Anatomic direct repair of chronic distal biceps brachii tendon rupture without interposition graft

Background: Rupture of the biceps brachii insertion is relatively uncommon and may present late. Chronic ruptures pose a management dilemma, with higher reported complication rates when surgery is delayed, whilst conservatively treated injuries may do badly in active patients. Materials and methods: Six consecutive male patients with delayed presentation of biceps rupture were treated operatively using a limited standard anterior approach, a secondary proximal "retrieval'' incision, and EndoButton fixation. This modification of the well-described EndoButton technique for distal biceps reconstruction allows passage of the shortened tendon in maximal elbow flexion and a rehabilitation program without immobilization. The mean interval to repair was 79 days (range, 35-116 days). The mean age at presentation was 47.5 years. The injury mechanisms were unexpected loads on a flexed supinated forearm. Results: Patients were assessed at a mean of 20.2 months. Range of motion was restored to 94% in flexion and 95% in prosupination compared with the uninjured limb. Supination endurance was reduced by 9 repetitions/min compared with the contralateral side (mean, 83.4 repetitions/min). Mayo Elbow Performance Scores were universally 100 and the mean Disabilities of Arm, Shoulder and Hand score was 4. Patient satisfaction was high, with visual analog scores of 92 to 100. No major complications occurred, and all repairs were intact at the final follow-up. Conclusions: Our outcomes are comparable to acute repair, with restoration of range of motion and function and few complications.