The incidence of distal biceps ruptures is 1.2/100,000 people per year. It is most commonly seen in men 40--60 yr old involving their dominant arm. The mechanism of injury is the application of an eccentric load to the elbow region. Some report a preceding tendinitis, which speaks to the degenerative changes and decrease in vascularity as contributing factors to the tendon rupture. Nonoperative treatment is an option. However, most younger, healthy, and active patients benefit from early surgical management to regain supination and flexion strength. Chronic and retracted tears also may benefit from surgical fixation. Many new techniques have been described and studied recently. However, they present a different set of challenges to the treating surgeon. With this influx of operative techniques and further study of accepted techniques, new light has been shed on the outcomes and complication profiles of distal biceps tendon repairs. The postoperative course of these repairs also has changed to early motion and earlier return to full activity with increased confidence in fixation techniques.