Revision Distal Bicep Repair in the Setting of Heterotopic Ossification: Case Study

TL;DR

A patient with heterotopic ossification after bicep tendon repair regained elbow function through surgical revision using an Achilles tendon allograft.

Contribution

Demonstrates successful treatment of HO after bicep repair using Achilles tendon allograft.

Findings

Heterotopic ossification can cause significant functional limitation after distal biceps repair.

Surgical revision with Achilles tendon allograft improved motion and resolved pain.

Early recognition and treatment minimized recurrence of ossification.

Abstract

Heterotopic ossification (HO) following distal biceps tendon repair is an uncommon but potential complication. This may present pain, limited range of motion, or sensory changes due to nerve compression. This case study reports the case of a patient who developed significant functional limitation after primary distal biceps tendon repair complicated by heterotopic ossification. Radiographs confirmed extensive ossification surrounding the radial tuberosity. Plain radiographs were obtained to confirm the presence and maturity of the HO; a CT scan was performed to delineate the extent and proximity to the neurovascular bundle for operative planning. Surgical revision was performed using an Achillies tendon allograft to reconstruct the distal biceps tendon while excising the ossified tissue. Postoperatively, the patient experienced marked improvement in motion and resolution of pain. No recurrence was observed at follow‐up. This case emphasizes the importance of early recognition of heterotopic ossification after tendon repair and demonstrates that timely revision with an Achillies allograft can effectively restore elbow function and minimize recurrence.

Heterotopic ossification (HO) is a rare but significant complication following a distal biceps tendon repair. It can lead to functional impairment and soft tissue pain. Early recognition, prevention, and reconstruction with an Achilles tendon allograft can restore function in cases of failed primary repair.

Radiographic and intraoperative findings demonstrating heterotopic ossification following distal biceps tendon repair.

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