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Reconstruction of Chronic Distal Biceps Ruptures: Surgical Anatomy and Operative Technique

February 01, 2014

Contributors: Max P. Michalski, MSc; Peter J Millett, MD, MSc; Jared T. Lee, MD; Jared T. Lee, MD

Acute distal biceps ruptures typically can be repaired, thanks to relatively well-preserved anatomy, but surgical treatment of chronic distal biceps ruptures requires extensive exposure, identification of critical anatomic structures, and, often, graft augmentation for tendon reconstruction. The indications for surgical treatment of a chronic rupture are pain, cramping, decreased endurance, and weakness in supination and elbow flexion. Considering the altered anatomic relationships in cases of chronic tendon ruptures, a review of the anatomy highlights the veins, arteries, and nerves at risk for injury during surgical dissection. A literature review highlighting surgical treatment options is discussed, including primary repair, tenodesis to the brachialis, and reconstruction using graft. We present a video surgical demonstration of a 50-year-old man who ruptured his distal biceps tendon 6 years previously and presents with symptoms of pain, cramping, and weakness. Surgical dissection is performed, the pertinent anatomy is shown, and distal biceps tendon reconstruction with allograft is demonstrated. Our rehabilitation protocol is described, with the goals of full extension by postoperative week 6 and strengthening at postoperative month 3. At follow-up, the patient had minimal pain and an increase in sports activity level with improvements in his Single Assessment Numeric Evaluation, Quick-DASH, and ASES outcome scores. Good outcomes can be expected with surgical treatment of chronic distal biceps ruptures when appropriate indications for surgery are met, the pertinent surgical anatomy is recognized, and appropriate surgical techniques are employed.

Results for "Shoulder: Biceps/Labrum"

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