Late distal biceps repair.

Distal biceps ruptures occur in well-muscled, middle-aged males. A delay in diagnosis can result in significant shortening of the biceps muscle, making late repair very difficult if not impossible. If the distal biceps tendon is not repaired, there will be a significant loss of primarily supination strength. Experience involving the late reconstruction of this muscle tendon unit is increasing. Delayed distal biceps repair requires extensive mobilization of the muscle and repair with the elbow in flexion or the use of a graft to bridge the gap from the distal end of the biceps to the radial tuberosity. Many substances have been used, including autogenous flexor carpi radialis graft, semitendinosus, and fascia lata. More recently, allograft Achilles tendon has been used. Both 1-incision and 2-incision techniques for late distal biceps tendon reconstruction using allograft Achilles tendon are presented in this paper. Late reconstruction of a distal biceps tendon using an allograft yields a good, predictable result with strength of supination returning to near normal.