Comparing Surgical Treatments for a Torn Biceps Tendon Near the Elbow

Here's the typical picture of a patient with a biceps tendon that is torn where it attaches to the elbow: a middle-aged man who injures the dominant arm while lifting with his elbow bent. Elbow strength and motion are reduced. However, pain is usually minimal to nonexistent.

How should this problem be treated? Doctors used to think that some cases would do well without surgery. The idea was that the tendon would reattach to the bone close to the place where it ended up after the tear. The patient could get along just fine after healing. Now we know strength is reduced by almost half if the biceps tendon is not reattached to its normal location.

This study compared two different surgical methods of repair. One operation uses one incision to reattach the biceps tendon to the bone using special fasteners, called suture anchors. The second approach uses two incisions to gain access to the bone.

The results showed very little difference between the groups after one year. Strength in both groups was near normal. However, short-term results were slightly different. The one-incision group could bend the elbow farther than the two-incision group. Although the one-incision group also had more complications, most of these problems went away given enough time. The two-incision group had a faster recovery early on, but the results were the same between groups by the end of one year.

The authors conclude that that there isn't much difference in the results between these two surgical techniques for a biceps tendon rupture near the elbow.

References: Ron El-Hawary, MD, et al. Distal Biceps Tendon Repair: Comparison of Surgical Techniques. In The Journal of Hand Surgery. May 2003. Vol. 28A. No. 3. Pp. 496-502.