Distal biceps tendon ruptures can be repaired with either a single or a double-incision technique.
Step 1 (Single-Incision Technique): Surgical Exposure and Preparation of the Tendon
Through a single anterior incision, identify the tendon and debride the distal degenerated portion.
Step 2 (Single-Incision Technique): Preparation of the Radius
Expose the bicipital tuberosity and prepare the bone for insertion of suture anchors.
Step 3 (Single-Incision Technique): Tendon Reattachment
Suture the tendon with a reduction knot technique that allows for anatomic tendon apposition to bone.
Step 1 (Double-Incision Technique): Surgical Exposure and Preparation of the Tendon
Through a small anterior incision retrieve the tendon, debride the distal degenerated portion of the tendon, and place your sutures.
Step 2 (Double-Incision Technique): Preparation of the Radius
Through a second posterolateral incision, expose the biceps tuberosity and, using a burr, create a trough for the tendon.
Step 3 (Double-Incision Technique): Tendon Reattachment
Pass the sutures through the transosseous tunnels and tension the sutures, allowing the biceps tendon to be pulled into the trough created in the bicipital tuberosity, and then tie the sutures.
Step 4: Postoperative Care
Assess tension across the repaired tendon, initiate prophylaxis against heterotopic ossification, and begin rehabilitation.
We recently conducted a prospective randomized controlled trial at our center comparing the single and double-incision techniques for the repair of acute distal biceps tendon ruptures11.
What to Watch For
Pitfalls & Challenges