Considerations of Distal Biceps Tendon Reinsertion: Commentary on an article by Christopher C. Schmidt, MD, et al.: "Factors That Determine Supination Strength Following Distal Biceps Repair".

In consideration of the relatively benign natural history of distal biceps tendon avulsions, indications for operative treatment require a balanced appraisal. To meet our value proposition, the aim of surgical reinsertion must be the restoration of nearly full function. In simple words, the result of surgical treatment must be clearly better than the result of conservative treatment. Historically, surgeons have focused on the restoration of biceps tendon continuity with the primary aim of regaining elbow flexion force. This led to the development of techniques using transosseous suture passages introduced from an anterior approach and tied posteriorly over the cortex of the radius using a second posterior approach. It was soon realized that the relative contribution of the biceps muscle to elbow flexion force was small (on the order of 10% to 15%) and that weak and sometimes incomplete active forearm supination persisted. Thus, restoration of supination force and motion was recognized as the main potential benefit of surgical reinsertion of a torn distal biceps tendon. The evolution of the technique was then complicated by the advent of suture anchors. It was now possible to directly reattach a torn tendon to the radius, without the need for transosseous suture passage. Suddenly, reattachment was …