# Allograft reconstruction of distal biceps ruptures: surgical technique and analysis of outcomes in chronic tears and failed repairs

## TL;DR

This paper presents a surgical technique using allografts for chronic distal biceps tendon tears and shows good patient outcomes with no major complications.

## Contribution

The study introduces a reproducible allograft-based surgical technique for chronic or recurrent distal biceps tendon tears and evaluates its clinical outcomes.

## Key findings

- Patients reported excellent outcomes with average Mayo Elbow Performance Score of 93.5 and minimal pain.
- No complications or revision surgeries were observed in the 10 patients followed for an average of 54 months.
- Range of motion was preserved with average flexion–extension of 3°-130° and prono–supination of 79°-89°.

## Abstract

Distal biceps tendon tears are relatively uncommon injuries that may result in pain and dysfunction. When these injuries are addressed acutely, healing rates, functional recovery, and patient outcomes are excellent. Despite generally good outcomes, failures do occur. Chronic tears of the distal biceps or those requiring revision surgery pose a unique challenge, as the tendons are often retracted and atrophic, requiring allograft reconstruction to bridge the gap in the repair construct. This manuscript aims to describe a safe, reproducible surgical technique and examine the clinical outcomes of distal biceps tendon reconstructions performed with allografts.

A retrospective review of patient records from 2000 to 2022 to include Current Procedural Terminology code 24342 for reinsertion of biceps tendon, distal, with or without tendon graft, was performed. Operative notes were screened to determine which procedures included a distal biceps repair with an allograft. Charts were reviewed to determine a patient's most recent documented range of motion, pain score, and any postoperative complications. Patients were contacted by phone to determine their Quick Disabilities of Arm, Shoulder and Hand, Mayo Elbow Performance Score, and 12-Item Short Form Health Survey (SF-12) scores, as well as current visual analog scale for pain.

Fifteen patients who underwent distal biceps repairs with allograft were identified, and we were able to contact 10 (66%) of them. Six of these patients had chronic tears, while four had recurrent ruptures of previously performed acute distal biceps repairs. None of these patients reported complications or revision procedures. The average follow-up time for patients was 54 months (range: 8-182 months). The average visual analog scale pain score was 0.4 (range: 0-2). Average final flexion–extension was documented as 3°-130°, and prono–supination as 79°-89°. Patients reported an average Mayo Elbow Performance Score of 93.5 (range: 80-100), Quick Disabilities of Arm, Shoulder and Hand score of 4.8 (range: 0-15.9), SF-12 physical score of 54.3 (range: 50-57), and SF-12 mental score of 57.6 (range: 51-62).

Allograft reconstruction of distal biceps injuries for chronic and recurrent tears results in excellent patient-reported outcomes and range of motion, with no significant complications among our cohort. Future studies with larger patient populations will help further validate our results.