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Repair Surgery for Distal Biceps Tendon Rupture

NYU Langone orthopedic surgeons are internationally known experts in distal biceps repair surgery and offer a full range of approaches for this injury. They typically offer distal biceps repair surgery to people who are active, perform physical work, or who want to return to sports.

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During a distal biceps repair your doctor reattaches the torn biceps tendon to the radius, which is one of the bones in the lower arm. If there is a delay in getting surgery, your surgeon may recommend distal biceps tendon reconstruction surgery. While many factors influence the decision to perform distal biceps reconstruction, the procedure is usually required in chronic cases, in which the injury has occurred four to six weeks ago. At this point the tendon has started to atrophy and scar, making it difficult to reattach it directly to where it inserts in the bone without creating tension.

The procedure should be performed as soon as possible after injury to avoid further tissue damage. Repair surgery typically requires a comprehensive rehabilitation program to restore range of motion and strength in your arm.

Single-Incision Repair

For this approach, surgeons make a single incision along the inside of the elbow. They locate the end of the biceps tendon and remove any damaged tissue.

They then drill a small hole through the top of the radius and size the end of the tendon to fit the width of this hole. Surgeons suture the tendon to a small surgical button that they pass through the hole. The button sits on the opposite side of the radius, anchoring the tendon. Surgeons further fix the biceps tendon to the bone with a plastic screw or another fixation device and then close the incision with sutures. Other ways to reattach the tendon involve the use of suture anchors, which also allow the tendon to be reattached directly to bone.

Double-Incision Repair

Surgeons may perform biceps tendon repair using two incisions. The decision to proceed with a two-incision rather than a single-incision repair is based on what your surgeon prefers: both techniques have similar excellent outcomes. They first make a cut across the skin crease in the inside elbow and locate the end of the severed tendon. They clean the tendon and pass it between the ulna and radius, the two bones that make up the forearm, below the elbow.

Surgeons make the second incision on the outside of the arm below the elbow to pull the tendon through. They then attach it to the radius bone by using a fixation technique, such as passing high-strength sutures through tiny holes drilled in the bone. Both incisions are closed with sutures.

After Distal Biceps Tendon Repair Surgery

A splint and sling are worn for two weeks after surgery, followed by a hinged elbow brace for an additional four weeks. This method allows for a gradual increase in motion. During this time, you begin physical therapy.

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