Distal biceps tendon ruptures: clinical features, diagnostic strategy and treatment options

Abstract

Relevance. This paper reviews the latest evidence concerning distal biceps tendon repair, particularly aspects such as tear type, patient demographics, diagnostic clues, surgical indications, the anatomy of distal tendon insertion, radial tuberosity, single- vs double-incision reconstruction, fixation techniques (bone tunnels, distal biceps button, interference screw, button plus screw) and postoperative outcomes.Material and methods. The MEDLINE, Cochrane, Web of Science, Scopus and Elibrary online databases were searched using the keywords ‘distal biceps tendon’, ‘elbow’, ‘intramedullary’, ‘partial’. ‘complete’, ‘review’ and ‘rupture’. Sixty publications on distal biceps tendon rupture treatment were identified that appeared over 60 years, between 1951 and October 2021.Results and discussion. The review has demonstrated that complete deltoid ligament (DBT) tears are predominantly diagnosed clinically, while medical imaging has proven to be a valuable adjunct for diagnosing partial tears. Advances in clinical and medical imaging of partial tears have the potential to expedite the diagnostic process and guide treatment strategies. Primary repair is commonly employed for complete tears, utilizing either a single-incision or double-incision approach, resulting in favorable clinical outcomes. However, the double-incision technique carries a higher risk of heterotopic ossification, whereas the single-incision approach presents a greater risk of nerve-related complications. To mitigate the risk of posterior interosseous nerve lesions in single-incision repairs, intramedullary fixation may serve as a viable solution. Additionally, DBT endoscopy holds promise for the treatment of low-grade partial tears and tendinosis.