Distal biceps reconstruction using an Achilles tendon allograft, transosseous EndoButton, and Pulvertaft weave with tendon wrap technique for retracted, irreparable distal biceps ruptures

J Shoulder Elbow Surg. 2016 Jun;25(6):1013-9. doi: 10.1016/j.jse.2016.01.014. Epub 2016 Mar 31.


Background: Distal biceps ruptures can result in ongoing pain and weakness when treated nonoperatively. If retraction of the tendon renders primary repair impossible, reconstruction using a graft is recommended. The current literature includes a variety of techniques with studies reporting small patient numbers. The aim of this study was to report the results of a larger cohort of patients using a technique modified from those previously described in the literature.

Methods: Twenty-one consecutive male patients underwent distal biceps reconstruction through 2 small anterior incisions using an Achilles tendon allograft that was fixed distally using a transosseous EndoButton and secured proximally using a Pulvertaft weave and tendon wrap. The mean age was 44 years, and the mean time to surgery was 25 months (range, 2-96 months). Functional outcomes were collected prospectively.

Results: The mean preoperative Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score (11 patients) was 1.9 (range, 0-4.5). The mean postoperative Oxford Elbow Score, QuickDASH score, and Mayo Elbow Performance Score were 44.7 (range, 35-48), 4 (range, 0-20.5), and 92.9 (range, 70-100), respectively, at a mean follow up of 15 months (range, 6-35 months). The mean postoperative QuickDASH score was significantly improved compared with preoperatively (P < .001). All patients were satisfied and all returned to their previous level of activity. There were 2 transient lateral antebrachial cutaneous nerve paresthesias, and 2 patients had a 5° extension lag. There were no other complications.

Conclusion: Achilles allograft reconstruction of retracted irreparable distal biceps ruptures provides consistently good results with few complications using this technique.

Keywords: Achilles; Biceps tendon; allograft; chronic; distal; graft.

MeSH terms

  • Achilles Tendon / transplantation*
  • Adult
  • Allografts
  • Elbow / surgery*
  • Elbow Joint / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Muscle, Skeletal / surgery*
  • Reconstructive Surgical Procedures / adverse effects
  • Reconstructive Surgical Procedures / instrumentation
  • Reconstructive Surgical Procedures / methods*
  • Retrospective Studies
  • Rupture / surgery
  • Treatment Outcome
  • Young Adult