Surgical Technique for Single and Double-Incision Method of Acute Distal Biceps Tendon Repair

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JBJS Essential Surgical Techniques, Volume 2, Issue 4

Scientific Articles   |   November 28, 2012 

Surgical Technique for Single and Double-Incision Method of Acute Distal Biceps Tendon Repair

Ruby Grewal, MD, MSc, FRCSC¹; George S. Athwal, MD, FRCSC¹; Joy C. MacDermid, BScPT, MSc, PhD¹; Kenneth J. Faber, MD, MHPE, FRCSC¹; Darren S. Drosdowech, MD, FRCSC¹; Graham J.W. King, MD, MSc, FRCSC¹ 

¹ Hand and Upper Limb Center, St. Joseph’s Health Care, Division of Orthopedic Surgery, University of Western Ontario, 268 Grosvenor Street, London, ON N6A 4L6, Canada. E-mail address for R. Grewal: rgrewa@uwo.ca. E-mail address for G.S. Athwal: gathwal@uwo.ca. E-mail address for J.C. MacDermid: joy.macdermid@sjhc.london.on.ca. E-mail address for K.J. Faber: kjfaber@uwo.ca. E-mail address for D.S. Drosdowech: ddros@mac.com. E-mail address for G.J.W. King: gking@uwo.ca

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JBJS Essential Surgical Techniques, 2012 Nov 28;2(4):e22 1-17. doi: 10.2106/JBJS.ST.L.00018

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Extract

Overview

Introduction

Distal biceps tendon ruptures can be repaired with either a single or a double-incision technique.

Step 1 (Single-Incision Technique): Surgical Exposure and Preparation of the Tendon

Through a single anterior incision, identify the tendon and debride the distal degenerated portion.

Step 2 (Single-Incision Technique): Preparation of the Radius

Expose the bicipital tuberosity and prepare the bone for insertion of suture anchors.

Step 3 (Single-Incision Technique): Tendon Reattachment

Suture the tendon with a reduction knot technique that allows for anatomic tendon apposition to bone.

Step 1 (Double-Incision Technique): Surgical Exposure and Preparation of the Tendon

Through a small anterior incision retrieve the tendon, debride the distal degenerated portion of the tendon, and place your sutures.

Step 2 (Double-Incision Technique): Preparation of the Radius

Through a second posterolateral incision, expose the biceps tuberosity and, using a burr, create a trough for the tendon.

Step 3 (Double-Incision Technique): Tendon Reattachment

Pass the sutures through the transosseous tunnels and tension the sutures, allowing the biceps tendon to be pulled into the trough created in the bicipital tuberosity, and then tie the sutures.

Step 4: Postoperative Care

Assess tension across the repaired tendon, initiate prophylaxis against heterotopic ossification, and begin rehabilitation.

Results

We recently conducted a prospective randomized controlled trial at our center comparing the single and double-incision techniques for the repair of acute distal biceps tendon ruptures¹¹.