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Chapter 09 Video 1: Anatomic Distal Biceps Repair: Two Intramedullary Buttons or Modified Trough Technique and Chronic Distal Biceps Repair with Achilles Tendon Allograft

July 02, 2016

Contributors: Christopher C Schmidt, MD

This video demonstrates distal biceps tendon repair by two intramedullary buttons and by a modified trough technique. Tips for retrieving the tendon are discussed. The long and short heads are distinguished, and the lacertus fibrosis is generally connected to the short head. Modified Krakow whipstiches are placed in the distal ends of each head. The radial tuberosity is exposed posteriorly, and holes are drilled for each head. The tendon is placed from front to back along the bicipital tunnel, and buttons are placed on the docking suture limbs. The long head tendon and button are inserted in the proximal hole, and the short head and button into the distal hole.  The buttons are flipped and lock against the inner surface of the near cortex, and this is confirmed fluoroscopically. The tendon is then sutured into place and the joint tested for impingement. Trough repair is an alternative that many surgeons prefer.  The placement of the trough is demonstrated to be posterior to the apex of the tuberosity. A distal biceps repair with achilles tendon allograft is next demonstrated on a patient with a history of two failed distal biceps repairs, supination weakness, and a reverse popeye sign. The relationship between supination angle and strength are discussed and demonstrated. The musculotendinous junction is reconstructed with the allograft divided into three slips. These are fixed with intramedullary buttons. The patient is shown postoperatively with no popeye sign, and the vast improvement in supination angle versus strength is demonstrated and discussed.

Results for "Advanced Reconstruction: Elbow 2"