Vascular anatomy relevant to distal biceps tendon repair

Avoiding bleeding and vascular complications in open repair of distal biceps tendon rupture requires knowledge of the local vascular anatomy. This study examined the vascular anatomy relevant to distal biceps tendon repair.

The antecubital regions of 17 cadaveric upper extremities were dissected using ×2.5 loupe magnification to identify the brachial artery, the radial artery and its recurrent branches, and venous branches crossing the distal biceps tendon. With the elbow in full extension and supination, the position of each vascular structure was measured relative to the most proximal aspect of the bicipital tuberosity.

The most common pattern (13 of 17 specimens) was a single radial recurrent artery (RRA) crossing volar to the tendon at a mean of 4 mm proximal to the tuberosity and positioned 15.4 mm volar to the tuberosity. The RRA bifurcated 2 to 9 mm from its origin in 6 arms and demonstrated a single bifurcation. In 8 of 17 specimens, an additional recurrent branch off the brachial artery traveled dorsal to the intact biceps tendon 16 mm proximal to the RRA. Two arms demonstrated a high brachial artery bifurcation. The crossing veins were venae comitantes of the RRAs and radial and ulnar arteries. They connected to the superficial veins by way of a perforating branch. Most often, 3 transverse veins positioned on average 0.2 mm proximal and 16 mm volar to the tuberosity were seen.

The vascular anatomy encountered during distal biceps repair is variable, and RRAs occasionally travel dorsal to the biceps tendon. Most often, a single RRA on average 4 mm proximal to the tuberosity will branch once.