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Acute distal biceps tendon ruptures: anatomy, pathology and management - state of the art
  1. Neil Kruger1,
  2. Joideep Phadnis2,
  3. Deepak Bhatia3,
  4. Melanie Amarasooriya4,
  5. Gregory Ian Bain1
  1. 1 Department of Orthopaedic Surgery, Flinders University, Adelaide, South Australia, Australia
  2. 2 Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton, Brighton and Hove, UK
  3. 3 Orthopaedics, Sportsmed Mumbai, Parel, Maharashtra, India
  4. 4 Orthopaedics, Base Hospital Diyatalawa, Diyatalawa, Sri Lanka
  1. Correspondence to Dr Neil Kruger, Department of Orthopaedic Surgery, Flinders University, Bedford Park SA 5042, Australia; neilkruger6{at}


All patients with acute complete distal biceps tendon ruptures who are not low demand or medically unfit to proceed with surgery are offered operative repair. This restores arm shape, supination strength and function, and decreases their cramping symptoms. Surgical repair technique varies significantly depending on location and training centre. Nuances in technique and appropriate implant selection need to be noted in order to achieve a strong repair allowing early active range of motion. Intimate knowledge of distal biceps tendon anatomy is key to avoid complications associated with the different approaches. The cumulative body of evidence on complications, coupled with knowledge of the different biomechanical construct strengths of the alternative methods of fixation, points to the use of the cortical button technique without the addition of an interference screw. Subtle variations in drill hole positioning on the bicipital tuberosity secures either an anatomic or non-anatomic repair. Anatomic repair results in greater supination peak torque and fatigue strength, and in greater flexion fatigue strength. It is advisable to perform an anatomic repair in elite athletes or those patients who significantly rely on supination strength and endurance for their livelihood. A universal postoperative protocol is suggested for all repairs.

  • tears
  • tendon
  • endoscopy
  • repair / reconstruction
  • upper extremity
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  • Contributors NK planned, drafted and wrote the manuscript. JP edited and revised the manuscript. DB edited and revised the manuscript. MA wrote, edited and revised the manuscript. GIB designed the concept, edited and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was not sought for the present study because this was an invited review article on the state of the art of acute distal biceps tears. No patient identifying data are included in this review. This review was completed in accordance with the Helsinki Declaration as revised in 2013.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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