Distal Biceps Reinsertion
Distal Biceps Reinsertion
What is distal biceps reinsertion?
What is distal biceps reinsertion?
When the biceps tendon ruptures at its insertion in the elbow, surgery can be performed to repair it to its original insertion site.
How is the distal biceps tendon repair performed at the elbow?
How is the distal biceps tendon repair performed at the elbow?
There are several techniques for repairing the distal biceps tendon. Single-incision approaches to the anterior aspect of the elbow may be simpler and reduce the risk of heterotopic ossification (bone debris that can interfere with elbow mobility). However, access to the native insertion site of the biceps may be more difficult and the risk of nerve injury is greater. Alternatively, two-incision techniques use an anterior approach to reference the tendon and a posterior approach to access the radial tuberosity, where the tendon inserts.
Regarding the methods of fixing the tendon to its bone insertion, high-resistance wires are usually used and the insertion point is fixed using anchors, button systems, screws or even transosseous tunnels with the wires themselves, without the need for other implants.
What is the ideal timing for distal biceps repair?
What is the ideal timing for distal biceps repair?
Ideally, these injuries should be repaired as soon as possible to avoid tendon retraction and degeneration, but a period of 10-14 days may be acceptable without worsening the outcome. Injuries older than 3-4 weeks may be considered chronic and not as suitable for primary reconstruction as more acute injuries. However, even in injuries older than 4 weeks, it may be possible to mobilize the tendon to its native insertion and hope that it can elongate to its normal length over time.
What to Expect After Distal Biceps Repair?
What to Expect After Distal Biceps Repair?
Distal biceps reattachment surgery can be performed overnight or as an outpatient procedure. The surgery takes approximately 1 hour. After the procedure, a plaster cast or orthosis is usually placed to prevent excessive extension that could lead to reconstruction failure. This splint may be left in place for 2 to 4 weeks, depending on the quality of the tissue and the tension obtained intraoperatively. After this period, rehabilitation is aimed at recovering the range of motion and strength of the biceps in elbow flexion and supination movements. A return to work is expected after 3 to 4 months, and sports activities are usually resumed after 4 to 6 months.
