Distal Biceps Tendon Repair and Reconstruction

Distal biceps tendon ruptures can result in functionally significant loss of supination and flexion strength, as well as decreased resistance to fatigue. Although the diagnosis of distal biceps tendon ruptures remains straightforward, substantial debate continues with regards to surgical indications, pertinent surgical anatomy, single- versus double-incision surgical technique, and fixation options. This review discusses the latest evidence-based literature regarding distal biceps tendon repair/reconstruction including types of tears, demographics, clues for diagnosis, surgical indications, anatomy with special attention to how the distal tendon inserts distally and the relevant tuberosity anatomy (height and cam effect), common reconstruction techniques (single- vs double-incision and single-incision power optimizing cost-effective technique), fixation techniques (bone tunnels, distal biceps button, interference screw, button plus screw), surgical technique pearls, postoperative rehabilitation, postoperative outcomes, as well as the treatment of chronic tears with special reconstruction techniques including Achilles allograft, pedicled latissimus transfer, and the use of a free innervated gracilis.