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Distal Biceps Tendon Reconstruction - Two-incision Technique

March 01, 2017

Contributors: Amos Dai, BS; Daniel James Kaplan, BA; Andrew S Rokito, MD; Mina Abdelshahed, MD; Mina Abdelshahed, MD

Purpose: Distal biceps tendon ruptures are an uncommon injury. Ruptures usually occur from a single traumatic event with sudden eccentric contraction while the elbow is flexed. Patient-reported symptoms include sudden sharp pain and an audible pop at the onset of injury as well as ecchymosis pain and swelling about the antecubital fossa. Most patients with complete distal bicep ruptures are indicated for surgical management, while nonoperative management is reserved for elderly, low demand patients, and patients who are not medically fit for surgery. This video demonstrates the use of a two-incision semitendinosus allograft technique during distal biceps tendon reconstruction. Methods: In this video, we present a 41-year-old male who presented two months after a lifting accident, hyperextending the right elbow and having immediate pain, swelling, and weakness. Upon physical examination, the patient had full range of motion (ROM), but was noted to have a retracted biceps, a positive hook test, and tenderness to palpation over his distal biceps. X-rays confirmed no acute fracture, but MRI did confirm a complete tear of the distal biceps tendon. This video demonstrates the surgical technique of a distal biceps reconstruction using a two-incision technique. Results: The patient was instructed to splint the elbow at 90 degrees with slight supination for four weeks, followed by a hinged elbow brace with 30-40 degree extension stop for three to four weeks. Physical therapy begins at the six to eight week mark, with biceps strengthening at 10-12 weeks. After six to nine months of continued improvement, the patient can expect to return to sports and manual work. Conclusion: Although distal biceps tendon ruptures are uncommon injuries for patients, the semitendinosus allograft reconstruction technique can provide an operative intervention with promising outcomes. Related studies showed patients who required an allograft reconstruction for chronic distal biceps ruptures to have normal ROM and strength, with no significant difference in endurance between affected and unaffected limbs for flexion or supination. One complication may include cosmetic deformity, but patients report the deformity as acceptable and the surgery a success.

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