Treatment of distal biceps tendon ruptures.

Distal biceps tendon rupture is an injury typically reported in the dominant extremity of middle-aged men. Clinical findings are the mainstay of diagnosis, but magnetic resonance imaging or ultrasound imaging can provide additional diagnostic information. Anterior 1- or 2-incision repairs are commonly used. Various fixation techniques have been reported, all with comparable biomechanical results and clinical outcomes. Complication rates are lower in patients treated closer to time of injury. Tendon retraction associated with chronic ruptures can present a difficult surgical problem. Advanced soft-tissue imaging adds helpful information about the level of biceps tendon retraction and possible reparability. When the tendon can be reapproximated safely at less than 45 degrees to 90 degrees of elbow flexion, then primary repair may be performed. When reapproximation is not possible, options are reconstruction and tenodesis. Reconstruction performed through 1 or 2 incisions with either allograft or autograft has successfully restored both motion and power.