Surgical repair is the most reliable method of restoring flexion and supination strength of the elbow and forearm after acute rupture of the distal biceps tendon. Although there may be small measurable deficits in power, endurance, and terminal forearm rotation when carefully evaluated, most of the patients regain near normal upper extremity motion and function and can return to preinjury activities. There are currently 2 basic surgical approaches for distal biceps tendon repair, using 1 anterior incision or using 1 anterior and 1 lateral incision. Anterior repair alone has the advantage of a minimal risk of heterotopic bone formation, but carries a greater chance of injury to the posterior interosseous nerve. In turn, the 2-incision technique markedly diminishes the risk of radial nerve palsy, but is associated with a greater likelihood of heterotopic bone formation limiting forearm rotation. Rerupture of the distal biceps tendon after repair is uncommon with either technique, and the risk of all complications seems to increase with a delay in surgical intervention after rupture. When motion limiting heterotopic ossification does occur, surgical resection can proceed when the process becomes mature as defined by plain radiographs. Fortunately, functional forearm motion can be commonly restored in these cases with careful attention to surgical details and postoperative rehabilitation.





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