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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le jeudi 6 décembre 2018
Doi : 10.1016/j.otsr.2018.10.012
Received : 12 July 2018 ;  accepted : 5 October 2018
Double incision repair technique with immediate mobilization for acute distal biceps tendon ruptures provides good results after 2 years in active patients

Hugo Barret a, , Matthias Winter b, Olivier Gastaud c, David J. Saliken d, Marc Olivier Gauci a, Nicolas Bronsard a
a CHU Nice, 30, voie romaine, 06000 Nice, France 
b Clinique Saint-Jean, 06800 Cagnes sur mer, France 
c CH Cannes, 06800 Cannes, France 
d Orthopaedic surgery, Victoria BC, Canada 

Corresponding author.

Surgical treatment of distal biceps tendon ruptures is recommended in an active population to avoid loss of strength, especially in supination and flexion.


A double incision repair technique with immediate postoperative mobilization for acute distal biceps tendon ruptures is safe and provides good results after 2 years in active patients.

Material and methods

Seventy-four men (47±7 years) with acute tears of the distal biceps tendon tears were included in this retrospective single-center study. All patients were operated using the double-incision repair technique described by Morrey. The tendon was inserted with transosseous sutures into the biceps tuberosity. Patients were allowed to perform immediate postoperative active mobilization. A minimum follow-up of two years was required including clinical and radiological evaluation.


Sixteen patients were lost to follow up leaving 58 (78%) patients for analysis with a mean follow-up of 53±19 months. At final follow-up, the mean evaluation for pain on the VAS scale was 0.22±0.7. Mean range of motion results included extension −1°±2°, flexion 138°±6°, pronation 72°±16° and supination 81°±10°. The strength ratio in flexion was 94±8% and in supination 90.5±12% compared to the contralateral limb. Subjective elbow value and DASH score were respectively 94±6% and 7.5±9%. All patients were satisfied or very satisfied and all except one returned to their previous sport. We noticed 2 heterotopic ossifications and one patient needed a reoperation for a radioulnar synostosis. Neither re-rupture nor nerve injury were observed.


A double incision technique for distal biceps tendon repair is a minimally invasive procedure with reliable results. Morrey's modification of the initial procedure associated with early mobilization is associated with a low rate of complications and limited the occurrence of synostosis or ossifications.

Level of evidence

IV, case series, with no comparison group.

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Keywords : Distal biceps tear, Double incision technique, Early mobilisation, No nerve palsy

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