What is distal biceps tendon repair?

It's ultimately an open-day case procedure under general anesthesia. You incise over the top part of your forearm, 3cm. The tendon ripped off from your arm is gently teased out; this exposes the tuberosity of your biceps, where it has avulsed. Then, it is reintroduced into the tuberosity, a small hole socket carved into your radius bone. The tendon is tied to the button and flipped over on the far side of the radius, holding it within its socket. An interference screw is typically driven into position as secondary security. The wound is lavaged, infiltrated with local anesthetic, and closed.

Sometimes, the tendon has retracted up pretty far in your arm, and it is almost always necessary to have a second incision to retrieve it and bring it down into position over the radius.

How is a distal biceps tendon repair carried out?

There are many techniques to repair a distal biceps tendon tear, and all are done under anesthesia. One is a technique carried out with one incision at the front of the elbow. Another method uses two small incisions at the elbow's front and back. The following techniques are:

Single-Incision Repair

For this operation, surgeons cut the medial side of the elbow. They locate the end of the tendon and remove any damaged tissue.

They then drill a small hole at the top of the radius. They measure the diameter the end should receive to fit into that hole. The tendon is sutured to a minor surgical button, and the surgeon drills through the hole. The button is secured on the other side of the radius, and it serves as a point of anchorage to the tendon. The surgeons then further secure the biceps tendon to the bone with a plastic screw or another fixation device. The incision is then closed using sutures. Other techniques to anchor the tendon include anchors made of suture, which offer direct anchorage of the tendon to the bone.

Double-Incision Repair

Surgeons can carry out biceps tendon repair through two independent incisions. A two-incision repair will usually be performed instead of a one-incision procedure because both techniques have equally good results and are at your surgeon's discretion. They make an incision across the inside elbow skin crease to locate the end of the severed tendon. They suture the tendon and place it between the ulna and radius, the two bones in the forearm below the elbow.

The surgeons create a second incision on the outside of the arm below the elbow to bring down the tendon for insertion. They then fix the tendon to the radius bone using fixation techniques, including bringing high-strength sutures through tiny holes drilled into the bone. All the incisions are then closed with sutures.

How soon after the injury should I seek treatment?

You must get your distal biceps rupture repaired within two weeks because any delay for too long leads to increased retraction of the muscle and the tendon, allowing dense scarring around the ruptured tendon. Retraction down to the radius is even impossible in some cases in delayed procedures. In this case, a graft is placed across the defect (either a hamstring tendon from your leg or a donor 'allograft' tendon). Repairs of chronic tears (older than a few weeks) are also performed at a greater risk of damage to nerves and vessels; therefore, a longer curved incision is necessary to achieve safe visualization of structures.

What is the recovery period after?

A sling and a splint are used for two weeks following the surgery, after which a hinged elbow brace is used for four more weeks. This helps to increase the motion progressively. During this time, you begin attending physical therapy.

What are the potential complications of distal biceps tendon repair?

The success rate for tendon repair surgery is very high; however, a few risks may come with such a surgery. These may include:

• Temporary numbness or weakness of the hand or forearm
• Abnormal new bone formation of new bone
• Tendon re-ruptures

How long does it take to recover from distal biceps tendon repair?

A splint or a cast is expected immediately after surgery to immobilize the elbow and ensure proper healing. This splint is continued for a week. After removing the splint, a dynamic elbow orthosis is worn to protect the elbow for about a month. Dr. Williams allows patients to move their arms with gentle motions. At this stage, physical therapy will focus on regaining some strength and range of motion. Very light exercises may begin a few weeks following surgery, but heavy lifting should be avoided for 3-4 months. Distal biceps tendon repair is imperative and almost requires more than three months to attain full recovery; its recovery of strength and mobility, however, depends on the tear severity. Full recovery and strength of function usually result from this procedure.

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