Biceps tendon: diagnosis, therapy and results after proximal and distal rupture.

Klonz A, Reilmann H. Orthopade 2000 Mar;29(3):209-15.

Ruptures of the long head of the M. biceps humeri are commonly caused by degenerative changes within the tendon. They are associated with pathologies of the subacromial space. The loss of power regarding elbow flexion and supination amounts to 8 to 21% after conservative treatment. Refixation offers a small but evident improvement of flexion and supination power. Especially endurance is improved. The number of cases with remaining light or marked weakness is reduced by more than 50%. Deformity by the slipped muscle can be corrected effectively. Function of the glenohumeral joint can only be improved if associated subacromial problems are identified and treated simultaneously. As complications are uncommon surgery should be recommended to young and active patients and should at least be offered to less active patients. Ruptures of the distal tendon are less common. Thirteen patients were re-examined after operative repair for distal biceps tendon avulsion and 277 reported cases were reviewed. After conservatie management (n = 20) the power of flexion will remain reduced by 30%-40%, that of supination by more than 50%. The loss of flexion power, as well as the deformity can be diminished by attachment of the distal biceps to the brachialis muscle (n = 22). The anatomic re-insertion (n = 248) additionally reduces the loss of supination power to 0%-25%, but bears a higher risk of complications. Using the ‘double-incision technique’ (n = 105 of 248) does not decrease the risk of naval lesions but increases the incidence of radioulnar synostosis. The use of suture anchors provides a nice way of fixation of the tendon but does not facilitate the approach to the tuberosity. The distal biceps tendon rupture should be treated operatively. The adequate method of repair is to be determined individually.