Anatomy of the Distal Biceps Brachii Tendon and Its Clinical Relevance

Abstract

Rupture of the distal biceps tendon is a relatively uncommon injury. Different methods have been described for its surgical repair. According to published reports, current surgical techniques result in decreased strength and endurance of upper extremity functions requiring supination and flexion. In our anatomic study of 74 cadaveric elbows, we observed that the distal biceps tendon spirals in a predictable manner and has a complex fiber arrangement. Successful surgical repair of a ruptured distal biceps tendon should be predicated on an understanding of the tendon anatomy, but current surgical techniques do not take into account the salient anatomic features of the distal biceps tendon. To our knowledge, there is no description in the surgical literature of the fiber arrangement of the distal biceps tendon. We provide a basis for developing an anatomically accurate protocol for repairing a distal biceps tendon rupture.

Morphology of the bicipital aponeurosis: a cadaveric study

“…Successful surgical repair of a ruptured distal biceps tendon should be contemplated on a thorough understanding of the anatomy of BA and the tendon. Those surgical techniques which do not take into account the anatomy of aponeurosis and distal biceps tendon lead to loss of range of supination, even a decrease in supination greater than 30° in some patients [5,9]. Bain et al [2] and Bell et al [3] have also reported decrease in strength of supination.…”

“…Chew and Giuffre [4] have mentioned that in the complete tear of the biceps tendon, there is discontinuity and if the BA is also ruptured, there is retraction of the tendon. Non-consideration of anatomic details during repair of these ruptures has been reported to have a significant loss of range of supination which might be due to improper fixation of the BA to the repaired tendon [9]. There is no unanimity in the reviewed literature, concerning the role of the BA in the actions of the biceps brachii.…”

Lesão do bíceps distal: avaliação funcional e dinamometria digital da sua reconstrução pela técnica da minidupla via de mayo

“…The treatment for ruptures of the distal tendon on the biceps can be conservative or surgical . With conservative treatment, the loss of muscle strength for supination is maintained (1,2,8,18) . This suggests that surgical repair might be more indicated for athletes, patients with high functional demands and patients who do not accept loss of strength or esthetic deformity (1,4,7) .…”

“…Loss of movement is not a significant characteristic, but loss of strength occurs, particularly for performing supination of the forearm, with a deficit of around 40%. Since the loss of flexion strength is around 30%, it may go unnoticed by the patient (2)(3)(4)8,12,13,18) . The diagnosis is clinical, and the hypothesis of the lesion can be confirmed by means of imaging examinations (ultrasonography and magnetic resonance) .…”

“…In 1961, Boyd and Anderson (3) introduced a double-incision technique in order to minimize these risks. However, their technique may have the complication of proximal radioulnar synostosis (3,4,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)20,21) . More recently, Morrey et al (22) modified the original technique using a mini-double route, thereby achieving lower complication rates (13)(14)(15)20) .…”