Scientific Articles   |    
Surgical Technique for Single and Double-Incision Method of Acute Distal Biceps Tendon Repair
Ruby Grewal, MD, MSc, FRCSC1; George S. Athwal, MD, FRCSC1; Joy C. MacDermid, BScPT, MSc, PhD1; Kenneth J. Faber, MD, MHPE, FRCSC1; Darren S. Drosdowech, MD, FRCSC1; Graham J.W. King, MD, MSc, FRCSC1
1 Hand and Upper Limb Center, St. Joseph’s Health Care, Division of Orthopedic Surgery, University of Western Ontario, 268 Grosvenor Street, London, ON N6A 4L6, Canada. E-mail address for R. Grewal: rgrewa@uwo.ca. E-mail address for G.S. Athwal: gathwal@uwo.ca. E-mail address for J.C. MacDermid: joy.macdermid@sjhc.london.on.ca. E-mail address for K.J. Faber: kjfaber@uwo.ca. E-mail address for D.S. Drosdowech: ddros@mac.com. E-mail address for G.J.W. King: gking@uwo.ca
View Disclosures and Other Information
  • Disclosure statement for author(s): PDF

Based on an original article: J Bone Joint Surg Am. 2012 Jul 3;94(13):1166-74.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2012 Nov 28;2(4):e22 1-17. doi: 10.2106/JBJS.ST.L.00018
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case



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

Figures in this Article

    First Page Preview

    View Large
    First page PDF preview
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS Essential Surgical Techniques?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    Provided by:
    Essential Surgical Techniques
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    W. Virginia - Charleston Area Medical Center
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina
    New York - Icahn School of Medicine at Mount Sinai
    District of Columbia (DC) - Children's National Medical Center