APEX Elbow Mastering Surgical Techniques for Clinical Success-Acute Distal Biceps Ruptures

Acute Distal Biceps Ruptures - Dual Incisions or Posterior Approach

Video Transcription

Video Summary

This lecture discusses distal biceps tendon tears and the surgical dual approach for repair, focusing on restoring terminal supination strength. Two main repair techniques are highlighted: onlay (tendon on top of bone) and inlay (tendon within bone). An anatomical onlay repair at the native radial tuberosity footprint preserves the cam effect of the radial protuberance, maximizing supination torque. Anterior repairs often miss this footprint, causing significant supination weakness. External rotation of the tendon during repair prevents impingement. Posterior approaches via an extensor carpi ulnaris (ECU) split better access the native footprint and protect nerves, reducing complications compared to anterior approaches. A two-hole, two-button fixation provides strong, anatomic tendon reattachment. Heterotopic ossification risk is lower with posterior approach and postoperative use of anti-inflammatory medications like indomethacin. Accurate tendon placement at the anatomic footprint is the critical factor for restoring native function and improving outcomes in distal biceps tendon repair.

Asset Caption

Christopher C Schmidt, MD

Keywords

distal biceps tendon tear

dual surgical approach

onlay repair technique

radial tuberosity footprint

posterior ECU split approach

heterotopic ossification prevention