What is the surgical procedure to correct a torn biceps tendon?

Surgical Correction of a Torn Biceps Tendon

The primary surgical procedures for a torn biceps tendon are tenodesis or repair, with the specific technique depending on whether it's a proximal (long head) or distal biceps tear. The choice of procedure is determined by the location and extent of the tear, with the goal of restoring function and reducing pain.

Types of Biceps Tendon Tears

• Proximal (Long Head) Biceps Tears: Occur at the shoulder joint
• Distal Biceps Tears: Occur at the elbow where the tendon inserts into the radial tuberosity

Surgical Procedures for Proximal Biceps Tears

Biceps Tenodesis

This is the preferred procedure for proximal biceps tears, especially when associated with rotator cuff pathology:

1. Arthroscopic Tenodesis:

   • Involves securing the detached tendon to the humerus using suture anchors or interference screws
   • Can be performed through the subclavian portal (1-2 cm medial to the acromioclavicular joint) 1
   • Provides optimal angle for suture anchor placement at the edge of the articular cartilage

2. Technique Options:

   • Suture Anchor Technique: The tendon is secured using suture anchors placed at a 45-degree "Deadman's angle" 1
   • Interference Screw Fixation: Using bioabsorbable screws (8-9mm x 25mm) to secure the tendon in a humeral socket 2

3. Outcomes: 91% good/excellent results with arthroscopic tenodesis using suture anchors 1

Biceps Tenotomy

Simple release of the tendon without reattachment - may be appropriate in older, less active patients.

Surgical Procedures for Distal Biceps Tears

Distal biceps ruptures typically occur in middle-aged males after an eccentric extension load is applied to the elbow 3.

Anatomic Reattachment Options:

1. Single-Incision Technique:

   • Anterior approach with suture anchor fixation
   • Reduces risk of heterotopic ossification compared to two-incision method 4
   • Allows for early mobilization and rapid return of function

2. Two-Incision Technique:

   • Involves anterior and limited posterior forearm muscle-splitting incisions
   • Avoids exposure of the ulna to reduce risk of heterotopic ossification 4

3. Fixation Methods:

   • Suture anchors: Common and effective method
   • Endobutton: Higher load-to-failure strength in biomechanical studies 3
   • Biotenodesis screws: Alternative fixation method
   • Bone tunnels: Traditional method still used by some surgeons

Chronic Tears Management

For chronic tears with retraction and poor tissue quality:

• Tendon grafts may be required using:
  • Semitendinosus
  • Fascia lata
  • Hamstring
  • Achilles (calcaneal) tendon
  • Flexor carpi radialis 3

Complications to Monitor

• Nerve injuries (particularly posterior interosseous nerve)
• Heterotopic ossification
• Postoperative fracture
• Tendon rerupture
• Complex regional pain syndrome
• Wound infection 3

Rehabilitation Considerations

While specific rehabilitation protocols aren't detailed in the evidence provided, early anatomic reattachment allows for earlier mobilization and better functional outcomes.

Special Considerations

• Partial tears are less common and may initially be treated conservatively 3
• For irreparable rotator cuff tears with biceps pathology, arthroscopic biceps tenodesis can be used as an alternative to simple tenotomy 2
• MRI is the gold standard for evaluating the extent of tendon rupture 5

Remember that early anatomic reattachment provides the best outcomes for active patients with acute distal biceps ruptures 4.