Distal Biceps Reconstruction

Surgical intervention aimed at addressing distal bicep ruptures

What is a distal biceps reconstruction?

A distal biceps reconstruction is a surgical intervention aimed at addressing distal bicep ruptures. Surgery is typically performed within 2-3 weeks of injury as non-surgery past this timeframe will risk non-recovery of arm function. Delay in surgical treatment also increases complications and reduces healing capabilities. 

Not all distal bicep ruptures require reconstruction surgery. Reconstruction is reserved for the incidence of complete tears where distal bicep tendons have detached from the elbow joint. Additionally, reconstruction is also necessary where atrophy is present. This occurs when patients have neglected the timeframe to address rupture, subsequently leading to tendons shortening. Consequently, the distal bicep tendons are irreparable and reattachment of the tendon to the radius (repair) is no longer an option. 

Given that candidates for surgery have damaged tendons that can no longer be salvaged, a  reconstruction involves the use of harvested tissue known as tissue graft. One may opt for donor tissues (allograft) or tissues harvested from other parts of the body (autograft). 

muscle atrophy
Distal biceps reconstruction is usually necessary when there are signs of atrophy.

How does distal biceps reconstruction work?

Following your orthopaedic evaluation, imaging tests such as x-rays and magnetic resonance imaging (MRI) will be conducted to confirm surgery suitability. A surgery date will then be assigned. Prior to addressing the injury, tendons are harvested and prepared. Upon completion, the injury will be addressed. 

During surgery, an incision is made at the inner part of the elbow (near the forearm). Muscle and tissue are moved to inspect the distal bicep location. The harvested graft is then attached to the stump of the tendon using sutures as a reparative measure. 

The tendon is then fixed in place by metal screws which are connected to the radial bone. Drilling will be required to fix the buttons of the screws to the bone. Once the grafted tissues are secure, the site of surgery is cleaned to prevent infections. Subsequently, incisions are closed with sutures. 

distal biceps reconstructions
Distal biceps reconstruction involves the use of harvested tendons, metal screws, and sutures.

Benefits of distal biceps reconstruction

  • Reduces risk of strength loss
  • Prevents arm deformity 
  • Restores arm function 
  • Increased mobility 
  • Improved quality of life
  • Relief from pain

What conditions can distal biceps reconstruction treat?

Distal biceps reconstruction can be used to  treat the following conditions:
  • Bicep tendonitis: inflammation of the tendons that leads to weakening of tendon strength and subsequent tears.
  • Cortisone use: overusing anabolic steroids leads to the weakening of tendon strength which can be corrected with a distal biceps reconstruction surgery.
  • Arthritis: arthritis such as osteoarthritis causes mucoid changes that lead to distal bicep ruptures.  
  • Obesity: mechanical stress and vascular changes from obesity cause a likelihood of distal biceps tendon rupture. 
Distal biceps reconstructions have been linked to patients with anabolic steroid abuse.

What results can I expect?

Distal biceps reconstruction tends to be successful with reoperation rates as low as 2%. One can expect to recover over 90% of their pre-injury arm strength and improved arm functionality over time. It could take up to 6 months for one to recover from the surgery. By then, patients can expect to regain their range of motion. 

Discipline and dedication towards physiotherapy would help in speeding up recovery. Diets and post-surgical habits could also impact your healing rate. With positive post-surgical care and collaborative work with your orthopaedist, a positive outcome can be anticipated. 

Your orthopaedist can give you a better idea of what to expect based on your individual needs and circumstances. 

How many treatment sessions are needed?

A distal bicep reconstruction is a one-off surgery. However, treatment does not end at surgical intervention. Habits such as smoking and continued abuse of anabolic steroids will also impede the recovery rate. To attain complete recovery, one will need to attend physiotherapy sessions and appropriately manage medications such as painkillers, antibiotics, and blood thinners. The frequency of physiotherapy sessions will vary according to your condition. 

Though rare, there are occurrences in which a revision of surgery has been necessary. Causes of revision included continued pain and weakness, limited range of motion, and acute traumatic re-rupture. It is essential to have a collaborative relationship with your orthopedist to monitor recovery. 

Your orthopaedic surgeon will be able to provide you with a bespoke treatment plan, tailored to your needs and requirements.

Dr Puah KL is our Senior Consultant Orthopaedic Surgeon at Artisan Sports & Orthopaedic Surgery. He used to serve the sports service of Singapore General Hospital - the highest volume trauma centre for orthopaedics in Singapore.

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