Distal Biceps Repair

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Click for larger view of biceps rupture

A 4cm incision is made 2cm distal to the elbow crease, overlying the biceps tuberosity of the radius.
Biceps Tendon is retrieved and a No. 5 Ticron whip-stitch inserted. The tendon edge is debrided and chevron shaped.
Chevron shape of distal biceps tendon.
The chevron is sized for a Biotenodesis screw. Only the chevron portion of the distal tendon will enter the hole with the screw, due to the large surface area of the biceps tendon and small area of
the biceps tuberosity.
Two Fiberwire (Arthrex) sutures are inserted in a modified Kessler fashion:
1. into the chevron portion of the tendon.
2. into the broader section (for overtying).
The pilot hole is drilled in the biceps tuberosity of the radius - with the forearm fully supinated.
A 5mm drill-bit was used here.
It is essential to use the Biotenodesis drill guide to protect the soft tissues - the radial nerve and posterior interosseous branch are very close by.
The most distal Fiberwire suture (in the chevron tip) is passed through the Biotenodesis inserter, with a 5.5mm screw mounted. This is best done with a wire passer (Arthrex).
Insertion of the screw (1)
Screw insertion, as per Biotenodesis system guidelines (2).
Insertion of screw & tendon (3)
Insertion of Biotenodesis screw & tendon
(from www.arthrex.com )
Screw and chevron portion in position.

Then Ticron whip-stitch suture tied to Fiberwire to allow further apposition and support.

Wound Closure
Result at one year post-op:

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