Distal biceps brachii tendon anatomy revisited from a surgical perspective

Abstract

The distal biceps brachii tendon is commonly susceptible to traumatic injury. This study aimed to describe the morphology of the distal biceps brachii tendon in relation to the commonly used endobutton repair of tendon rupture. The results suggested that the distal tendon is a series of distinct bands of variable number. These bands are obscured surgically by the tendon sheath. Upon opening this sheath, blunt dissection of the tendon released fibrous connections between the tendon bands. Adjacent bands were variably connected via small oblique bands. The separations between bands were continuous onto the radius. They were therefore considered as separate force-conducting units. This notion is of high relevance to endobutton repairs, as the sutures are typically only passed through the margins of the tendon. Where few connections exist between tendinous bands, this represents a potential weakness, as central bands are therefore free to be pulled proximally. This is of primary concern in the early rehabilitative stages of postoperative care. It may be suggested that sutures that cross the width of the tendon will eliminate the give of central bands, improving postoperative results, reducing revision numbers, and potentially reducing rehabilitation time.

Controversies in the surgical treatment of distal biceps tendon ruptures: single versus double-incision repairs

“…While 1 study showed a definable separation of tendon fascicles from each muscle belly in 10 of 15 specimens. 1 Another study showed much variability in tendon fascicle separation and noted that complex interdigitations of multiple tendon fascicles were often present 16 (Fig. 3).…”

Anatomic and biomechanical analysis of the short and long head components of the distal biceps tendon

“…3,27 More recently, several anatomic studies have brought forth the awareness that the distal biceps tendon may actually remain as 2 distinct anatomic and functional tendon bundles with varying amounts of interconnections. 1,6,8,9 In light of these findings, some researchers have speculated that each musculotendinous unit of the biceps could have separate roles in elbow and forearm motion. 6,8,19 Eames et al hypothesized that the short head musculotendinous unit is positioned to be a better flexor, while that of the long head a better supinator.…”

Incidence of Third Head of Biceps Brachii in Indian Population

“…In most of the reported cases, it inserts into either the tendon or the aponeurosis of biceps brachii. Insertion into both may cause clinical entrapment syndrome [18,19]. In the present study also, in 2 out of three cases, it was inserted into the tendon.…”