Distal biceps tendon injuries--current treatment options

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Anatomy

Background:

• Distal biceps tendon ruptures constitute 3% of all biceps tendon injuries, typically affecting middle-aged males.
• These injuries result from eccentric elbow extension loads, presenting with sharp pain and a palpable defect in the antecubital region.
• Diagnostic tools include physical examination maneuvers (biceps squeeze, hook test) and imaging (MRI, ultrasound) to differentiate tear types.

Purpose of the Study:

• To review the etiology, diagnosis, and management of distal biceps tendon ruptures.
• To discuss surgical techniques, fixation methods, and potential complications.
• To highlight treatment considerations for partial and chronic tears.

Main Methods:

• Review of anatomical studies on distal biceps tendon insertions.
• Analysis of biomechanical and clinical studies on surgical repair techniques and fixation devices.
• Discussion of nonoperative and operative management strategies, including graft options for chronic tears.

Main Results:

• Anatomic studies reveal distinct insertions for the short and long biceps heads, influencing flexion and supination.
• Endobutton fixation demonstrates superior load-to-failure strength biomechanically, though clinical outcomes are comparable across fixation methods.
• Nonoperative treatment leads to significant strength deficits; early anatomic re-attachment is recommended.

Conclusions:

• Surgical repair with early anatomic re-attachment is the preferred treatment for distal biceps tendon ruptures to restore function.
• While various fixation methods exist, clinical success is generally achieved regardless of the specific technique used.
• Management of partial and chronic tears requires tailored approaches, including conservative treatment for partial tears and grafting for chronic cases.