APEX Elbow Mastering Surgical Techniques for Clinical Success-Distal Biceps Tears

Video Transcription

Video Summary

The speaker reviews distal biceps tendon rupture/repair, emphasizing that surgery is performed not only to correct the “reverse Popeye” deformity but also to restore terminal supination, a subtler functional deficit. Key controllable surgical variables include the tendon’s anatomic attachment site (onlay vs inlay), tendon rotation, and initial (“time zero”) fixation strength. The distal biceps has distinct short- and long-head insertions positioned posterior to the radial tuberosity “protuberance,” which acts as a cam for supination. Multiple studies show that anterior placement of the tendon (or drilling that removes the protuberance) reduces terminal supination strength; therefore, repairs should recreate the native posterior footprint, favoring an onlay technique. External tendon rotation does not change mechanics but may cause tendon “bunching” and clicking, potentially contributing to early failure.<br /><br />Cases include: (1) a partial tear/isolated short-head rupture (noting ~9% have a bifid tendon) repaired via a posterior approach; (2) an FBI agent with an intact but anteriorly malpositioned repair causing loss of active supination, successfully revised to a posterior anatomic position; (3) a chronic failed reconstruction revised with Achilles allograft and strong two–cortical button fixation to restore supination torque; and (4) radioulnar synostosis after a two-incision approach requiring takedown.<br /><br />Rehab: splint ~2 weeks, gradual motion, strengthening around 6 weeks, full activity ~3 months. Potential failure mechanisms discussed include impingement/clicking and suture abrasion at sharp drill holes.

Asset Caption

Moderator: Chris C. Schmidt, M.D.

Keywords

distal biceps tendon rupture

anatomic distal biceps repair

terminal supination strength

radial tuberosity protuberance cam effect

onlay versus inlay fixation

cortical button two-cortex fixation

radioulnar synostosis complication