Biceps Tendon Rupture: Contemporary Evidence, Evolving Techniques, and a Mechanics-to-Management Clinical Framework

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Musculoskeletal Research

Background:

• Biceps tendon ruptures encompass a range of injuries, from proximal degenerative attrition to distal acute tears.
• These injuries present distinct biomechanical and clinical characteristics based on their location.

Purpose of the Study:

• To review current evidence on the anatomy, biomechanics, diagnosis, and management of proximal and distal biceps tendon ruptures.
• To discuss long-term outcomes and future research directions in biceps tendon pathology.

Main Methods:

• Systematic review of contemporary evidence.
• Synthesis of data on diagnostic strategies, including clinical examination, ultrasound, and MRI.
• Analysis of operative and non-operative management approaches for different rupture types.

Main Results:

• Proximal ruptures often involve degenerative tissue and may coexist with rotator cuff pathology.
• Distal ruptures result from eccentric overload, causing significant functional deficits.
• Management varies: tenotomy/tenodesis for proximal, anatomic repair/reconstruction for distal tears.
• Surgical outcomes are generally excellent with proper technique, and complications are infrequent.

Conclusions:

• Personalized treatment for biceps tendon ruptures requires understanding the mechanical and biological differences between proximal and distal injuries.
• Future research should focus on advanced fixation methods, imaging biomarkers, and value-based decision-making.