Essential Surgical Techniques
Surgical Technique for Single and Double-Incision Method of Acute Distal Biceps Tendon Repair
Ruby Grewal, MD, MSc, FRCSC; George S. Athwal, MD, FRCSC; Joy C. MacDermid, BScPT, MSc, PhD; Kenneth J. Faber, MD, MHPE, FRCSC; Darren S. Drosdowech, MD, FRCSC; Graham J.W. King, MD, MSc, FRCSC

Overview

Introduction 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.

Results 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 Indications

Contraindications

Pitfalls & Challenges

Introduction

Distal biceps tendon ruptures can be repaired with either a single or a double-incision technique. Both techniques have been proven to be safe and reliable, and they offer similar outcomes with respect to recovery rates and final results. Traditionally, the single-incision technique required a larger anterior exposure, placing the radial nerve at risk; this led Boyd and Anderson to describe an alternative, double-incision technique1 …


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