AANA Elbow Arthroscopy - August 2024-Acute Distal Biceps Ruptures

Acute Distal Biceps Ruptures - Dual Incisions or Posterior Approach

Video Transcription

Video Summary

This talk focuses on distal biceps tendon tears and repairs, emphasizing restoring native supination strength through anatomic footprint restoration. Key findings include that repairing the tendon at its original footprint on the radial tuberosity preserves terminal supination torque, while anterior or inlay repairs reduce strength by disturbing the tendon’s cam effect. An onlay repair preserving the radial protuberance is mechanically superior to inlay repairs. Tendon external rotation during repair avoids bulky, impinging repairs without affecting strength. The strongest repair method is a two-button near-cortical, double-loaded suture technique performed via a posterior muscle-splitting approach through the extensor carpi ulnaris, which reliably accesses the native footprint while minimizing nerve injury risk. Avoiding the anterior approach reduces suboptimal anterior tendon placements seen in 90% of cases, which correlate with impaired supination. Use of indomethacin postoperatively may reduce heterotopic ossification, though evidence remains inconclusive. Overall, anatomic, onlay, posterior approach repairs yield superior functional outcomes in distal biceps tendon reconstruction.

Keywords

distal biceps tendon tear

anatomic footprint restoration

supination strength

onlay repair technique

posterior muscle-splitting approach

two-button suture method