Reconstruction of a chronic distal biceps tendon rupture 4 years after initial injury

Rupture of the distal biceps insertion can produce, on average, a 40% loss of supination strength, a 47% loss of supination endurance, and a 21% to 30% loss of flexion strength at the elbow. In acute biceps tendon ruptures in which a patient will not tolerate resulting functional deficits, anatomical reinsertion of the biceps tendon into the radial tuberosity is usually recommended. The various surgical techniques that have been described for anatomical repair of distal biceps rupture include passage of the tendon stump through a transosseous tunnel and use of suture anchors, interference screws, and EndoButtons (Smith & Nephew, Andover, Mass). Reported results for these techniques have mostly been excellent with respect to restoration of functionality. Chronic cases, however, may involve retraction of the native tendon and extensive scar formation, which preclude anatomical repair. In these situations, one of several described reconstructive techniques, including use of semitendinosus autograft and Achilles tendon allograft, may be needed to reestablish acceptable function. Delayed (< or = 18 months) reconstruction of chronic ruptures, using allograft soft-tissue constructs, has been described in the literature. We present the case of a chronic distal biceps rupture reconstructed 4 years after initial injury using a single-incision technique with free semitendinosus autograft and EndoButton fixation.