Treatment of Distal Biceps Tendon Ruptures Using Biceps-to-Brachialis Tenodesis

Abstract

Anatomic repair of a ruptured distal biceps tendon can lead to restoration of good to excellent function, but there are many reports of complications that substantially compromise function. Loss of forearm rotation (pronation/supination) from errors in placement of the tendon attachment, bunching of the repair, tendon adhesion, or heterotopic ossification with incomplete or complete radioulnar synostosis is frequently described. Less commonly reported, but more devastating, are injuries to the radial nerve. The goals of distal biceps repair are reduction of pain and restoration of strength without loss of mobility. As the need for supination power and endurance provided by the biceps can be accommodated by the supinator, tenodesis to the brachialis offers another option for restoring elbow flexion function while avoiding the risks of the complications listed above. This is not a new idea, but previous technical descriptions of the procedure have provided little detail. We present a detailed description of our surgical technique and postoperative management and describe a case series of 5 patients with short-term follow-up and limited clinical outcomes. All patients had relief of their preoperative pain and were satisfied with their procedure. We have not encountered any complications to date and believe that biceps-to-brachialis tenodesis can successfully be used as an alternative to anatomic repair for acute distal biceps ruptures and failed prior repairs.