Distal Biceps Tendon Repair: 1-Incision Versus 2-Incision Techniques

Treatment options for distal biceps tendon ruptures include nonoperative and operative approaches. Candidates for conservative nonoperative management include elderly low-demand patients, those in whom surgery is contraindicated because of medical comorbidities, and those who are unable to adhere to the strict postoperative rehabilitation regimen. Data have clearly shown the superiority of operative over nonoperative management of these injuries. Currently, the most commonly used approaches are the 2-incision modified Boyd-Anderson approach and the limited 1-incision anterior approach. Transosseus suture fixation is typically combined with the 2-incision technique, whereas alternative fixation methods, such as the suture anchor or Endobutton techniques, are combined with the 1-incision technique. The clinical evidence reported in the literature to date does not support a clear single approach that should be used as the standard of care for distal biceps tendon ruptures. In fact, the data that are available show good to excellent results with both procedures and only relatively minor differences in outcomes. Thus, at this point in time, the decision of the technique to use for repair of these injuries should be based on surgeon preference, surgeon training, and comfort level with the approaches.