APEX Elbow Mastering Surgical Techniques for Clinical Success-Distal Biceps Tears

Video Transcription

Video Summary

The speaker reviews distal biceps tendon repair, emphasizing that surgery is done not only for the “reverse Popeye” deformity but also to restore subtle loss of terminal supination. Key controllable surgical variables include the tendon attachment site (onlay vs inlay), tendon rotation, and initial (“time zero”) fixation strength. The distal biceps has short- and long-head components that normally attach posterior to the radial tuberosity protuberance, which functions as a cam for supination. Studies show that anterior tendon placement reduces terminal supination; inlay techniques can also compromise the protuberance unless placed posteriorly. The preferred construct is an anatomic footprint restoration using an onlay technique, external tendon rotation, and strong fixation (e.g., two cortical buttons).<br /><br />Approach selection matters: an anterior approach may not allow anatomic placement in ~40% of patients who cannot hypersupinate; a posterior approach can better access the footprint. Cases include: (1) partial/isolated short-head rupture (sometimes with bifid tendon anatomy) repaired posteriorly; (2) failed prior anterior anchor repair causing inability to actively supinate (revision restored function for an FBI agent); (3) chronic failed repair/allograft reconstructed with Achilles allograft and strong button fixation to restore supination torque. A complication case (radioulnar synostosis/heterotopic ossification) highlights possible need for combined anterior/posterior takedown and prophylaxis (e.g., indomethacin). Rehab typically begins motion after early protection, strengthening around 6 weeks, and full activity near 3 months.

Asset Caption

Moderator: Chris C. Schmidt, M.D.

Keywords

distal biceps tendon repair

terminal supination restoration

anatomic footprint onlay technique

radial tuberosity protuberance cam effect

anterior vs posterior surgical approach

cortical button fixation time-zero strength

radioulnar synostosis heterotopic ossification prophylaxis