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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 uncommon. Ruptures usually result from a single traumatic event with sudden eccentric contraction while the elbow is in a flexed position. 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. Surgical treatment is indicated for most patients with a complete distal biceps tendon rupture, whereas nonsurgical treatment is reserved for elderly, low-demand patients and patients who are not medically fit for surgery. This video demonstrates the two-incision semitendinosus allograft technique during distal biceps tendon reconstruction. Methods: The video discusses the case presentation of a 41-year-old man who presented 2 months after a lifting accident, which involved hyperextension of the right elbow and resulted immediate pain, swelling, and weakness. On physical examination, the patient had full range of motion; however, a retracted biceps was observed, the hook test was positive, and tenderness to palpation was present over the distal biceps. Radiographs confirmed no acute fracture; however, MRI confirmed a complete distal biceps tendon tear. This video demonstrates the two-incision technique for distal biceps reconstruction. Results: The elbow was splinted at 90° in slight supination for 4 weeks postoperatively. A hinged elbow brace with a 30° to 40° extension stop was then used for 3 to 4 weeks. Physical therapy was initiated at 6 to 8 weeks postoperatively, with biceps strengthening initiated at 10 to 12 weeks postoperatively. The patient returned to sports activity and manual work after 6 to 9 months of continued improvement. Conclusion: Although distal biceps tendon ruptures are uncommon injuries, semitendinosus allograft reconstruction may result in promising outcomes. Studies have reported that patients who undergo allograft reconstruction for the management of a chronic distal biceps rupture have normal range of motion and strength, with no significant difference in flexion or supination endurance between affected and unaffected limbs. Cosmetic deformity may occur; however, patients report the deformity as acceptable and the surgery a success.

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