Anatomical Distal Biceps and Triceps Tendon Repairs

Distal biceps and triceps tendon ruptures are amongst some of the most important tendon ruptures encountered by the orthopaedic surgeon. Recent clinical and basic science studies have improved our understanding of both these injuries. In contrary to classical thinking, the distal biceps tendon appears to remain as 2 distinct anatomical and physiological tendons. The short head subunit of the distal biceps tendon inserts further distal and anterior on the radial tuberosity and functions as the more efficient elbow flexor. In comparison, the long head inserts more proximal and posterior as it wraps around the tuberosity. This distinct insertion site positions the long head subunit in a way that allows it to be the more efficient supinator of the 2 as the forearm is supinated. To closely replicate native anatomy and function, surgical repair of the ruptured distal biceps tendon should restore both unique footprints of the distal short and long head tendons, the “dual-head” repair. The native triceps tendon encompasses a broad insertion site along the proximal ulna; it also expands laterally as it incorporates into the anconeus. This allows an expansive transmission of force for elbow-extension power. A “dual-row” triceps tendon repair closely duplicates this broad native footprint and contact area in attempts to better restore elbow function. This article discusses modern anatomical-based techniques for surgical repair of both the distal biceps and triceps tendons.