Tears of the biceps tendon at the elbow are very common among middle-aged people of all activities, involving both athletic and non-athletic populations. It is almost always a sudden injury to the elbow with pain and immediately-noted deformity of the biceps in the arm. While the pain tends to subside, the weakness and usefulness of the biceps becomes limited after injury. Read more about biceps here.
Repair techniques have been created using either a single incision across the front of the elbow, or with two incisions. The original technique uses the two-incision method, however in recent years, the sports community has developed single incision methods using a variety of ways to attach the tendon down to the bone. This two incision method, developed by Morrey, uses one incision to find the torn tendon stump, and another to attach it to the radius bone.
Newer one-incision methods use suture anchors or other devices to attach the tendon down to bone. The best method remains controversial.
My preferred repair technique
After a review of the literature available, and personal experience with both approaches, I prefer the two incision approach. A recent study found very low complication rates and excellent return to function after the classic two incision method. This method allows placement of the tendon back at the anatomic point of detachment. The tendon is able to be placed directly into the bone as opposed to next to it and full rotation strength is restored. Starting passive range of motion following surgery can be done with confidence as the repair is solid. The risk for neurologic injury is lower than the single incision. Overall, this two incision technique remains the standard treatment for my patients.
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World J Clin Cases. Aug 16, 2014; 2(8): 357–361.
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