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

ABSTRACT Treatment options for distal biceps tendon rupturesinclude nonoperative and operative approaches. Candi-dates for conservative nonoperative management in-clude elderly low-demand patients, those in whomsurgery is contraindicated because of medical comor-bidities, and those who are unable to adhere to the strictpostoperative rehabilitation regimen. Data have clearlyshown the superiority of operative over nonoperativemanagement of these injuries. Currently, the mostcommonly used approaches are the 2-incision modifiedBoyd-Anderson approach and the limited 1-incision ante-rior approach. Transosseus suture fixation is typicallycombined with the 2-incision technique, whereas alter-native fixation methods, such as the suture anchor orEndobutton techniques, are combined with the 1-incisiontechnique. The clinical evidence reported in the literatureto date does not support a clear single approach thatshould be used as the standard of care for distal bicepstendon ruptures. In fact, the data that are available showgood to excellent results with both procedures and onlyrelatively minor differences in outcomes. Thus, at thispoint in time, the decision of the technique to use forrepair of these injuries should be based on surgeonpreference, surgeon training, and comfort level withthe approaches.Keywords: distal, biceps, tendon, repair, 1-incisiontechnique, 2-incision technique, radioulnar synostosis