Lacertus fibrosus augmentation for distal biceps brachii rupture repair: surgical technique

Repair of distal biceps tendon ruptures has become widely accepted. Unfortunately, care of retracted-degenerated injuries remains a challenge for orthopedic surgeons. Complication rates appear to increase when surgery is performed in chronic cases compared to those operated acutely. Multiple techniques for chronic reconstruction with the use of grafts have been described. Recently Morrey, from the Mayo Clinic, proposed a direct anatomic repair of retracted distal biceps tendon ruptures in extreme flexion (60°-90°) to avoid grafting.

The authors propose and describe a new surgical technique using the lacertus fibrosus (LF) as augmentation-elongation for retracted-degenerated distal biceps tendon tears. We present four cases with chronic ruptures with 2-year follow-up. The mean age was 45 years old (33-51), the time of surgery was 13 weeks (4-24) after the trauma, dominant arm was involved in two cases.

The mean MEPS was 95/100 at 2-year follow-up. With this technique we increase the length of the tendon up to 2.5 cm. The major complication in our study was transient sensitive radial nerve paresthesia. We did not have any hardware mobilization or muscular herniation.

With this study we want to present our experience in the treatment of retracted distal biceps tendon tear with lacertus fibrosus augmentation. Our surgical technique is an effective and cheap option for chronic-retracted distal biceps tendon lesions. Recovery time is quicker, and integration is faster due to the use of an autologous vascularized graft. Preoperative ultrasound scan is mandatory in order to evaluate LF integrity, thickness and size.