Distal Biceps Tendon Repair Surgery Overview

Distal biceps tendon repair is a surgical procedure performed to reattach the distal biceps tendon to the radial tuberosity of the forearm, typically following a rupture. This injury often occurs during activities that involve heavy lifting or sudden, forceful motion of the elbow. The procedure can be approached through an open or arthroscopic technique, depending on the specifics of the injury and surgeon preference. During the repair, the tendon is meticulously sutured back to its anatomical position to restore function and strength to the biceps muscle. Post-operative rehabilitation is crucial and typically involves a gradual increase in range of motion and strength training to ensure optimal recovery and function.

Distal biceps tendon repair with Arthrex’s Distal BicepsButton™ in combination with the tension slide technique

Step-by-Step Breakdown of Distal Biceps Tendon Repair Surgery

  1. Preoperative Assessment

    • Review the patient's medical history and perform a physical examination.

      Obtain imaging studies, such as MRI or ultrasound, to assess the extent of the injury.

      Discuss the surgical plan and obtain informed consent from the patient.

  2. Anaesthesia

    • Administer general anaesthesia or regional block, depending on the patient's health and the surgeon's preference.

  3. Surgical Positioning

    • Position the patient in a supine position with the arm extended on an armboard. Ensure adequate padding to prevent pressure injuries.

  4. Preparation and Draping

    • Clean the surgical site with antiseptic solution.

    • Drape the arm and surrounding area to maintain a sterile field.

  5. Surgical Approach

    • Make a longitudinal incision over the antecubital fossa (front of the elbow) extending to the mid-arm to access the biceps tendon.

  6. Identification of the Ruptured Tendon

    • Carefully dissect through the subcutaneous tissue and fascia to identify the ruptured distal biceps tendon.

    • Assess any associated injuries to the bicipital tuberosity on the radius.

  7. Tendon Preparation

    • Remove any degenerated tissue from the ruptured tendon.

    • Prepare the tendon end for reattachment by creating a suitable taper or width.

  8. Bone Preparation

    • Prepare the bicipital tuberosity on the radius for tendon fixation. This may involve decorticating the bone to enhance healing.

  9. Reinsertion of the Tendon

    • Use either a suture anchor or a two-incision technique to reattach the tendon to the bone.

    • For the anchor technique, insert the anchor into the prepared site and securely attach the tendon using heavy sutures.

  10. Closure

    • Check the tension of the repair before suturing. Ensure optimal tension is achieved to restore function.

    • Close the underlying fascia and subcutaneous tissue with absorbable sutures.

    • Close the skin in layers with non-absorbable sutures or staples.

  11. Postoperative Care

    • Apply a sterile dressing and a sling to support the operated arm.

    • Discuss pain management, blood clot prevention, and signs of complications with the patient.

  12. Rehabilitation

    • Initiate a rehabilitation plan post-surgery, including range of motion exercises and progressive strengthening as guided by the physiotherapist.

  13. Follow Up Appointments

    • Schedule follow-up appointments to monitor healing, assess progress, and remove sutures or staples as necessary.

  14. Long-term Outcomes

    • Discuss expected recovery times and outcomes, including return to activities and potential complications such as tendon re-rupture, stiffness, or weakness.

This straightforward outline covers the fundamental steps in distal biceps tendon repair surgery. Each case may require specific adjustments based on individual circumstances.