder Elbow Surg. 2014;23(6):850–4.
Cusick MC, Cottrell BJ, Cain RA, Mighell MA. Low incidence of tendon rerupture after distal biceps repair by cortical button and interference screw. J Shoulder Elbow Surg. 2014;23(10):1532–6.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer International Publishing Switzerland
About this entry
Cite this entry
Andelman, S.M., Parsons, B.O. (2015). Mini-incision Distal Biceps Tendon Repair. In: Scuderi, G., Tria, A. (eds) Minimally Invasive Surgery in Orthopedics. Springer, Cham. https://doi.org/10.1007/978-3-319-15206-6_30-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-15206-6_30-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Online ISBN: 978-3-319-15206-6
eBook Packages: Springer Reference MedicineReference Module Medicine