Distal biceps tendon repair reattaches a torn distal biceps tendon to its insertion on the radial tuberosity at the elbow. The procedure restores supination and flexion strength after a complete tear and is most effective when performed within the first few weeks of injury. Dr. Chudik performs both conventional and tunnelless distal biceps repair techniques.
What Is Distal Biceps Tendon Repair?
The distal biceps tendon is the single tendon that attaches the biceps muscle to the radius at the radial tuberosity, near the elbow. Complete rupture of this tendon disconnects the muscle from its lever arm, producing significant weakness with supination (turning the palm up) and elbow flexion. The torn tendon retracts up the arm and does not heal back to bone on its own.
Repair reattaches the torn tendon to the radial tuberosity using fixation devices placed in the bone. Dr. Chudik performs:
- Conventional repair using bone tunnels drilled through the radius for graft passage
- Tunnelless repair, a technique included in his developed-by-Chudik portfolio, that secures the tendon to the radial tuberosity without drilling through-and-through bone tunnels
Who Is a Candidate?
Candidates typically have:
- A complete distal biceps tendon rupture documented on MRI or by physical examination (loss of the hook test)
- An active patient with functional or cosmetic concerns
- A medical profile that allows safe surgery
- Acute injury (within four weeks) for the most reliable repair, though chronic repair is possible with tendon graft
Patients with low functional demands may be managed non-surgically, accepting permanent supination weakness of approximately 40 percent and a Popeye deformity.
How the Procedure Is Performed
The procedure is performed through a small incision in the front of the elbow. The torn tendon is identified and freed of scar tissue, then re-routed to its insertion site on the radial tuberosity.
For conventional repair, two bone tunnels are drilled through the radius. Sutures from the tendon are passed through the tunnels and tied over a button on the far cortex.
For tunnelless repair (Dr. Chudik’s developed technique), the tendon is secured with cortical button and interference screw fixation that does not require drilling completely through the radius, reducing the small risk of injury to the posterior interosseous nerve and adjacent bone structures.
Acute repair is typically possible within three to four weeks of injury. Chronic tears may require Achilles allograft or hamstring autograft to bridge the gap between the retracted tendon and the radius.
Recovery and Rehabilitation
Recovery follows a protected protocol:
- Hinged elbow brace with controlled motion for four to six weeks
- Passive range of motion within safe limits early
- Progressive active extension and supination from six weeks
- Strengthening at three months
- Return to most activity at four to six months
- Return to heavy lifting at six months
Risks and Outcomes
Risks include re-rupture, posterior interosseous nerve injury (lower with tunnelless repair than with conventional through-and-through tunnels), infection, heterotopic ossification, and persistent strength deficit. Outcomes after acute repair are very good, with restoration of most supination and flexion strength.
Why Dr. Chudik for Distal Biceps Tendon Repair
Dr. Chudik developed the tunnelless distal biceps repair technique, listed in his portfolio of innovations as part of the broader minimally invasive tendon repair work. For acute distal biceps ruptures, the tunnelless approach provides reliable fixation with a reduced risk of nerve injury compared to conventional through-and-through tunnel techniques.