Distal Biceps Tendon Repair:  Improving the Strength of the Repair

Charles Ruotolo, MD publishes an article demonstrating a technique to improve the strength on distal biceps tendon repairs.

The distal biceps tendon can rupture in 3-5 people per 100,000 persons per year.  When this first happens typically one has pain in the proximal forearm and cramping in the biceps muscle in the front of the arm.  Typically these tears occur during a specific injury as compared to proximal biceps tears in the shoulder which may be attritional over time.  The mechanism is usually an eccentric contraction meaning the muscle is lengthening as the muscle contracts.  For the elbow this would mean straightening the arm as the biceps muscle fires such as catching something heavy that causes the elbow to straighten. Distal biceps tendon tears can cause significant weakness of the arm and forearm with loss of strength for flexion and supinations (rotating the forearm so the palm is up).  Also when the biceps tears the muscle retracts causing a deformity of the biceps muscle itself.  

To return strength and cosmesis, a surgery may be considered.  For those who are older or who have significant medical problems nonsurgical treatment may be considered.  One of the techniques to repair the tendon is thru a single incision approach using a metal washer to hold the tendon to the bone.  This technique has gained popularity over the last 2 decades.  In the article published in the journal of Orthopedics, Dr. Ruotolo and his coauthors have demonstrated that using a combination of two sets of sutures both passed in a different suturing pattern significantly improves the maximum load to failure (strength of the repair) which theoretically should decrease the risk of retears.